What is a hyperhidrosis? | Hyperhidrosis diagnosis | Hyperhidrosis treatment options | Hyperhidrosis medications | Best hyperhidrosis medications | Side effects of hyperhidrosis | Hyperhidrosis home remedies | FAQ | Resources
Sweating is a normal, healthy function of the body. In fact, it helps keep us alive. At the wrong time, though, sweating can be embarrassing or awkward. For people with hyperhidrosis—which is excessive sweating—the condition can dramatically impair their lives. The good news is that hyperhidrosis can be successfully treated in most cases.
What is hyperhidrosis?
Hyperhidrosis is excessive sweating; most common on the feet, hands, face, back, and armpits.
Sweating is the body’s natural way to shed excess heat when it gets too warm due to events such as exercise, hard work, fever, or hot weather. Hyperhidrosis, on the other hand, involves excessive sweating that is unrelated to temperature or exercise. It does not threaten a person’s health, but it can be socially and personally devastating.
“Hyperhidrosis is a silent disease,” says Osita Onugha, MD, thoracic surgeon and director of the Hyperhidrosis Program at Providence St. John’s Health Center in Santa Monica, California. “It causes a lot of psychological distress; people with hyperhidrosis often don’t have the lives or careers they want because of the condition.”
Medicine distinguishes between two types of excessive sweating:
- Generalized hyperhidrosis, which happens all over the body, just as it does during exercise or in hot weather. It can be due to any number of causes.
- Focal hyperhidrosis, which occurs on only one or two parts of the body, such as the armpits, palms, feet, or face. Unlike generalized hyperhidrosis, focal hyperhidrosis is specifically a problem with the nervous system.
Hyperhidrosis affects about 1 in 20 people in the United States. However, half the people affected by this condition have never talked to a healthcare provider about it.
Fortunately, healthcare professionals have a number of treatment options that can successfully reduce or even eliminate hyperhidrosis. But, first, let’s discuss how hyperhidrosis is diagnosed.
How is hyperhidrosis diagnosed?
Hyperhidrosis is relatively straightforward to identify, but diagnosing the condition can be a bit more complex. First, healthcare providers need to determine if a person has primary focal hyperhidrosis or secondary generalized hyperhidrosis. Treatment will depend on the distinction. Primary focal hyperhidrosis is a nervous system problem, but secondary generalized hyperhidrosis is always due to some other cause.
To diagnose focal hyperhidrosis, the healthcare professional will rely almost entirely on medical history and a physical examination. “There are no tests that definitively diagnose hyperhidrosis,” Dr. Onugha says.
For some treatments, a specialist may use a starch iodine test to discover which sweat glands are responsible for the excess sweating, but this is rare. A specialist may also ask for blood and urine tests to rule out generalized hyperhidrosis.
A diagnosis of generalized hyperhidrosis may take more work. For generalized hyperhidrosis, the healthcare professional is searching for an underlying medical condition that is causing excessive sweating. In addition to taking a medical history and administering a physical examination, the healthcare professional may perform blood or urine tests. Oftentimes, an endocrinologist is consulted for an extensive hormonal workup to diagnose the cause of generalized hyperhidrosis. Rarely, infectious diseases and cancers, such as tuberculosis and Hodgkin Lymphoma, can present with generalized sweating particularly at night. Therefore, speaking to your doctor about excessive sweating is important.
Hyperhidrosis treatment options
Treatment of hyperhidrosis depends on the diagnosis.
For a diagnosis of secondary hyperhidrosis, treatment will focus on the underlying medical condition, but may also involve medications to directly treat the excessive sweating.
For focal hyperhidrosis, there are several successful treatment options. They start with the basic treatments, such as topical or mechanical antiperspirants, and then proceed to drug therapy or surgery.
The first-line treatment for people with mild to moderate hyperhidrosis, including generalized hyperhidrosis, will be prescription antiperspirants containing aluminum salts. These antiperspirants block the sweat pores and provide satisfactory improvement in most people with mild hyperhidrosis.
It is one of the treatment options for patients with hyperhidrosis of the hands or feet is iontophoresis. It is less effective for treating hyperhidrosis in the armpit areas. By submerging the hand or foot in water that has a continual, low-level electrical current running through it, charged ions from the water get into the sweat glands and disrupt their ability to produce sweat. Iontophoresis takes 30 to 40 minutes. The treatment may be required every day for some people or a couple of times a week for others. Iontophoresis is effective in 4 out of 5 patients.
Oral medications may be used to block nerves from provoking sweat glands to secrete moisture. For patients with focal hyperhidrosis, an injection of botulinum toxin (Botox) is the most effective drug treatment, but it is very painful and its effectiveness wears off each time it is used. Cost is a limiting factor as well. Patients with generalized hyperhidrosis may be prescribed medications to treat the underlying medical condition.
Microwave therapy is 90% effective in substantially reducing underarm sweating in even severe cases of focal hyperhidrosis. A microwave radiation device, such as the MiraDry, is applied to the armpits and selectively heats water molecules in the sweat glands. The sweat glands are destroyed by the process. Limited availability as well as the cost, limit access to this therapy option.
