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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Everyone’s had that awkward moment of feeling a little too moist under the arms. And a fair share of people have likely avoided holding hands with a crush because of slick palms. Sweat is a totally natural and normal part of being human, but for some people, perspiration is a real problem. What can you do if you’re soaking through clothes and struggling with a condition called hyperhidrosis?
What is excessive sweating?
Otherwise known as hyperhidrosis, excessive sweating is a medical condition that’s characterized by excessive amounts of unpredictable perspiration that may occur without reason. While most people sweat due to factors like an increase in body temperature, physical activity, or an emotional trigger like stress, people with hyperhidrosis may sweat excessively for no known reason (NIH, 2019). Some people simply have overactive sweat glands, and some people may have inherited hyperhidrosis since it does appear to be genetic in some cases. There are a lot of medical conditions that can cause hyperhidrosis, including anxiety, hyperthyroidism, cancer, heart disease, stroke, and more. According to research, about 4.8% of Americans (approximately 15.3 million people) have hyperhidrosis (Doolittle, 2016).
The mechanism responsible for primary hyperhidrosis is still mostly unknown, but experts believe it may be a result of a lowered sweat threshold and an exaggerated response to sweating. Usually, people with hyperhidrosis have excessive sweating in one area of the body (primary focal hyperhidrosis). It can happen all over the body too, but it’s less common. About 35% to 55% of people with primary hyperhidrosis have a family history of the condition, and most people who have it are between 14 and 25 years old when it develops (Lenefsky, 2018).
People who have secondary hyperhidrosis usually experience it later in life than people with primary hidrosis—typically after age 25. People with secondary hyperhidrosis also tend to have more generalized sweating than people with primary hyperhidrosis. It’s less common for there to be a family history of excessive sweating in people with secondary hyperhidrosis, and people who have it can often experience symptoms while they sleep (Lenefsky, 2018).
According to a survey mailed to 150,000 households in 2002, about 2.8 % of the U.S. population has primary hyperhidrosis (Doolittle, 2016). The survey also revealed that men and women were equally affected by hyperhidrosis, and about half of the people who reported having it said they experienced it in their armpits.
Symptoms of hyperhidrosis
According to the National Institute of Health (NIH), there’s one primary symptom of hyperhidrosis: wetness (NIH, 2019). But sweating can take a lot of different forms and present in different ways, so there are some signature signs to look for if you suspect you have hyperhidrosis.
People with hyperhidrosis don’t just perspire; they often sweat so much that it’s visible. If you have hyperhidrosis, you may see beads of sweat on your skin even if you’re not working out or moving at all. You may also sweat through your clothes without exerting any effort or experiencing any outside factors like hot weather. People with hyperhidrosis often sweat so much that it actually interferes with their daily activities and impacts their quality of life—even regular tasks like holding a pencil or turning a doorknob can be challenging because of the amount of sweat that’s present.
Another issue that people with hyperhidrosis often have to deal with is an increased risk of fungal skin infections. Because of the locations on the body where some people with hyperhidrosis tend to sweat (under the arms, around the groin, on the feet, etc.), infections like athlete’s foot and jock itch may be common. Even if skin infections aren’t a problem, people with hyperhidrosis may notice their skin is soft, white, and peels in the areas of the body where they sweat (AAD, n.d.). Clammy hands and feet, increased body odor, and sweating during sleep are all possible symptoms of hyperhidrosis as well.
Medications to reduce excessive sweating
Luckily, whether you have primary hyperhidrosis or secondary hyperhidrosis, there are treatment options that can help reduce symptoms.
Antiperspirants with deodorant are often the first line of hyperhidrosis treatment, and they work by plugging the sweat ducts. People using over-the-counter (OTC) antiperspirants should look for products that contain 10% to 20% aluminum chloride hexahydrate to control excessive sweating. If that’s not enough, your healthcare provider may recommend a prescription-strength antiperspirant (Drysol) that contains a higher dose of aluminum chloride. This type of antiperspirant is applied every night onto the areas where you sweat. Deodorants by themselves don’t prevent sweating, but they can help reduce body odor. It’s also important to know that antiperspirants do have the potential for side effects like skin irritation, and large doses of aluminum chloride can damage your clothing (NIH, 2019).
If you experience hyperhidrosis on your face, your doctor may recommend a topical prescription cream made up of 2% glycopyrrolate. This cream is usually compounded by a pharmacy and has been shown to have a 96% success rate with minimal side effects like mild skin irritation when applied once every two to three days (McConaghy, 2018).
