Hyperhidrosis

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View the Sweating (Hyperhidrosis) Slideshow Pictures

Hyperhidrosis facts

  • Hyperhidrosis, or excessive sweating, is a common disorder.
  • It can be localized to a particular anatomical area or may be diffuse, involving much of the skin.
  • Axillary hyperhidrosis is excess sweating of the underarms.
  • Palmoplantar hyperhidrosis is excess sweating of the palms and soles.
  • Hyperhidrosis usually occurs in people who are otherwise healthy.
  • The approach to treating hyperhidrosis generally proceeds from over-the-counter (OTC) antiperspirants to prescription antiperspirants, anticholinergic medicines, iontophoresis, microwave destruction of sweat glands, Botox injections, and occasionally surgery.

What is hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a common disorder that produces a lot of embarrassment and unhappiness. Primary hyperhidrosis occurs in otherwise healthy individuals. Secondary hyperhidrosis is much less common and can be due to certain drugs, a variety of serious systemic diseases, neurological disorders, facial surgery, and anxiety. Of the approximately 3% of Americans who suffer from excessive sweating, fully 50% involve the underarms (axillary hyperhidrosis). Underarm problems tend to start around puberty, while palm and sole sweating may begin earlier, often during childhood. Untreated, these problems may continue throughout life.

Sweating is embarrassing, stains clothes, and may complicate business and social interactions. Excessive sweat can have serious practical consequences, like making it difficult to hold a pen, grip a steering wheel, or shake hands.

Quick GuideWhat Makes You Sweat With Pictures

What Makes You Sweat With Pictures
Learn about the various ways to treat excessive perspiration, or hyperhidrosis.

Hyperhidrosis Surgery

Other Treatments for Excessive Sweating

Surgical sympathectomy is the specialized, permanent nerve cutting, or destruction surgery performed to help decrease some types of sweating. It does not work for all types of excess sweating or for all areas of the body. Consultation with a specialized thoracic surgeon is required and overall, surgery is usually reserved for severe or resistant cases because of potentially serious side effects.

What is the cause of hyperhidrosis?

Although neurologic, metabolic, and other systemic diseases and conditions can sometimes cause excessive sweating, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis perspire nearly all the time, regardless of their mood or the weather.

Hidrosis vs. hyperhidrosis

The word hidrosis is derived from the Greek and simply means "sweat." Hyperhidrosis is excessive sweat.

What are risk factors for hyperhidrosis?

As stated above, there are a number of conditions and diseases that produce secondary hyperhidrosis. Treating the underlying condition can help relieve at least some of the excessive sweating.

What signs and symptoms accompany hyperhidrosis?

Generally, the only sign of excessive sweating is the presence of abundant moisture in the anatomical area affected. The presence of this moisture can predispose to skin infections.

What health care professionals diagnose and treat hyperhidrosis?

Dermatologists are physicians specialized in diagnosing and treating skin conditions. Dermatologists diagnosis and treat this condition.

How do health care professionals diagnose hyperhidrosis?

The diagnosis is made clinically on the basis of a patient's history and physical examination. If the sweating is excessive and constant, then the diagnosis is obvious. It is not unusual that one must rely on the patient's history to determine the diagnosis.

What are medical treatment options for hyperhidrosis?

Through a systematic evaluation of causes and triggers of excessive sweating, followed by a judicious, stepwise approach to medical treatment, many people with this annoying disorder can achieve improved quality of life. The decision on initial treatment depends upon the severity of the condition and the anatomical areas that are affected.

The approach to treating hyperhidrosis generally proceeds as follows:

  • Over-the-counter antiperspirants: Patients usually try home remedies like these first because they are readily available. Antiperspirants containing aluminum chloride (for example, Certain-Dri) may be more effective when other antiperspirants have failed. So-called "natural" antiperspirants are often not very helpful for patients.
  • Prescription-strength antiperspirants: those containing aluminum chloride hexahydrate
  • Iontophoresis: a device that passes direct electricity through the skin using tap water
  • Oral medications: from the group of medications known as anticholinergics, which reduce sweating
  • Botox (botulinum toxin): approved in the U.S. by the Food and Drug Administration (FDA) for treating excessive axillary sweating
  • Microwave destruction: a device destroys the sweat glands, purportedly causing minimal damage to other tissues
  • Surgery: paraspinal sympathectomy, or interruption of certain nerve pathways, as a last resort

Aluminum chloride hexahydrate

When regular antiperspirants fail, as they often do, to remedy hyperhidrosis, most doctors start by recommending aluminum chloride hexahydrate (Drysol, various generics), a prescription-strength version of aluminum chloride. It is applied just before bedtime seven to 10 nights in a row, then roughly once a week as a maintenance medication. The aluminum salts in this preparation collect in the sweat ducts of the patient and block them. Over time, the excessive perspiration may diminish to such an extent that no further treatment is needed. This method works reasonably well for many patients whose problem is excessive underarm sweating, but it's not satisfactory for most of those with clammy palms and sweating of the soles of the feet.

The main side effect with aluminum chloride is irritation, which can sometimes, but not always, be overcome by reducing the frequency of use or applying anti-inflammatory medications such as lotions containing hydrocortisone.

Iontophoresis

Iontophoresis was introduced over 50 years ago to treat excessive sweating. Its exact mechanism of action is still unclear. The procedure uses water to conduct an electric current to the skin, which combats the production of sweat. The current is applied typically for 10-20 minutes per session, initially with two to three sessions per week followed by a maintenance program of treatments at one- to three-week intervals, depending upon the patient's response. Iontophoresis treatments sound painful but in fact are not.

