Hyperhidrosis (hi-pur-hi-DROE-sis) is excessive sweating that's not always related to heat or exercise. You may sweat so much that it soaks through your clothes or drips off your hands. Heavy sweating can disrupt your day and cause social anxiety and embarrassment.
Hyperhidrosis treatment usually helps. It often begins with antiperspirants. If these don't help, you may need to try different medications and therapies. In severe cases, your health care provider may suggest surgery to remove the sweat glands or to disconnect the nerves related to producing too much sweat.
Sometimes an underlying condition may be found and treated.
The main symptom of hyperhidrosis is heavy sweating. This goes beyond the sweating from being in a hot environment, exercising, or feeling anxious or stressed. The type of hyperhidrosis that usually affects the hands, feet, underarms or face causes at least one episode a week when you're awake. And the sweating usually happens on both sides of the body.
Sometimes excessive sweating is a sign of a serious condition.
Seek immediate medical attention if you have heavy sweating with dizziness, pain in the chest, throat, jaw, arms, shoulders or throat, or cold skin and a rapid pulse.
See your health care provider if:
Sweating is the body's mechanism to cool itself. The nervous system automatically triggers sweat glands when your body temperature rises. Sweating also occurs, especially on your palms, when you're nervous.
Primary hyperhidrosis is caused by faulty nerve signals that trigger eccrine sweat glands to become overactive. It usually affects the palms, soles, underarms and sometimes the face.
There is no medical cause for this type of hyperhidrosis. It can run in families.
Secondary hyperhidrosis is caused by an underlying medical condition or by taking certain medications, such as pain relievers, antidepressants, and some diabetes and hormonal medications. This type of hyperhidrosis may cause sweating all over the body. Conditions that might cause it include:
Risk factors for hyperhidrosis include:
Complications of hyperhidrosis include:
Diagnosing hyperhidrosis may start with your health care provider asking about your medical history and symptoms. You may also need a physical exam or tests to further evaluate the cause of your symptoms.
Your health care provider may recommend blood, urine or other lab tests to see if your sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Or you may need a test that pinpoints the areas of sweating and evaluates how severe your condition is. Two such tests are an iodine-starch test and a sweat test.
Treating hyperhidrosis may start with treating the condition causing it. If a cause isn't found, treatment focuses on controlling heavy sweating. If new self-care habits don't improve your symptoms, your health care provider may suggest one or more of the following treatments. Even if your sweating improves after treatment, it may recur.
Drugs used to treat hyperhidrosis include:
Prescription antiperspirant. Your health care provider may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac AC). Apply it to dry skin before going to bed. Then wash the product off when you get up, taking care to not get any in your eyes. Once you start seeing results from using it daily for a few days, you can scale back to once or twice a week to maintain the effect.
This product can cause skin and eye irritation. Talk with your health care provider about ways to reduce side effects.
Botulinum toxin injections. Treatment with botulinum toxin (Botox) blocks the nerves that trigger the sweat glands. Most people don't feel much pain during the procedure. But you may want your skin numbed beforehand. Your health care provider might offer one or more of the methods used to numb skin. These include topical anesthesia, ice and massage (vibration anesthesia).
Each affected area of your body will need several injections. It may take a few days to notice results. To retain the effect, you'll likely need repeat treatments about every six months. A possible side effect is short-term muscle weakness in the treated area.
Your health care provider might suggest other treatments:
Iontophoresis. With this home treatment, you soak your hands or feet in a pan of water while a device passes mild electric current through the water. The current blocks the nerves that trigger sweating. You can buy the device if you have a prescription from your health care provider.
You'll need to soak the affected areas for 20 to 40 minutes. Repeat the treatment 2 to 3 times a week until your symptoms improve. After you get results, you can reduce treatments to once a week or once a month to maintain the effect. Talk with your health care provider if you experience side effects.
Nerve surgery (sympathectomy). During this procedure, the surgeon removes a small section of the spinal nerves that control sweating in your hands. A possible side effect is permanent heavy sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure treats the palms. It interrupts the nerve signals without removing the sympathetic nerve (sympathotomy), which reduces the risk of compensatory sweating.
Because nerve surgery has a risk of side effects and complications, it is usually only considered for people who have tried many other treatments without good results.
Each of these procedures may be done with general anesthesia or with local anesthesia and sedation.
The following suggestions may help control sweating and body odor:
Hyperhidrosis can be the cause of discomfort and embarrassment. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.
Talk about your concerns with your health care provider, a counselor or a medical social worker. Or you may find it helpful to talk with other people who have hyperhidrosis.
You may start by seeing your primary care provider. You may then be referred to a specialist in diagnosing and treating conditions of the hair and skin (dermatologist). If your condition is not responding to treatment, you may be referred to a specialist in the nervous system (neurologist) or a surgeon.
Here's some information to help you get ready for your appointment.
Before your appointment, you might want to list answers to the following questions:
Your health care provider is likely to ask you several questions, such as:
