Sweating is a normal biological function that the body needs for temperature regulation. But when sweating goes beyond that — soaking through clothing, occurring unprompted by heat or exercise, and persisting despite standard antiperspirants — it is called hyperhidrosis. For patients dealing with excessive sweating, it tends to be both physically uncomfortable and difficult to manage. The good news is that treatment options exist for every level of severity.
Types of Hyperhidrosis
Hyperhidrosis falls into two main categories based on its cause.
Primary hyperhidrosis affects specific areas of the body (most commonly the palms, soles, underarms, and face) without a known underlying cause. The sweat glands themselves are entirely normal — they simply have a heightened response to stimulus. Primary hyperhidrosis tends to run in families, often begins at puberty or shortly after, and is typically triggered by heat, emotion, or stress, though it can occur at any time. It generally improves with age.
Secondary hyperhidrosis is sweating caused by an underlying condition or medication such as hormonal changes, thyroid disorders, certain infections, or specific drugs. It tends to involve more of the body rather than isolated areas, and identifying the underlying cause is the first step in treatment.
Where Hyperhidrosis Shows Up
While secondary hyperhidrosis tends to be more widespread, primary focal hyperhidrosis most commonly affects these areas:
- Underarms (axillary hyperhidrosis): The form most people recognize, often most disruptive to daily confidence and clothing choices.
- Palms (palmar hyperhidrosis): Interferes with handshakes, using phones and keyboards, and fine motor tasks.
- Soles (plantar hyperhidrosis): Causes slipping inside shoes and makes foot infections more likely.
- Face and scalp: Less common, but particularly noticeable and difficult to conceal.
Treatment Options
Prescription antiperspirants: For mild to moderate hyperhidrosis, prescription-strength antiperspirants containing aluminum chloride (such as Drysol) are typically the starting point. These are applied nightly at first, then tapered to one night per week once sweating is controlled. The main risk is skin irritation; applying plain Vaseline around the treated area before use can help, and over-the-counter hydrocortisone 1% ointment can be used in the morning if irritation develops.
Iontophoresis: Iontophoresis uses a mild electrical current passed through water to temporarily reduce sweat gland activity in the palms and soles. It requires multiple sessions per week initially, followed by maintenance treatments, and is effective for patients who haven’t responded to antiperspirants.
BOTOX injections: Botulinum toxin (BOTOX) injections block the nerve signals that trigger sweat glands. Underarm injections are FDA-approved and produce significant reduction in sweating for most patients, typically lasting six to twelve months. Results are usually apparent within two weeks.
Oral medications: When sweating affects multiple areas or focal treatments haven’t provided enough relief, oral anticholinergic medications such as glycopyrrolate (Robinul) may be used. These reduce sweating more broadly, with common side effects of dry eyes, dry mouth, and constipation.
Topical glycopyrronium: A pad or wipe form of glycopyrronium or glycopyrrolate is also available as a topical option. This treatment is newer and tends to be more costly, but provides a non-systemic alternative for patients who prefer to avoid oral medications.
For severe cases that don’t respond to these approaches, less common options include surgical excision (to remove sweat glands) or transthoracic sympathectomy (to disable nerve signals).
When to See a Dermatologist
If excessive sweating is interfering with your work, social life, or daily routines, and over-the-counter products haven’t helped, it’s worth a dermatology evaluation. Our dermatologists can confirm whether the sweating is primary or secondary hyperhidrosis, identify which treatment fits your pattern and severity, and help you manage your care over time as your needs change.
To schedule an appointment for hyperhidrosis, contact Medovate Dermatology at (847) 499-5500.