Why do you sweat?

Hyperhidrosis is excessive sweating. The best treatment for hyperhidrosis includes prescription medication, injections or surgery.
Hyperhidrosis is excessive sweating. The best treatment for hyperhidrosis includes prescription medication, injections or surgery.

When life turns up the heat, your body responds by sweating. Perspiring keeps you cool and helps maintain your internal temperature. Many things will make you sweat, like a hot summer day, an intense exercise class or an important job interview. 

What is hyperhidrosis?

Sometimes, sweating isn't just a reaction to heat, exertion or anxiety. It’s a problem in itself. Excessive sweating is called hyperhidrosis. This condition can affect the: 

  • Underarms 
  • Palms 
  • Feet 
  • Groin
  • Breasts (underneath)
  • Face (persistent blushing) 

When your hands and feet are involved, hyperhidrosis may cause your skin to become pink or slightly blue. Your skin texture changes too, becoming unusually soft, scaly or cracked. This is especially common on the soles of your feet. 

Hyperhidrosis is a common medical issue that occurs in otherwise healthy people. However, if left untreated, this condition may affect your quality of life.

Symptoms of hyperhidrosis  

Hyperhidrosis symptoms typically appear in childhood or puberty and continue into adulthood. The exact causes are unknown. Obesity or increased thyroid function may play a role. 

Certain situations or substances can overstimulate your nervous system. These can cause excessive sweating, and include: 

Types of hyperhidrosis 

There are two types of hyperhidrosis: 

  1. Primary focal hyperhidrosis: This refers to excessive sweating as a standalone medical condition. If you have primary focal hyperhidrosis, you'll experience sweating on specific parts of your body known as focal areas. The most common focal areas are sweaty hands, feet, underarms, face or head. The sweating is usually symmetric, which means it affects both sides of your body. 
  2. Secondary generalized hyperhidrosis: This type of hyperhidrosis is secondary. This means that your excessive sweating results from a primary medical condition like diabetes or a medication’s side-effect. Secondary generalized hyperhidrosis is not as common. It occurs more often in adults than children or teenagers. People with this condition tend to experience excessive general sweating all over. They often sweat while sleeping. 

Diagnosis for hyperhidrosis  

Only a licensed healthcare professional can diagnose hyperhidrosis. If you suspect that you have it, see a dermatologist. Expect a full physical exam, which includes the areas of your body that sweat excessively. Be prepared to answer specific questions about your lifestyle, medical conditions and family history. 

You may also undergo a medical test called a sweat test. The dermatologist will apply a powder to your skin that turns purple when it gets wet. If you have an underlying illness that’s causing your hyperhidrosis, an accurate diagnosis may involve additional tests. 


 

Treatments for hyperhidrosis 

Hyperhidrosis is treatable and most people experience significant improvement. The type of treatment you receive depends on where you're experiencing excessive sweating as well as your overall health. Treatment options include prescription drying medications, injections and surgery. 

Non-surgical treatments 

  • Antiperspirants: This is often the first step in treating hyperhidrosis. It’s affordable, effective and available in regular or clinical-strength. Antiperspirants are applied directly to your skin, on the underarms, hands, feet or hairline. When you start to sweat, the substance is pulled into your sweat glands, creating a plug. The body senses this and signals your glands to stop producing excess sweat. 
  • Iontophoresis: Often called the “no-sweat machine,” this medical device uses electricity to temporarily shut your sweat glands down. This treatment can be done at home and requires placing your hands or feet into a shallow bowl of tap water. The device then sends a low-voltage current through the water. Iontophoresis is effective but can be time-consuming. You’ll need between six to 10 treatments to notice an improvement. Each session lasts between 20 and 40 minutes. 
  • Botulinum toxin injections (Botox): Botox is usually associated with wrinkles, but the Food and Drug Administration (FDA) has approved Botox as a treatment for underarm sweating. Your dermatologist will inject tiny amounts of this medicine into different areas of your armpits. Botox temporarily blocks a chemical in your body that stimulates the sweat glands. The treatment usually takes four or five days to work and lasts between four to six months. 
  • Prescription cloth wipes: These individually wrapped cloths contain glycopyrronium tosylate, a substance proven to reduce underarm sweating. You’ll use one wipe per day, applying it to both underarms. 
  • Prescription medications: Certain oral medicines prevent your sweat glands from working. They’re used to treat excessive sweating all over the body. 

Surgical treatments 

Sometimes non-surgical options don’t work well enough to control your hyperhidrosis. In some cases they don’t work at all. The next step is typically a surgical procedure. There are two surgeries to treat hyperhidrosis:

  • Sweat gland removal: A dermatologist will use surgical techniques to remove sweat glands from your underarms. These may include lasers, liposuction or excision. This procedure can be done in your doctor’s office. The treated area is numbed, but you'll be awake during the procedure. 
  • Sympathectomy: This is major surgery and is performed in an operating room. The surgeon inserts a mini surgical camera into your chest just under your armpit. They then cut and destroy certain nerves to stop the nerve signals that your body sends to your sweat glands. During a sympathectomy, one lung will be temporarily collapsed. 

Possible complications and side effects

Prescriptions and other treatment options for your hyperhidrosis such as medications or injections can lead to side effects like dry mouth, dry eyes, blurry vision, heart palpitations and others.

Surgical treatments like sweat gland removal can lead to infections. You may experience soreness or bruising. Permanent side effects include a loss of feeling in your armpits. Scarring is also possible. 

New endoscopic techniques have made sympathectomy surgery safer, but there are still some risks. Some people will actually sweat more after the procedure. This is called compensatory sweating. 

Other side effects include damage to the nerves that run between the brain and the eyes, irregular heartbeat and extremely low blood pressure

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Medically Reviewed on 2/3/2021
References
SOURCES:

American Academy of Dermatology Association: "HYPERHIDROSIS: DIAGNOSIS AND TREATMENT."

Cedars-Sinai: "Hyperhidrosis."

International Hyperhidrosis Society: "Two Types of Hyperhidrosis."

National Organization for Rare Disorders: "Hyperhidrosis, Primary."