What Is Hyperhidrosis? Causes of and Treatments for Excessive Sweating

Sweating is typically a healthy and normal process. It allows the body to cool itself down. However, some people sweat excessively. Excessive sweating means that too much sweat is produced by the sweat glands. This is called hyperhidrosis. It’s a common condition that may have a significant social, professional, and psychological impact. Approximately 1% to 5% of the population suffer from this condition.

Hyperhidrosis may be divided into two broad categories: focal (or primary) hyperhidrosis and generalized (or secondary) hyperhidrosis. Focal hyperhidrosis causes excessive sweating limited to specific parts of the body, and generalized hyperhidrosis causes excessive sweating in all parts of the body. 

Here we’ll discuss the two main types of hyperhidrosis, causes, and treatment options.

What is the difference between focal hyperhidrosis and generalized hyperhidrosis? 

Focal hyperhidrosis causes too much sweating in parts of the body that you’d typically think of as “sweaty spots.” These include: 

• Underarms

• Palms

• Feet 

• Scalp

• Face 

• Groin

• Beneath the breasts

Focal hyperhidrosis is also referred to as “primary” hyperhidrosis, because it isn’t related to another medical condition. This type is more common. 

Generalized hyperhidrosis, on the other hand, causes sweating everywhere. This type is rare. It is usually caused by (or is secondary to) another medical problem, so it can also be called “secondary” hyperhidrosis. It could be a symptom of a more serious underlying medical condition, like infection or cancer. 

It’s a good idea to speak with your healthcare provider if you have any of the following symptoms in addition to generalized excessive sweating:

• Night sweats so severe that you must change your sheets or pajamas in the middle of the night

• Fevers (a temperature higher than 100.3°F)

• Unintentional weight loss

• Personal history of cancer

• Risk factors for, or known exposure to persons with tuberculosis or HIV/AIDS

• Recent close contact to someone with a known COVID-19 infection

Your healthcare provider can help determine if your sweating is due to something other than hyperhidrosis.

How is hyperhidrosis diagnosed?

Symptoms that meet certain criteria can lead to a diagnosis — there is no specific test. Hyperhidrosis causes extreme or excessive sweating — more than is expected in a certain situation. So how do you know if the sweating is “excessive”? 

Here are some questions you might ask yourself to help figure out if your sweating is excessive:

• Do you leave the house with “supplies” in case your sweating gets bad? For example, do you carry towels, wipes, or a change of clothes?

• Do you avoid certain events due to fear of sweating?

• Has sweating affected your ability to do your job?

• Do you avoid shaking hands due to sweaty palms?

To be considered hyperhidrosis, excessive sweating should be going on for at least 6 months and happening at least once a week. Typically, the sweating occurs on both sides of the body (like both armpits or both palms). Symptoms commonly start before age 25, though it’s possible to develop hyperhidrosis later in life.  

What causes hyperhidrosis?

Experts are not exactly sure what causes focal hyperhidrosis. There may be a problem with the nerves that control the sweat glands, but more research is needed to be sure. It can run in families, so there may be a genetic component as well. Here’s the good news: It isn’t a sign of a more serious underlying medical problem.

Sometimes medications may cause generalized sweating. If you suffer from focal hyperhidrosis, these medications may make the problem worse. Common culprits include antidepressants and pain relievers, among others. Your healthcare provider can help review your medication list to see if changes could be made.

What are the best treatments, and how effective are they?

Treatment of hyperhidrosis is tailored to the areas of the body that are sweatiest, and they are individualized to each person. There is no one-size-fits-all approach to treatment, but fortunately many options exist. Typically, a stepwise approach makes the most sense, starting with topical therapies and then working your way up to more invasive procedures, if needed. 

Topical therapies 

Topical therapies include medications that you apply to the skin, like creams or gels. They are an easy and low-risk place to start. 

• Topical antiperspirants: These work best in the underarm area, but you can also apply them to the palms, feet, face, and scalp. Deodorant masks body odor, but antiperspirant physically blocks the openings of sweat glands. Not all over-the-counter products contain an antiperspirant, so start by taking a look at your deodorant’s ingredient list. 

• Prescription antiperspirants: If your over-the-counter antiperspirant is not strong enough, prescription strength antiperspirants like aluminum chloride hexahydrate (Drysol) may help. This medication may cause skin irritation, so it’s best to apply it to dry skin at bedtime and wash it off in the morning. 

• Topical glycopyrrolate (Qbrexa) wipes: This medication decreases production of sweat from the sweat glands. Side effects may include dry mouth, blurry vision, and skin irritation. 

Minimally invasive procedures

If topical therapies fail, you might consider a minimally invasive procedure. Some examples include:

• Botox injections: These injections temporarily decrease sweat production for 6 to 8 months. Repeated injections are necessary for continued effect, and they can be expensive and painful. Only underarm injections are currently FDA approved for the treatment of focal hyperhidrosis. 

• Microwave thermolysis: This procedure uses microwaves — yes, like the kind in your kitchen — to destroy sweat glands. A device for this procedure is approved by the FDA. Side effects include pain, swelling, and decreased sensation in the treated area.

• Iontophoresis: This involves using electricity and tap water to impair sweat glands. It works best for sweaty palms and soles. We still don’t understand exactly how this procedure works, but it has been around for over 70 years, and it’s FDA approved. Treatments start at 3 to 5 times a week and may be performed at home. Mild stinging and redness of the skin may occur.

Oral medications

Systemic oral medications — pills you take by mouth — are another option. But they typically come with a higher risk of side effects. Options include:

• Anticholinergic medications: Glycopyrrolate and oxybutynin can decrease sweating. But they may cause side effects such as dry mouth, blurry vision, and difficulty urinating. 

• Antianxiety medications: If your sweating is triggered by certain situations (like public speaking) or emotions, antianxiety medications may help. However, many of these medications are not FDA approved specifically for the treatment of hyperhidrosis.

Invasive procedures

In severe cases where the above options have failed, an invasive procedure like endoscopic thoracic sympathectomy may provide relief. A thoracic surgeon performs this surgery. It involves cutting one of the nerves in the chest that causes sweating. It works best for sweaty palms or underarms, though it may also help other areas. This procedure is riskier since it’s a major surgery. There are many potential side effects, like extra sweating in new places (generally mild, but possibly severe) or slow heart rate. It’s important to discuss the risks and benefits of this procedure with your surgeon.

Can I treat hyperhidrosis myself? 

If you’re struggling with excessive sweating, it’s a good idea to see your healthcare provider to discuss treatments. But there are some things you might try first:

• Confirm that your deodorant contains antiperspirant (look for an aluminum-based compound on the ingredient list).

• Wear natural fabrics (like wool) or moisture-wicking athletic materials.

• Avoid triggers that you know increase your sweating, if at all possible.

• Try relaxation techniques (like meditation) if emotional sweating is an issue for you.

If these options fail, talk to your healthcare provider. You may feel embarrassed to talk about your sweating, and that’s OK! But there are treatments available that could help, and your healthcare team will be there for you when you’re ready to talk about your symptoms. Your primary care provider may prescribe some of the treatments mentioned above or refer you to a dermatologist for expert help.

Is hyperhidrosis a serious issue to worry about? 

The good news is that focal hyperhidrosis is not physically harmful. But it can have a serious impact on your day-to-day life and mental health. If you’re struggling with the social or mental aspects of hyperhidrosis, it may help to connect with others who are experiencing the same thing. You can find support groups and other information on the International Hyperhidrosis Society website.  

If you have worrisome symptoms for generalized hyperhidrosis, consult your healthcare provider for a closer look. 

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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