What Is Hyperhidrosis?
Many people have had at least one experience of excessive sweating, perhaps after an intense workout or during times of high stress. For most of us, these instances come and go, and may be only mildly annoying. But for roughly 4.8 percent of people living in the United States, hyperhidrosis, or excessive sweating, is a regular occurrence. (1)
Hyperhidrosis is a condition in which sweating is frequent and hard to control. It’s often visible to others, and for this reason, it can trigger anxiety and make you feel self-conscious. (2)
Fortunately, modern medicine offers a variety of ways to reduce or stop excessive sweating.
Excessive sweating is the main symptom of hyperhidrosis. (3)
“Sweating can become so severe that armpit sweat can drip down your arms and body, and sweaty feet can make it difficult to walk around on noncarpeted floors because of the risk of slipping,” says Tsippora Shainhouse, MD, a board-certified dermatologist based in Santa Monica, California.
Feet and toes may always appear prune-like, similar to when you sit in the bath for too long, and the skin on the feet can become red or white, or it may peel or itch, Dr. Shainhouse says.
Hyperhidrosis sweating tends to occur on both sides of the body. (2) So if you have excessive sweating under your right armpit, you’ll also have excessive sweating under your left armpit.
Sweating associated with hyperhidrosis mostly occurs while you’re awake and stops when you’re asleep. (2)
Excessive sweating can happen in different parts of the body, including: (4)
Hyperhidrosis is a result of overactive sweat glands. (2)
Sweating is how the body naturally cools itself and avoids overheating. Your nervous system signals your body to produce sweat when your body temperature rises, such as after a workout, when the temperature is warm, or when you feel anxious or nervous. (2)
Risk factors for hyperhidrosis include a family history of excessive sweating. You may also develop hyperhidrosis if you have a medical condition that causes sweating, or if sweating is a side effect of a medication you take. (2)
There are two different types of hyperhidrosis.
Primary focal hyperhidrosis isn’t the result of another medical condition or medication. (2)
In this scenario, excessive sweating is your diagnosis. Sweating occurs symmetrically, affecting both hands and feet or underarms. This type of hyperhidrosis can start in childhood or adolescence. And in most cases, some of your family members also have excessive sweating. (4)
In this case, excessive sweating is either the result of a medical condition or the side effect of a medication. This type may not begin until you’re older or after you start taking a certain medication. Secondary hyperhidrosis can also cause excessive sweating while you’re asleep. (4)
Medical conditions that can lead to secondary hyperhidrosis include: (5)
To diagnose hyperhidrosis, your doctor will ask questions about your medical history, including conditions you’ve been diagnosed with and medications you currently take. (6)
Your doctor may also perform a physical examination and order lab tests. These tests may include a urine and blood test to check for an overactive thyroid or low blood sugar. Both factors can be an underlying reason for excessive sweating. (6)
You may also need a sweat test, which your doctor uses to identify the parts of your body that experience excessive sweating. For this test, your doctor applies a powder substance to different areas of your skin. The powder turns purple as you sweat. (7)
Although you don’t have to see your family doctor or a dermatologist for this condition, you should make an appointment if excessive sweating starts suddenly, or if you experience other symptoms such as chest pains, nausea, light-headedness, or night sweats. This could indicate a serious medical problem. (2)
With treatment, hyperhidrosis can be managed well. In some cases, with procedures such as miraDry and endoscopic thoracic sympathectomy (ETS), you can even enjoy permanent relief from excessive sweating, though there may be side effects. (8)
Unfortunately, you can’t outgrow hyperhidrosis, nor does it simply go away. (9) Yet when an underlying medical problem causes excessive sweating, treating this problem may treat hyperhidrosis. (10)
The telltale symptom of hyperhidrosis is sweating without a known trigger like a warm day or a grueling workout.
But the effects of excessive sweating are more than skin-deep, as mental health disorders, such as anxiety and depression, are also common among people managing hyperhidrosis, according to the International Hyperhidrosis Society.
Everyday situations like riding the subway, dining out, or going to a shared working space — all places that require being in public view and interacting with others — can take an emotional toll on people with hyperhidrosis. Indeed, in a nationally representative survey of 393 people with excessive sweating, 72 percent reported that the condition negatively affects their mental health.
