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The Ins and Outs of Hyperhidrosis

November 2, 2021


Hyperhidrosis, or excessive sweating, is when we sweat more than is required for regulation of our body temperature. Sweat is normally comprised of water, acids, and salts and is produced in our eccrine or apocrine sweat glands, which are found scattered over the entire surface of the body. The production and the release of sweat from our glands is regulated by our nervous system and occurs in response to increased body temperature. It can also be triggered by strong emotions, such as nervousness or excitement.

The causes of hyperhidrosis can be separated into two main categories:

Primary Hyperhidrosis is the most common cause of hyperhidrosis and is defined as excessive sweating limited to only certain parts of the body (i.e. the armpits, palms, soles, or face) that cannot be explained by an underlying illness or medication. It is only present while awake. Primary hyperhidrosis is believed to be an inherited or genetic condition with 80% of patients having a family history of hyperhidrosis.

Secondary Hyperhidrosis is less common than primary hyperhidrosis and is typically seen as generalized sweating which can occur even while sleeping. Secondary hyperhidrosis is usually associated with an underlying medical condition (i.e. metabolic disorder, neurologic condition, infection, or malignancy) or certain medications. Treatment of the underlying condition or removal of offending medications can resolve secondary hyperhidrosis.


The most common locations affected by primary hyperhidrosis are the axilla (armpits), palms of the hands, soles of the feet, and the face. Patients can experience excessive sweating at one or a combination of these locations.

Armpits: Excessive armpit sweating is the most frequently seen location for primary hyperhidrosis and is also the most noticeable, appearing as large wet circles under the armpits on clothing. Axillary hyperhidrosis is typically not associated with an odor, however the social stigma surrounding underarm sweating can make patients feel undesirable or appear more nervous or anxious then they are.

Hands: Excessive sweating of the hands can be especially distressing as it can cause significant anxiety and embarrassment and can disrupt social and professional activities, especially those that require a dry grip. Those with palm involvement can be seen frequently wiping or drying their hands and may avoid social situations that typically are associated with hand shaking.

Feet: Excessive sweating of the feet can cause feet to feel soggy, ruining or limiting types of shoes that can be worn. Some feet can feel constantly cold due to wetness. Although sweat and excessive sweating is odorless, when it occurs on the feet, the wet environment can lead to excess growth of bacteria associated with unwanted foot odors, which can also lead to maceration and skin infections.

Face & Scalp: Excessive sweating of the face and scalp although not as common as other locations but can often be the most distressing as it is the most difficult to hide. It can cause significant social anxiety, embarrassment, and impairment.



Myth: Excessive sweating is just annoying but is not considered a real medical condition.

Truth: Hyperhidrosis is a real and definable medical condition that can have severe negative impacts on patients daily functioning and quality of life and should be treated.

Myth: Hyperhidrosis is a rare disorder.

Truth: Hyperhidrosis affects up to 5% of the worlds population, that is 391 million people!

Myth: Everyone with hyperhidrosis knows they have a medical condition.

Truth: Most people with hyperhidrosis DO NOT realize their excessive sweating is a medical condition, and so they go untreated.

Myth: Excessive sweating is good for your body because it gets rid of ‘toxins’.

Truth: Physiologic sweating is a normal and healthy way for your body to regulate its temperature though evaporation and conductive cooling, however your sweat glands are not involved in the regulation or disposal of any of the bodies waste products.

Myth: Treatment for hyperhidrosis is difficult to do and rarely works.

Truth: While there is currently no cure for primary hyperhidrosis, there are a variety of vary effective and simple treatments.

Myth: Over-the-counter antiperspirant treatments for hyperhidrosis don’t work. Truth: For mild hyperhidrosis of the axilla the proper use of an OTC antiperspirant can be very effective!

Myth: Long term antiperspirant use can cause cancer in your armpits.

Truth: Extensive studies and decades of safety data do not show an increased risk of cancer with daily use of antiperspirant or deodorant.



As there is no cure for primary hyperhidrosis, management of this condition can be life long and involves a combination of medical treatments and behavior modifications to avoid triggers. It is recommended to seek the care of a medical professional, such as a Dermatologist, to treat hyperhidrosis to help guide your management choices.

The most common and potentially effective treatment for mild hyperhidrosis of the armpits is the proper use of an over-the-counter antiperspirant. The most common mistake patients make when they use an antiperspirant is using it during the day. The excessive sweating washes away the salts in the antiperspirant before they can work.

OTC antiperspirants should be applied at night, just before going to bed. As primary hyperhidrosis typically does not occur at night, the medication has time to work and is not washed away by excessive sweating.

Note: do not confuse antiperspirants (anti-sweat) with deodorant (anti-odor). Typically, deodorant will be labeled as both an antiperspirant and deodorant, however some brands are packaged as only deodorant and do not contain the salts used in antiperspirants.

Unfortunately over-the-counter antiperspirants are typically not powerful enough to deal with significant hyperhidrosis and are limited only to use in the armpits.

Neuromodulators, such as Botox, although typically used to treat fine lines and wrinkles, have revolutionized the treatment of hyperhidrosis and can be used in a variety of locations, including, the armpits, hands, face, and scalp. By introducing neuromodulators into the affected areas we are able to dramatically reduce, if not stop the excessive sweating for up to nine months to one year with only one treatment.

Other effective treatments include iontophoresis. Iontophoresis is a medical device that can be used at home to reduce sweat production by passing small amounts of electric current through the hands or feet while they are submerged in a thin layer of regular tap water.

Systemic oral medication can also be used to treat hyperhidrosis, typically when multiple locations are involved or they are in areas not amenable to the treatments listed above.



Our doctors are trained in the diagnosis, treatment, and management of primary and secondary hyperhidrosis. We are specifically trained in the use of neuromodulators (Botox) to treat the armpits, hands, face, and scalp, and have seen phenomenal results with this treatment.  We incorporate a number of techniques to reduce any discomfort while injecting, making the experienced as comfortable as possible.

We are also trained in the use of iontophoresis devices, prescription topicals and systemic medications when indicated.

If you or someone you know is experiencing hyperhidrosis, please know there are a variety of treatments options available to reduce the embarrassment and discomfort associated with excessive sweating. At Dermatology Consultants, we encourage you to speak to one of our providers about which treatment is best tailored for what is causing your hyperhidrosis, please contact us today.


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