Focal hyperhidrosis is a problem with the sympathetic and parasympathetic nervous system (the nerves that control and regulate the body’s involuntary actions, such as sweating). Cutting or blocking the sympathetic nerve that controls sweating, a procedure called an endoscopic thoracic sympathectomy, eliminates hyperhidrosis of the armpits, hands, and face in nearly all cases and relieves hyperhidrosis of the feet in about two out of three patients. Risks include compensatory sweating on other parts of the body and nerve pain as well as recurrence of sweating in the treated areas.
Some dermatologists and surgeons may remove sweat glands and the nerves that connect to them by scraping skin tissue in the area (called curettage) or using liposuction. These procedures are an effective treatment for 4 out of 5 patients but carry a risk of infection and scars.
Some patients grow frustrated with antiperspirants, iontophoresis, and drug treatment. Patients typically will spend years running through various treatment options with different specialists before turning to surgery. “These treatments are forever,” says Dr. Onugha, “because they only manage the symptoms. Only surgery offers a cure.”
Prescription antiperspirants are an effective first-line treatment for hyperhidrosis and have comparatively few side effects. Both over-the-counter and prescription antiperspirants use aluminum chloride salts, but in different concentrations. Whereas a typical non-prescription antiperspirant might have 2% aluminum chloride, prescription antiperspirants have anywhere from 15% to 25%. Aluminum chloride reduces sweat volume by seeping into sweat glands and “plugging” them.
For hyperhidrosis, the goal of drug therapy is to block the nerves that directly stimulate sweat glands to secrete moisture. The chemical those nerves utilize to stimulate sweat glands is a neurotransmitter called acetylcholine. Anticholinergic drugs block acetylcholine. Because anticholinergic drugs block all sweat glands, they are used to treat generalized rather than focal hyperhidrosis when taken orally.
Topical anticholinergic drugs with glycopyrrolate are used as the first-line of treatment to treat focal hyperhidrosis of the face or armpits.
Botulinum toxin injection
Botulinum toxin A, better known as Botox, is the most effective non-surgical treatment for focal hyperhidrosis. Injected beneath the skin in the affected areas, botulinum toxin prevents the nerves that connect to sweat glands from releasing acetylcholine, so sweat is dramatically reduced. Botulinum toxin injections will reduce sweating until the nerve fibers grow back, typically in four to seven months. Botulinum toxin injections, however, are very expensive, very painful, and become less effective over time. They are most effective the first two or three times they are used.
Healthcare professionals will often prescribe other types of drugs to control generalized hyperhidrosis and, in rare cases, focal hyperhidrosis. These include antidepressants, benzodiazepines, and blood pressure medications (beta-blockers, clonidine)
What is the best medication for hyperhidrosis?
Because hyperhidrosis is not a health-threatening condition, the goal of drug treatment is to effectively treat the condition as safely as possible. In this light, the best medication is the one that provides the maximum relief of symptoms with a minimum of adverse side effects. The good news is that most therapies for hyperhidrosis, including drug therapy, are highly effective.
|Best medication for hyperhidrosis
(aluminum chloride hexahydrate)
||Apply sparingly at bedtime and wash off in the morning
||Burning, redness, swelling
(botulinum toxin A)
||50 units per underarm
||Pain, redness, swelling
||One pad applied to the underarm area once daily
||Dry mouth, dilated pupils, sore throat
||One 5 mg tablet 3 times per day
||Dry mouth, headache, sleepiness
The standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your healthcare professional based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.
What are the common side effects of hyperhidrosis medication?
Different classes of medications have different side effects. However, this is not a complete list, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
The aluminum salts in antiperspirants, particularly in high concentrations, can cause skin irritation, burning, pain, or unusual sensations.
Anticholinergics commonly cause dry mouth and headache, but they also can cause problems with urination, pupil dilation, blurred vision, constipation, fast heartbeat, and memory impairment.
Botulinum toxin injections are very painful, usually involving 20 to 30 injections in each area. Outside of the pain, botulinum toxin typically has minor side effects such as redness and swelling. The most serious side effect of botulinum toxin happens if it spreads to other parts of the body (which can occur up to weeks after the injection). The side effects can be serious when the toxin starts to kill nerves in other parts of the body
What are the best home remedies for hyperhidrosis?
Most home remedies for hyperhidrosis will help patients manage the condition, but they do not usually produce significant improvement (or sometimes even noticeable improvement).
Modify your diet
Changes in diet help to reduce sweating. Decrease the amount of carbohydrates, gluten, and salt in your diet and increase the number of foods with B-vitamins, magnesium, and other nutrients. Digestion can be a source of sweating, so eat more easily digested foods and include foods that aid in digestion, such as olive oil and fiber.
Modify your lifestyle
You may not be able to substantially reduce sweating, but some lifestyle changes can make it easier to manage. Good hygiene, shaving, wearing breathable clothing, and regularly changing socks and shoes can help manage the effects of hyperhidrosis. Avoid activities or habits that increase blood pressure or body temperature, such as smoking, hot foods, spicy foods, caffeine, or stimulants. Relaxation, such as meditation or taking a bath, helps to reduce sweating.
