What Is Hyperhidrosis? Causes of Excessive Sweating and Treatment Options

Focal 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

Generalized hyperhidrosis causes sweating all over the body. This type is rare. It’s usually caused by another medical problem or medication you may be taking, so it’s often called “secondary” hyperhidrosis. In some cases, it could be a symptom of a more serious underlying medical condition, like infection or cancer. 

It’s a good idea to speak with a healthcare professional 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

A healthcare professional can help determine what type of hyperhidrosis you have and what’s causing your excessive sweating.

Drugs that cause excessive sweating

Sometimes, medications may cause generalized sweating. And if you suffer from focal hyperhidrosis, these medications may make the problem worse. Here are some common medications that can cause excessive sweating:

• Antidepressants: Examples include sertraline (Zoloft), fluoxetine (Prozac), and venlafaxine (Effexor XR)

• Pain medications: Examples include oxycodone (Roxicodone, OxyContin) and tramadol (Ultram).

• Diabetes medications: These include ones that can cause low blood sugar, such as insulin and glipizide (Glucotrol XL).

• Hormone therapies: Examples include testosterone and leuprolide (Lupron Depot).

• Certain blood pressure medications: Examples include amlodipine (Norvasc) and carvedilol (Coreg).

• Medications used to treat Alzheimer's disease: Examples include donepezil (Aricept).

• Steroids: Prednisone can cause excessive sweating and flushing.

• Migraine medications: These include triptans like sumatriptan (Imitrex) and rizatriptan (Maxalt).

If you notice increased sweating after starting a new medication, talk with your prescriber. Don’t stop taking prescribed medication without medical advice.

What are the symptoms of hyperhidrosis?

Hyperhidrosis causes excessive sweating that’s more than what the body needs to stay cool. Symptoms you might notice are:

• Visible sweating even when you aren’t exercising or in a hot environment

• Sweat that soaks through clothing

• Frequent sweating of the hands, feet, underarms, face, or scalp

• Difficulty gripping objects because of sweaty hands

• Moist or damp skin for long periods of time

• Needing to change clothes, socks, or shoes frequently because of sweating

• Skin irritation or infections caused by excess moisture

• Feeling embarrassed, self-conscious, or anxious about sweating

Symptoms of hyperhidrosis can range from mild to severe, and they may occur daily or only in certain situations.

How is hyperhidrosis diagnosed?

There’s no specific test for hyperhidrosis. A healthcare professional will make the diagnosis of hyperhidrosis if your symptoms meet certain criteria. This includes excessive sweating that also:

• Has been going on for at least 6 months

• Happens at least once a week

• Occurs on both sides of the body (like both armpits or both palms)

• Started before age 25 (though it’s possible to develop hyperhidrosis later in life) 

• Decreased, or with no sweating at night

• Links with a family history of excessive sweating

• Interferes with daily activities

Topical therapies 

Topical therapies for hyperhidrosis include medications that you apply to the skin, like creams or gels. They are an easy place to start for mild to moderate symptoms. 

• Over-the-counter (OTC) 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 OTC deodorant products contain an antiperspirant. So you’ll want to look for metallic salts like aluminum in the ingredient list. 

• Prescription antiperspirants: If your OTC antiperspirant isn’t 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 anticholinergics: Glycopyrrolate (Qbrexa) wipes and sofpironium gel (Sofdra) decrease production of sweat from the sweat glands. They’re the only FDA-approved topical anticholinergics for hyperhidrosis. 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 decades, 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. These are often used off-label because they aren’t FDA approved for hyperhidrosis. 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 high emotions, anti-anxiety medications may help. 

Dietary changes

Certain foods and drinks may trigger or worsen sweating in some people. Common triggers include:

• Spicy foods

• Caffeine

• Alcohol

• Hot foods or beverages

Because triggers vary from person to person, consider keeping a food and symptom journal to identify patterns. Tracking what you eat and when sweating occurs may help you recognize and avoid foods or drinks that make your symptoms worse.

Staying well-hydrated is also important, especially if your excessive sweating leads to significant fluid loss.

Behavioral strategies

Hyperhidrosis can affect more than physical comfort. Excessive sweating may impact your:

• Confidence

• Social interactions

• Work

• School

• Daily activities

Behavioral strategies can help reduce the emotional impact of hyperhidrosis and improve quality of life. Things to consider include:

• Identifying situations that trigger sweating

• Practicing stress-management techniques such as deep breathing, mindfulness, or meditation

• Working with a mental health professional to learn coping strategies — such as cognitive behavioral therapy (CBT) — to manage anxiety, embarrassment, or social avoidance related to sweating

• Using positive affirmations to reduce negative self-talk

• Gradually facing situations you may have been avoiding because of sweating, such as shaking hands, attending social events, or speaking in front of groups

• Techniques like biofeedback, which may help some people better recognize and manage their body's stress response, although data on its effectiveness is limited 

For some people, anxiety can create a type of secondary hyperhidrosis through a cycle in which sweating leads to worry, and worry leads to more sweating. While behavioral strategies may not stop the sweating itself, they can help people feel more in control of how hyperhidrosis affects their daily lives.

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.

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