Hyperhidrosis: Causes and Treatments for Excessive Sweating

Sweating is a normal reaction to heat, exercise or stress. However, people with hyperhidrosis sweat too much. They may sweat even when it is cool or when they are resting.

This condition can affect various parts of the body, but it often targets specific areas. Visible signs include:

• Damp skin that stays wet
• Discoloration or stains on clothes
• A frequent need to wipe or dry off sweat

Treatment for hyperhidrosis depends on which of the two types you have.

Primary focal hyperhidrosis involves excessive sweating in certain body parts due to overactive nerves. Common areas include the underarms, hands, feet and forehead. This condition often runs in families.

Secondary hyperhidrosis is caused by medical conditions or medications. It usually affects the whole body.

Common triggers and underlying conditions include:

• Diabetes
• Gout
• Injury (especially those involving nervous system)
• Menopause
• Obesity
• Overactive thyroid
• Tumor

Hyperhidrosis often presents with:

• Persistent sweating without a clear cause
• Sweat-soaked clothing
• Damp hands that affect grip
• Increased body odor
• Irritated, soft or peeling skin

Some people may also have symptoms from nervous system stimulation. These can include shaking hands, blurred vision and a dry mouth.

Doctors begin diagnosis with a medical history review and physical exam. Tests to confirm include:

• Starch-iodine test highlights sweat-prone areas using a color change.
• Thermoregulatory sweat test evaluates overall sweating in a heated environment.
• Sweat analysis measures the amount of sweat produced over time.

If a medical condition is found, treating it is the first step in managing excessive sweating. If no specific cause is found, the focus is shifts to symptom management.

For mild symptoms, home care may help. This includes wearing breathable fabrics, avoiding common triggers, such as spicy foods and alcohol and using over-the-counter antiperspirants to reduce sweating.

“You may need a stronger antiperspirant if sweating is severe, constant or interfering with your daily life. Your doctor can evaluate your symptoms and can prescribe a stronger antiperspirant if necessary,” Dr. Ross says.

Wearing the right clothing can make a difference for people dealing with excessive sweating. “I recommend natural fibers, like cotton and wool. Synthetics tend not to breathe as well. Having a spare set of clothes may also help reduce anxiety,” says Dr. Ross.

Managing emotional triggers is equally important. “As we all know, sweat can be a function of nervousness. Anxiety may increase sweat production. Finding ways to relax is a good approach to breaking the excessive sweating cycle. Techniques for relaxation may include mediation and breathing exercises,” Dr. Ross explains.

When home remedies and over-the-counter products don’t provide relief, medical treatments for excessive sweating can offer effective solutions.

Depending on the severity and location of sweating, treatment options may include:

Oral anticholinergic medications help reduce sweating by blocking nerve signals that trigger sweat glands. They are often used when many parts of the body are affected.

Prescription antiperspirants contain a higher amount of aluminum chloride than regular products. This ingredient helps block sweat glands and keep skin dry.

Qbrexza wipes are FDA-approved wipes applied daily to the underarms. They work by blocking the nerve signals that cause sweating.

Botox (botulinum toxin) injections are approved by the FDA to treat excessive sweating. They can be used in the underarms, hands, feet and face. These injections temporarily stop nerve signals from reaching the sweat glands.

Iontophoresis is a noninvasive treatment that uses a mild electrical current in water to reduce sweat gland activity. It is especially helpful for sweating in the hands and feet.

MiraDry is an FDA-cleared device that uses microwave energy to destroy sweat glands in the underarms. This provides long-term results without surgery.

Surgery might be an option for people with severe hyperhidrosis who did not respond to other treatments.

In these cases, several advanced procedures may help reduce excessive sweating by targeting or removing the sweat glands or interrupting the nerves that trigger them.

Suction curettage (sweat gland removal) is a minimally invasive procedure similar to liposuction. A small metal tube, called a cannula, is inserted through a tiny incision to loosen and suction out the sweat glands from the underarm.

Laser sweat ablation uses heat to target and destroy sweat glands in the underarms.

Endoscopic thoracic sympathectomy (ETS) is a surgery for severe primary focal hyperhidrosis. This condition mainly affects the hands, face and sometimes the underarms. The surgery cuts or clamps the sympathetic nerves that cause sweating.

If you sweat too much and it affects your daily life, talk to a dermatologist. Getting checked early helps doctors find the right diagnosis. It also gives you more treatment options.

“There are many causes for hyperhidrosis,” Dr. Ross says. “You may need to try several options before finding one that works for you, which is why it’s important to see an expert.”