Try herbal supplements
Some herbal supplements such as tea tree oil, valerian root, St. John’s wort, or Schisandra may reduce sweating. The tannins in black tea also reduce sweating, but the tea should be cool. For people with focal hyperhidrosis, soaking the feet or hands in black tea or sage water may help to reduce sweating in those areas.
Use astringents or natural antiperspirants
Astringents do not reduce sweating, but they do narrow pores and tighten skin. Baking soda, lemon juice, apple cider vinegar, salt, and witch hazel all can help reduce the volume of sweating by closing pores. Some, like apple cider vinegar, also kill bacteria and help control the odor related to excessive sweating in the armpits or feet.
Frequently asked questions about hyperhidrosis
Can hyperhidrosis be cured naturally?
Generalized hyperhidrosis can be managed with natural remedies, dietary changes, or lifestyle changes. However, if the symptoms are from an underlying disease, it may need medical attention. Focal hyperhidrosis is specifically a problem with the nervous system that cannot be cured naturally.
What is the best treatment for hyperhidrosis?
The most universal treatments for mild to moderate hyperhidrosis are antidepressants, antiperspirant therapies, such as an antiperspirant topical drug or iontophoresis. They are both highly effective and often the only medical treatment needed. Botulinum toxin injections, microwave therapy, and surgery are safe, highly effective, and produce satisfactory results in a large majority of patients with focal hyperhidrosis when antiperspirant therapy is not effective.
What causes hyperhidrosis?
Generalized hyperhidrosis can have many causes: medications, cancer, infections, alcoholism, drug withdrawal, hyperthyroidism, or hormone imbalances. Focal hyperhidrosis is a problem with the sympathetic and parasympathetic nervous system, which is the part of the nervous system that controls and regulates involuntary muscle movements like sweating, blood vessel tone, intestinal contractions, and so on.
What medications can cause excessive sweating?
Some medications produce excessive sweating (generalized hyperhidrosis) as a side effect. Antidepressants, opioids, and dry mouth medications are the primary culprits, but thyroid medications, diabetes medications, insulin, some antibiotics, NSAIDs, and drugs that treat Parkinson’s or Alzheimer’s can also produce excessive sweating as a side effect.
What are the side effects of Robinul?
Robinul is an anticholinergic drug injection that is approved for the treatment of stomach ulcers, though it is sometimes used off-label to treat generalized hyperhidrosis. Robinul blocks nerves from signaling sweat glands to produce sweat. To control hyperhidrosis, it is often prescribed in the doses usually used for stomach ulcers. These doses are high enough to produce significant side effects, such as dry mouth, blurred vision, fast heart rate, palpitations, and headaches.
What kind of doctor treats hyperhidrosis?
Hyperhidrosis can and often is treated by a family healthcare provider or general practitioner. Antiperspirant therapy using a topical antiperspirant or iontophoresis is often enough to resolve the problem. If not, a patient may be referred to a dermatologist, an endocrinologist, a thoracic surgeon, or a specialist. A dermatologist might treat hyperhidrosis with microwave therapy, curettage, liposuction, or botulinum toxin. An endocrinologist may need to work-up the cause of hyperhidrosis. A thoracic surgeon will treat hyperhidrosis with an endoscopic thoracic sympathectomy. A patient with generalized hyperhidrosis may be referred to a specialist to treat the underlying condition that is causing the excessive sweating.
What home remedy can I use to stop my head from sweating?
If head sweating is a problem, see a healthcare professional. You can help manage head sweating at home by modifying your diet, washing your head frequently, modifying your lifestyle, applying antiperspirant to the scalp at night, and using mild astringents on the scalp. Living with head sweating may involve applying an absorbing powder, such as baking soda or talc, to the scalp and keeping an absorbent towel with you at all times.
How do doctors test for hyperhidrosis?
A hyperhidrosis diagnosis rarely requires a test. A clinical diagnosis based on the patient’s history and a physical examination is usually enough to determine if a patient has focal or generalized hyperhidrosis. Because generalized hyperhidrosis is due to other causes, such as medications, medical conditions, or a hormone imbalance, a healthcare provider may ask for blood and urine tests if the cause can’t be easily determined from the medical history. When specific interventions are being considered, a healthcare professional may perform a starch iodine test as well as blood and urine tests to rule out generalized hyperhidrosis.
How can I reduce the side effects of sweating?
Sweating can interfere with life and cause several unwanted effects including odor, wet clothes, social anxiety, and emotional distress. Treating excess sweating with antiperspirant medications or iontophoresis is typically enough to reduce unwanted effects. Drugs and surgery also reduce sweating. Otherwise, to control unwanted effects, use antiperspirants at night, use both antiperspirants and deodorants throughout the day, modify your diet to include fewer carbohydrates and more B-vitamin and nutrient-rich foods, eliminate stimulants such as caffeine and nicotine, use astringents, apply powders to the skin to absorb excess moisture, and carry an absorbent towel. For clothing, wear loose clothes with breathable fabric—no tight or restricting clothes. Wear breathable socks and change them often.
Related resources for hyperhidrosis