Patients purchase devices for this treatment through a doctor's prescription. There are three iontophoresis devices that are registered with and cleared by the U.S. FDA; the R.A. Fischer and the Hidrex USA devices require a prescription, whereas the Drionic device is available without a prescription. They work best on palms and soles but can be adapted for use in the underarms. Medical insurers sometimes cover the cost.

Oral medicines

Oral anticholinergic drugs such as glycopyrrolate (Robinul) can be quite effective for this condition, but they can produce side effects like dry mouth, insomnia, and blurred vision.

Botox

Botulinum toxin (Botox), a muscle poison much in the news as a cosmetic treatment for wrinkles, has actually been used in many areas of medicine for some time, such as in the treatment of muscle spasms and certain types of headaches. Its latest medical use is for treating excessive underarm sweating.

Botox is injected into tissues of the armpit or hand. The drug works by inhibiting the release of acetylcholine, which is the chemical that activates sweat glands. This may produce approximately six months of relief from sweating. The injections are uncomfortable, but use of a very small needle minimizes discomfort.

Now that this treatment option has received FDA approval, many health insurers are providing coverage for the injections and the Botox itself, which is quite costly.

Currently, the FDA has not approved Botox for treating sweating of the palms and soles of the feet, though some physicians are administering it as an off-label use, with some success. Drawbacks of using this treatment for the palms and soles are pain, requiring nerve blocks to numb the hands in order to make the injections tolerable, and the potential for temporary muscle weakness.

Microwave, laser, and ultrasound destruction

These new techniques produce energy that presumably destroys sweat glands while preserving other tissues. Currently, only the armpits seem to be appropriate treatment sites. Treatments occur in a doctor's office and in recent studies have been accompanied by local swelling and irritation as well as a variety of other relatively minor side effects. Sweating seems to be significantly decreased for a time with these treatments. How these would be used in other anatomical areas aside from the armpits is not clear.

Quick GuideWhat Makes You Sweat With Pictures

What Makes You Sweat With Pictures

Are there home remedies for hyperhidrosis?

Over-the-counter antiperspirants may be effective, but usually the patient has already tried these.

Can surgery treat hyperhidrosis? What are potential side effects of surgery for hyperhidrosis?

Localized axillary hyperhidrosis has been treated by surgical removal of a substantial portion of axillary skin. Another approach is the use of liposuction curettage, although how this effectively damages the dermal sweat glands is hard to visualize.

Endoscopic thoracic sympathectomy (ETS) refers to surgical interruption of the sympathetic nerves responsible for sweating. Sympathectomy is an operation intended to destroy part of the nerve supply to the sweat glands in the skin. The surgeon inserts a special endoscopic instrument into the chest between two ribs just below the armpit. The lung is briefly deflated to better visualize and destroy the nerves. Sympathectomy is both effective and risky. Even with newer endoscopic techniques, complications of the procedure can include compensatory, excessive sweating in other parts of the body as well as lung and nerve problems. As many of these complications are serious and not reversible, this option is rarely used, and then only as a last resort.

What is the prognosis for hyperhidrosis?

Most hyperhidrosis patients can be effective and safely treated.

Is it possible to prevent hyperhidrosis?

No, it is not possible to prevent hyperhidrosis.

Where can people find more information about hyperhidrosis?

An excellent source of information is the International Hyperhidrosis Society (https://www.sweathelp.org/).

REFERENCES:

Cruddas, L., and D.M. Baker. "Treatment of Primary Hyperhidrosis with Oral Anticholinergic Medications: A Systematic Review." J Eur Acad Dermatol Venereol Dec. 15, 2016.

Fujimoto, Tomoko. "Pathophysiology and Treatment of Hyperhidrosis." Curr Probl Dermatol: Perspiration Research. 51. Eds. Yokozeki, H., H. Murota, and I. Katayama. Basel: Karger, 2016. 86-93.

Schlereth, Tanja, Marianne Dieterich, and Frank Birklein. "Hyperhidrosis -- Causes and Treatment of Enhanced Sweating." Dtsch Arztebl Int 106.3 (2009): 32-37.

Stashak, Anna-Bianca, and Jerry D. Brewer. "Management of Hyperhidrosis." Clinical, Cosmetic and Investigational Dermatology 7 Oct. 29, 2014: 285-299.

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Reviewed on 5/30/2017
References
REFERENCES:

Cruddas, L., and D.M. Baker. "Treatment of Primary Hyperhidrosis with Oral Anticholinergic Medications: A Systematic Review." J Eur Acad Dermatol Venereol Dec. 15, 2016.

Fujimoto, Tomoko. "Pathophysiology and Treatment of Hyperhidrosis." Curr Probl Dermatol: Perspiration Research. 51. Eds. Yokozeki, H., H. Murota, and I. Katayama. Basel: Karger, 2016. 86-93.

Schlereth, Tanja, Marianne Dieterich, and Frank Birklein. "Hyperhidrosis -- Causes and Treatment of Enhanced Sweating." Dtsch Arztebl Int 106.3 (2009): 32-37.

Stashak, Anna-Bianca, and Jerry D. Brewer. "Management of Hyperhidrosis." Clinical, Cosmetic and Investigational Dermatology 7 Oct. 29, 2014: 285-299.

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