Excessive Sweating
(Hyperhidrosis)

Hyperhidrosis is a medical condition that causes excessive sweating. Sweating cools the body, which prevents us from overheating. People who have hyperhidrosis, however, sweat when the body does not need cooling. Many people who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat.

This excessive sweating can interfere with everyday activities. Hands can be so sweaty that it becomes difficult to turn a doorknob or use a computer. Sweat from the underarms often soaks through clothes, causing obvious sweat marks. Because the skin is often wet, skin infections can develop.

How do dermatologists diagnose hyperhidrosis?

To diagnose this condition, a dermatologist gives the patient a physical exam and takes a thorough history. Sometimes medical testing is necessary. Some patients require a test called the sweat test. This involves coating some of their skin with a powder that turns purple when the skin gets wet. Other medical tests may be necessary if an underlying medical condition is suspected.

How do dermatologists treat hyperhidrosis?

Treatment depends on the type of hyperhidrosis and where the excessive sweating occurs on the body. Treatments that dermatologists use to help their patients control hyperhidrosis include:

Antiperspirants

This may be the first treatment that a dermatologist recommends and may include a clinical or prescription-strength product.

Botulinum toxin injections

The U.S. Food and Drug Administration (FDA) has approved this treatment for the underarms; however, several studies have shown efficacy when used elsewhere on the body, including the palms, soles, and scalp, for hyperhidrosis. Botulinum toxin injections temporarily block a chemical in the body that stimulates the sweat glands. Most patients notice results 4 to 5 days after receiving treatment and results last for approximately 3 to 6 months. 

Prescription medicine

Some patients receive a prescription for a medicine, glycopyrrolate or oxybutynin, that temporarily prevents sweating and can effectively treat sweating that involves the entire body. These medicines that prevent the sweat glands from working can cause dry mouth, dry eyes, blurry vision, and heart palpitations, thus the dose is titrated up slowly in close consultation with your board certified dermatologist.

Iontophoresis

If excessive sweating affects your hands, feet, or both areas, this at-home treatment using electric currents that temporarily disable sweat glands may be an option.

Surgery

If other treatments fail to bring relief, surgery may be considered. Surgeries to stop excessive sweating include surgically removing sweat glands and sympathectomy. Liposuction and laser surgery have also been used.

During sympathectomy, the surgeon tries to stop the nerve signals that your body sends to the sweat glands. To do this, the surgeon will cut or destroy certain nerves. To find these nerves, the surgeon inserts a mini surgical camera into the patient’s chest just beneath the underarm. The patient’s lung must be temporarily collapsed so that the surgeon can cut or destroy nerves.