Furthermore, 77 and 76 percent reported that hyperhidrosis negatively affects their social life and sense of well-being, respectively. (1)
If the aforementioned statistics describe you, know that you’re not alone — and that you have several treatments at your disposal that can help you lead a more comfortable, confident life.
Weigh in on whether hyperhidrosis has affected your mental health, and if so, how, below.
Some people never see a doctor for hyperhidrosis because they’re embarrassed, and that’s unfortunate, because many remedies are available to control excessive sweating. The one you choose will depend on the severity of your symptoms.
A good first line of defense is over-the-counter antiperspirant designed to control excessive sweating. Hyperhidrosis deodorant options include Certain Dri and Secret Clinical Strength. (7)
Depending on the severity of your condition, over-the-counter products may have little effect on sweating. In this case, your doctor may prescribe a stronger antiperspirant with aluminum chloride, such as Drysol. Keep in mind that antiperspirants for excessive sweating should be applied before bed and washed off in the morning. (6)
Qbrexza (glycopyrronium) is an anticholinergic medicated cloth approved for excessive underarm sweating in people age 9 and older. Use the same cloth for both underarms daily. (11)
Possible side effects of the cloth include headache, sore throat, skin dryness, and stinging or burning. It’s important to wash your hands with soap and water after using the cloth. Temporary pupil dilation or blurry vision can occur if the medicine comes in contact with your eyes. (11)
Another option is oral glycopyrrolate, which can be taken daily for primary hyperhidrosis. Unfortunately, this medication can cause side effects like heart palpitations, oral dryness, and headaches, so speak with your doctor to determine if it’s right for you. (12)
Other medications used to treat hyperhidrosis include nerve blocking medications, which stop overactive sweat glands, as well as antidepressants. (6)
You can also talk to your doctor to see if you’re a candidate for Botox (onabotulinumtoxinA) injections. (6)
“Botox is FDA approved for hyperhidrosis of the underarms and the results can last for six months to a year,” says Katerina Gallus, MD, a plastic surgeon based in San Diego. (6) “It prevents the release of a chemical that signals your sweat glands to activate, and it’s sometimes covered by insurance.”
Although helpful, Botox has potential side effects. These include pain at the injection site and short-term muscle weakness. (6)
When over-the-counter and prescription hyperhidrosis medications don’t work, your doctor may recommend other procedures, such as miraDry, which can be performed in your doctor’s office and provides a permanent solution to underarm sweating, says Dr. Gallus. “It uses electromagnetic energy to target and destroy the sweat and odor glands in your underarm area,” she continues. (8)
Although healthcare providers consider it a last resort, surgery is another avenue for treating excessive sweating that medical options fail to help.
One surgical option is endoscopic thoracic sympathectomy (ETS), also called a thoracoscopic sympathectomy, which cuts the nerves in your sympathetic nervous system that trigger localized sweating. When successful, the fix is permanent. (13)
Your doctor may recommend this minimally invasive procedure if you have stubborn hyperhidrosis in your hands or armpits that other first-line treatments haven’t helped. (4)
In this procedure, you’ll be under general anesthesia while a surgeon makes two or three incisions in the armpit on the side of your body where you’re prone to hyperhidrosis. One of your lungs will be collapsed temporarily to prevent airflow during surgery and to offer extra space for the operation. (4)
The surgical team will insert an endoscope, which is a small camera, through one of the cuts. This will help the surgeon look inside of your chest via a monitor while he or she carries out the procedure. When the surgeon identifies the nerve associated with your overactive sweat glands, he or she will disrupt it by destroying, clipping, or cutting it. Next, your deflated lung will be inflated again, and the cuts will be stitched up. The surgeon may repeat the procedure on the opposite side of your body, depending on your case of hyperhidrosis. (4,13)
Usually, the procedure is complete within one to three hours. (14)
Benefits of this procedure include a short hospital stay and often a quick recovery. Risks, on the other hand, include developing gustatory sweating, which refers to sweating during eating. Gustatory sweating occurs in 5 to 10 percent of people who undergo ETS. (4)
More commonly, you may begin excessively sweating in areas of the body where you did not before. This type of sweating, called compensatory hyperhidrosis, affects about 70 percent of people treated with this procedure. (4)
Rarely, people who get ETS may develop Horner’s syndrome, which can happen because of nerve damage during the procedure. This syndrome may cause your pupil to look smaller, your eyelid to droop, or a complete lack of sweating on one side of your face. In time, this side effect may subside. (4)
Again, ETS is permanent. There have been no reports of successful reversal of this operation. (13)
Iontophoresis is an alternative therapy that may improve symptoms of hyperhidrosis. This technique can be performed at home and uses an electrical current to temporarily stop sweat glands in certain parts of the body. It’s an option for excessive sweating in your hands or feet. (7)
Basically, you’ll place your hands or feet in a shallow pan of water. With your feet or hands immersed in the water, the device passes a mild electrical current through the water with the intent of disrupting your sweat glands. (7)
This therapy is effective, but also time consuming. You may need two to three treatments a week, and each treatment may take up to 40 minutes. Results are temporary. (7)
Hyperhidrosis natural treatments include herbal supplements like sage, chamomile, and St. John’s wort. Consult your doctor before taking herbal supplements, especially if you take prescription medications.