Hyperhidrosis treatment: solutions for a common problem
In some cases, a nerve-blocking medication called oxybutynin may be used to treat hyperhidrosis. Oxybutynin is a type of medication called an anticholinergic drug, which blocks the action of a certain chemical messenger in the body and prevents certain nerve impulses. Research has shown that oxybutynin is effective in treating both focal (in one place) and generalized (everywhere) hyperhidrosis, regardless of a person’s age, gender, and weight. Side effects, however, are possible and can include dry mouth, blurred vision, and bladder problems (Campanati, 2015).
Some healthcare practitioners recommend botulinum toxin (Botox) as a treatment for hyperhidrosis. Botulinum toxin can be used to treat severe underarm, palm, and foot sweating. When it’s injected, it temporarily blocks the nerves that stimulate sweating. Botox injections can, however, be painful for some people, and have the potential to cause side effects like injection-site pain and flu-like symptoms. When it’s injected into the palms of the hands, botulinum toxin can cause intense pain and mild, temporary weakness (NIH, 2019). Botox injections do have to be repeated every 6–12 months.
Other treatment options for excessive sweating
If topical, injected, and oral medications don’t do the trick, your healthcare practitioner may recommend other options for treatment of hyperhidrosis.
Iontophoresis (also called “the no-sweat machine”) is an at-home treatment that can target excessive sweating in the hands and feet. It involves immersing your hands and feet in a shallow pan of tap water and then using a medical device to send a low-voltage current through the water to temporarily shut down the sweat glands. Most people require between 6 to 10 treatments to see results, and a treatment session may last between 20 to 40 minutes. Some common side effects include dry skin, irritated skin, or discomfort during the treatment sessions (ADA, n.d.).
There are a couple of different surgical options for people with hyperhidrosis: sweat gland removal and nerve surgery (known as endoscopic thoracic sympathectomy or ETS). While sweat gland removal surgery can be done in a dermatologist’s office through a relatively non-invasive method like laser removal or liposuction, ETS is major surgery. It must be performed by a surgeon in an operating room, and it requires the cutting or destruction of certain nerves. It’s usually done on people who have excessive sweating in the palms and face but may not work as well for armpit sweating (NIH, 2019).
Like all medical procedures, these surgeries carry the risk of side effects. Temporary side effects include bruising and soreness. When sweat glands are removed from under the arms, there’s a risk of infection, and permanent side effects can also occur that cause scarring or loss of feeling in the underarm.
Hypohidrosis: is not sweating unhealthy?
Some people who receive surgery develop a condition called compensatory sweating, meaning they sweat even more heavily than they did with the hyperhidrosis. One study indicates that about 86.4% of people experienced compensatory sweating. It was considered minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5% (Gossot, 2003).
Sympathectomy, in particular, carries some very serious side effects and can even be fatal. Some of the serious risks include damage to the nerves that run between the brain and eyes, very low blood pressure, irregular heartbeat, and heat intolerance (ADA, n.d.). One study of 467 patients found that there were three major complications: one tear of the right subclavian artery and two chylothoraces, 25 cases (5.3%) of bleeding during surgery, and 12 pneumothoraces (collapsed lungs) (1.3%) after the removal of chest tubes (Gossot, 2001).
- AAD (n.d.). Hyperhidrosis. Retrieved from: https://www.aad.org/public/diseases/a-z/hyperhidrosis-symptoms
- Campanati, A., Gregoriou, S., Kontochristopoulos, G., & Offidani, A. (2015). Oxybutynin for the Treatment of Primary Hyperhidrosis: Current State of the Art. Skin appendage disorders, 1(1), 6–13. doi: 10.1159/000371581, https://www.ncbi.nlm.nih.gov/pubmed/27172124
- Doolittle, J., Walker, P., Mills, T., & Thurston, J. (2016). Hyperhidrosis: an update on prevalence and severity in the United States. Archives of dermatological research, 308(10), 743–749. doi: 10.1007/s00403-016-1697-9, https://link.springer.com/article/10.1007/s00403-016-1697-9
- Gossot, D., Kabiri, H., Caliandro, R., Debrosse, D., Girard, P., & Grunenwald, D. (2001). Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. The Annals of Thoracic Surgery, 71(4), 1116–1119. doi: 10.1016/s0003-4975(01)02422-5, https://www.annalsthoracicsurgery.org/article/S0003-4975(01)02422-5/fulltext
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.