Hyperhidrosis: Diagnosis and treatment (2024)

Dermatologists help many patients control excessive sweating. Before treatment begins, it is important to find out why a patient has excessive sweating.

How do dermatologists diagnose hyperhidrosis?

To diagnose this condition, a dermatologist gives the patient a physical exam. This includes looking closely at the areas of the body that sweat excessively. A dermatologist also asks very specific questions. This helps the doctor understand why the patient has excessive sweating.

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.

To find an underlying medical condition, other medical tests may be necessary.

How do dermatologists treat hyperhidrosis?

Treatment depends on the type of hyperhidrosis and where the excessive sweating occurs on the body. Your dermatologist also considers your overall health and other factors.

Treatments that dermatologists use to help their patients control hyperhidrosis include:

Antiperspirants

This may be the first treatment that a dermatologist recommends. It is affordable. When applied as directed, an antiperspirant can be effective. Your dermatologist may recommend a regular or clinical-strength antiperspirant. Some patients need a stronger antiperspirant and receive a prescription for one.

Uses: Apply to underarms, hands, feet, or hairline

How it works: The antiperspirant sits on top of your skin. As you sweat, the antiperspirant is pulled into your sweat glands. This plugs the sweat glands. When your body senses that its sweat glands are plugged, this should signal your body to stop producing so much sweat.

Side effects: Where they apply the antiperspirant, some people develop:

• Burning sensation

• Irritated skin

If these occur, be sure to tell your dermatologist. Changing how you use the antiperspirant can reduce these side effects.

Do antiperspirants increase risk of breast cancer, Alzheimer’s?

Some patients are concerned that antiperspirants can cause breast cancer. Others worry about getting Alzheimer’s disease. To date, we do not have evidence that using an antiperspirant causes breast cancer or Alzheimer’s disease.

If you want to know more about this, read:

• Antiperspirants/Deodorants and Breast Cancer (National Cancer Institute)

• Risk factors: Aluminum not a cause (Alzheimer’s Association)

Iontophoresis (the no-sweat machine)

If excessive sweating affects your hands, feet, or both areas, this may be an option. You will use this treatment at home. It requires you to immerse your hands or feet in a shallow pan of tap water. As you do this, a medical device sends a low-voltage current through the water.

Many people obtain relief. Some people dislike that this treatment can be time-consuming.

Uses: Hands and feet

How it works: The electric current shuts down the treated sweat glands temporarily.

Most people need about 6 to 10 treatments to shut down the sweat glands. To get improvement, you begin by using the device as often your dermatologist recommends. At first, you may need two or three treatments per week. A treatment session usually takes 20 to 40 minutes.

Once you see results, you can repeat the treatment as needed to maintain results. This can range from once a week to once a month.

If this treatment is right for you, your dermatologist will teach you how to use the device and give you a prescription so that you can buy one. Some patients also receive a prescription for a medicine that they add to the tap water.

Side effects: Some people develop:

• Dry skin

• Irritated skin

• Discomfort during treatment

If you experience any side effects, tell your dermatologist. Making some changes often eliminates these side effects.

Botulinum toxin injections

Your dermatologist can inject a weak form of this medicine into your underarms. To treat excessive sweating, a patient will need to have very tiny amounts injected in many areas of the underarms. When performed properly, patients have little pain or discomfort.

Uses: Underarms

The Food and Drug Administration (FDA) has approved this treatment for the underarms. Findings from some research studies suggest that this treatment may be effective for other areas of the body. It may help post-menopausal women who sweat excessively on the head. It may be effective for excessive sweating that affects the hands and feet.

How it works: The injections temporary block a chemical in the body that stimulates the sweat glands. Most patients notice results four to five days after receiving treatment.

Reduced sweating lasts about four to six months, and sometimes longer. When the excessive sweating returns, you can be retreated.

Side effects: The most common one is temporary muscle weakness, which can occur when this is injected into the hands.

Prescription cloth wipes

The U.S. Food and Drug Administration (FDA) has approved this treatment for people who have excessive underarm sweating and are 9 years of age or older.

How it works: These individually wrapped cloths contain an active ingredient, glypyrronium tosylate, that can reduce underarm sweating.

Uses: Most people use one wipe per day at home to treat both underarms.

Side effects: Possible side effects include dry mouth, redness on the treated skin, and burning or stinging where the wipe touched your skin.

Prescription medicine

Some patients receive a prescription for a medicine that temporarily prevents them from sweating. These medicines work throughout the body.

How it works: These medicines prevent the sweat glands from working. Athletes, people who work in a hot place, and anyone who lives in a warm climate should use extreme caution when using this treatment. The body may not be able to cool itself.

Uses: These medicines can effectively treat sweating that involves entire body. This medicine also can be an effective treatment for post-menopausal women who sweat excessively only from their head.

Side effects: The medicines that prevent the sweat glands from working can cause:

• Dry mouth

• Dry eyes

• Blurry vision

• Heart palpations (abnormal heartbeat)

The risk of side effects increases with higher doses. Before taking this medicine, you should talk with your dermatologist about your individual risks and benefits.

Surgery

If other treatments fail to bring relief, surgery may be considered. Surgery is permanent and carries risks. The following surgeries can stop excessive sweating:

• Surgically remove sweat glands

• Sympathectomy

How it works: A dermatologist can surgically remove sweat glands from the underarms. This surgery can be performed in a dermatologist’s office. Only the area to be treated is numbed, so the patient remains awake during the surgery.

A dermatologist may use one or more of the following surgical techniques to remove sweat glands from the underarms:

• Excision (cut out sweat glands)

• Liposuction (remove with suction)

• Curettage (scrape out)

• Laser surgery (vaporize)

Sympathectomy is another surgery used to treat hyperhidrosis. This is major surgery, which a surgeon performs in an operating room.

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.

Uses:

• Surgical removal of sweat glands is used to treat the underarms

• Sympathectomy is mainly used to treat the palms

Side effects: All surgeries carry some risk. When sweat glands are removed from the underarm, there is risk of developing an infection. Patients may have soreness and bruising. These will go away.

Permanent side effects also can occur. Loss of feeling in the underarm and scarring are possible.

Advances in endoscopic surgery have reduced some risks from sympathectomy. Serious side effects can still occur. Some patients develop a condition known as compensatory sweating. For some people, this causes them to sweat more heavily than did the hyperhidrosis.

Other possible side effects from sympathectomy include damage to the nerves that run between the brain and eyes, extremely low blood pressure, irregular heartbeat, and inability to tolerate heat. Patients have died during this surgery.

Hand-held medical device destroys sweat glands

This is a newer treatment approved by the FDA. A medical doctor such as a dermatologist must give these treatments.

If this is an option, the dermatologist uses a machine that emits electromagnetic energy. This energy destroys the sweat glands. In one or two office visits, the glands can be destroyed. Once destroyed, the sweat glands are gone forever.

This device can only treat the underarms because this area of the body has enough underlying fat to protect itself. This device cannot be used to treat the hands and feet because these areas do not have enough fat.

This is a newer treatment option. Unlike other treatments, there is not a lot of information about this treatment for hyperhidrosis. We do not know how long the results last. Long-term side effects are not known.

Outcome

By seeing a dermatologist, many people find treatment that effectively controls their excessive sweating. This often greatly improves their quality of life.

Many people control their hyperhidrosis by combining treatment with tips for managing.

References
Bechara F, Gambichler T, Bader A, et al. “Assessment of quality of life in patients with primary axillary hyperhidrosis before and after suction-curettage.” J Am Acad Dermatol. 2007;57:207-12.