Unfortunately, there’s little research to confirm the effectiveness of these therapies. (15)
Acupuncture for hyperhidrosis may also provide positive results. In one past study, three people with primary hyperhidrosis received 20 to 25 acupuncture sessions over the course of a few months. All participants reported a decrease in sweating, and they didn’t report any side effects from treatment. (16)
Excessive sweating might seem like a minor annoyance, but depending on its severity, hyperhidrosis can cause physical and psychological distress.
Hyperhidrosis creates a moist environment where fungus can grow and thrive. Heavy sweating in your groin area can make you susceptible to jock itch, or you might develop athlete’s foot if your feet sweat continuously. It can also lead to fungal nail infections, as well as body odor. (17)
Excessive sweating can also cause the skin to break down, allowing entry of bacteria and viruses that can trigger skin infections like warts. According to research, people with hyperhidrosis have a 300 percent greater risk of skin infections. (18)
Plus, excessive sweating can make you uncomfortable in social settings. You might avoid events or gatherings out of fear or embarrassment over visible perspiration. It also prevents some from pursuing educational and professional goals. (2,18)
Hyperhidrosis can take an emotional and psychological toll. If you’ve had an embarrassing experience with excessive sweating, you know these effects well. Seeing a doctor helps. But if you need a more immediate solution, several strategies can help you cope and reduce feelings of anxiety.
Some people have found it helpful to keep a sweat journal. (19) This can help you identify situations that trigger excessive sweating. In your journal, make a note of days that you experience abnormal sweating, and then log your activity level, what foods you ate, and your emotional state during this day.
You may find that eating certain types of foods — perhaps spicy foods — or being upset or anxious triggers excessive sweating.
If you’re feeling stressed, practice relaxation and mindfulness techniques like yoga or meditation. These approaches may also lower your stress level and reduce excessive sweating. In addition, set limitations and avoid overbooking yourself. You might even cut back on caffeine. (19)
Tips to make hyperhidrosis less embarrassing include: (19)
Although reports indicate that primary hyperhidrosis affects about 4.8 percent of Americans, which is roughly 15.3 million people, the number of actual cases are likely higher. That’s because many people with hyperhidrosis do not seek out a diagnosis or treatment, possibly due to embarrassment. (18)
Typically, primary hyperhidrosis develops between ages 14 and 25, and it most commonly affects young adults ages 18 to 39. In those diagnosed with hyperhidrosis, about 35 percent to 55 percent have a family history of the condition. (18)
Secondary hyperhidrosis usually occurs after age 25. (18)
Hyperhidrosis can affect anyone, but some data shows that Japanese Americans are affected more than any other group. (20) In this group, the condition often affects the soles of the feet and the palms. (18)
Excess sweating can have an impact on your emotional well-being, and can increase the risk of skin infections. If you have secondary hyperhidrosis, sweating can occur as a symptom of another medical condition.
People with hyperhidrosis may also have one or more of the following conditions: (2,4,18)
Hyperhidrosis can be embarrassing and provoke anxiety, but this condition doesn’t have to control your life. Don’t let sweating stop you from living. You can’t always hide hyperhidrosis hands, hyperhidrosis feet, a sweaty face, and pit stains. But you can talk to your doctor and learn ways to put excessive sweating behind you.
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