Excessive Sweating (Hyperhidrosis)

Last Updated December 2022

What is Hyperhidrosis?

Hyperhidrosis is a condition characterised by perspiration that is more than the body’s normal needs. This can cause various practical problems in everyday life. Hyperhidrosis can be separated into two types of sweating: primary and secondary.

Primary Hyperhidrosis

Primary hyperhidrosis is excessive sweating not due to any specific underlying medical condition. Overactive nerves cause excessive sweating in the palms, feet, underarms, face and scalp. Sweating occurs less often at night than during the day. Primary hyperhidrosis could be due to a genetic predisposition to excessive sweating.

Secondary Hyperhidrosis

Secondary hyperhidrosis, however, is the result of an underlying medical condition. Therefore, the underlying problem must be treated to treat hyperhidrosis, which is a symptom of the underlying issue. The medical conditions causing hyperhidrosis include:

• Infection
• Endocrine disorders
• Metabolic disorders
• Menopause
• Diabetes
• Neoplastic diseases
• Neurological conditions
• Spinal cord injuries
• Cardiovascular disorders
• Respiratory disorders
• Anxiety and stress
• Certain medications

What causes or triggers excessive sweating? 

There can be triggers for your sweating, and identifying them will allow you to avoid situations where you might exacerbate your sweat production.

Hyperhidrosis is usually a result of apocrine sweating, the sweat produced from spikes in stress or anxiety. You will find sweat produced predominantly under the arm, from the palms, and on the soles of the feet.

While moments of anxiety commonly trigger excessive sweating, many find everyday activities will also cause hyperhidrosis. These triggers include:

• Caffeine
• Exercise
• Spicy foods
• Alcohol
• Hot environments

This apocrine sweat differs from eccrine sweat, the temperature-regulating sweat that comes from the head, torso and limbs. Therefore, treatments for hyperhidrosis intentionally do not interfere with body temperature-regulating glands.

How to stop excessive sweating?

If you believe you are experiencing hyperhidrosis, you should concentrate on keeping the area as clean and dry as possible to prevent irritation or infection. 

Various treatment options can reduce and stop excessive sweating;

• Aluminium chloride (topical medication) – usually used for underarm sweating.
• Iontophoresis –  regular treatments, placing the affected area in electrically charged water/sodium glycopyrrolate
• Anticholinergic medication – suited to those who sweat in several areas
• Anti-wrinkle injections (botulinum toxin injections) – injections used normally for facial wrinkles can be injected in areas such as the underarms/hands/feet. The average duration of effect is 8 months
• miraDry – a permanent treatment for underarm sweating using microwave energy
• Endoscopic thoracic sympathectomy (surgery) – an operation that destroys a portion of the sympathetic nerve trunk to stop problems such as sweating and facial flushing.

At Victorian Cosmetic Institute, we specialise in anti-wrinkle injections and miraDry for treating excessive sweating in the armpits, hands and scalp.

Antiperspirants and aluminium chloride

Antiperspirants are usually the first line of treatment for underarm sweating, but it should be noted that they may not be as useful in other areas. The most common type of these over-the-counter topical treatments is aluminium chloride. 

Iontophoresis

A regular treatment that places the affected area in water electrically charged by a device. Initial treatment begins three times a week, but once a satisfactory level of dryness has been reached, treatments drop down to once a week. The gentle electric current is usually used for hyperhidrosis of the hands or feet.

Anticholinergic medications

Suited to those who sweat in several areas, this oral medicine affects part of the autonomic nervous system, which is the nervous system for unconscious functions and helps to reduce sweating

It is not completely selective for sweating, making it difficult to regulate temperature and affecting other parts of the autonomic nervous system. This can lead to dry mouth, constipation, urinary retention, and blurred vision. A script can be written by your local doctor or the doctors at Victorian Cosmetic Institute.

Anti-wrinkle injections

Anti-wrinkle injections (also known as botulinum toxin injections) are normally used for reducing facial wrinkles. Still, when injected into the skin of the underarms, scalp, hands or feet, they can reduce sweating for approximately eight months.

The underarms (also known as the axilla) is the most common area treated by these injections, and usually, 100 units are used for treatment (in total to treat both sides).

Facial sweating can also be treated with anti-wrinkle injections. Their use needs to take into consideration their possible effect on the muscles of facial expression. Excessive dosage or depth of injection in certain areas may also affect one’s ability to express normally. They are particularly suited to areas of sweating, such as the upper lip and forehead.

This treatment can also be used on the palms and scalp. The dosage varies in the hands but usually requires around 50-100 units per hand. However, it can be uncomfortable to inject in this area and may require some form of topical anaesthetic, or the use of an injecting device to reduce the associated discomfort. 

Generally, we don’t recommend the feet for treatment with anti-wrinkle injections, as the feet are particularly sensitive, and may be better suited to treatments such as iontophoresis.

miraDry

A non-surgical treatment that uses microwave energy to destroy the sweat glands located in the armpit. miraDry radically reduces odour and excessive sweating in this area, and is a good option for those wanting a more permanent treatment. Because your underarm sweat glands are only 2% of the body sweat glands, eliminating them will not affect your body’s ability to regulate temperature.

Endoscopic Thoracic Sympathectomy (ETS)

Endoscopic thoracic sympathectomy is usually the final step in improving hyperhidrosis. By surgically disrupting the nerves that cause sweating (the sympathetic nervous system), this procedure is able to reduce sweating in the upper limbs, feet, or underarms. Facial flushing can also be treated with this procedure.

Choosing which treatment is best for you can be difficult, so it is best to talk to a professional to decide which option you should choose. 

FAQs

What age do you get hyperhidrosis?

Symptoms generally begin to show from ages 14-25, but some may experience excessive sweating from a young age. This is usually palmar and plantar sweating, which contrasts with the axillary hyperhidrosis that is more common in those who are afflicted after puberty.

However, the severity of one’s hyperhidrosis is thought to lessen with time. It is far less common to find someone dealing with the condition over 65 years, which is good news for many.

When should I be worried about excessive sweating?

While this condition is not life-threatening by any means, its impact on your social or emotional wellbeing should not be underestimated. You should contact a professional if you feel that hyperhidrosis is affecting how you live your life.

Otherwise, excessive sweating can be a symptom of an underlying condition. If you experience nausea, dizziness or chest pain alongside sweating, you should seek immediate help.

Can hyperhidrosis be cured?

Regardless of the magnitude of sweating you are experiencing, all types of hyperhidrosis can be managed through the treatments. The treatment you initially decide on may not be effective against your sweating, but talking with a professional can allow for more long-lasting solutions like miraDry to be considered.