There are now more treatments for hyperhidrosis than ever before. Hyperhidrosis treatments fall into three main categories: topical antiperspirants, medications, and medical procedures. No one treatment is effective for everyone with hyperhidrosis, and it may be necessary to try several before finding one that works for you. Each treatment has its potential side effects.
There are two types of hyperhidrosis. In primary focal hyperhidrosis, there is no underlying cause for the condition. In secondary generalized hyperhidrosis, sweating is caused by another health condition or a medication. Treatment is likely to differ between the two types of hyperhidrosis. Secondary hyperhidrosis may require treating the underlying condition or discontinuing the medication that is causing excessive sweating. In primary focal hyperhidrosis, the sweating itself is the condition, so treatment is focused on directly reducing sweat production.
Antiperspirants are the first line of treatment for hyperhidrosis. Some antiperspirants are available with higher-than-normal concentrations of active ingredients without a prescription. Most familiar brands of antiperspirant offer a “clinical strength” version that may be readily available in the personal care section at department stores or drugstores. Other brands, such as Certain Dri, Duradry, and ZeroSweat specialize in clinical strength, over-the-counter (OTC) antiperspirants. The most common active ingredients of OTC antiperspirants are aluminum zirconium trichlorohydrex and aluminum chloride hexahydrate. Both ingredients work by forming temporary plugs at the opening of sweat ducts in the skin.
Antiperspirants with the maximum concentrations of active ingredients are available only with a prescription. Prescription antiperspirant brands include Drysol, Xerac AC, and Hypercare. The most common active ingredient of prescription antiperspirants is Aluminum chloride hexahydrate.
Antiperspirants can cause a rash or skin irritation, especially when applied to wet or broken skin, or immediately after shaving. Antiperspirants may stain clothing. People with advanced kidney disease should discuss antiperspirant use with their doctor.
Anticholinergic medications such as glycopyrrolate (sold under the brand names Cuvposa and Robinul), propantheline, oxybutynin, and benztropine are believed to work by blocking chemical messengers that trigger the sweat glands to produce sweat. Common side effects of anticholinergics are headaches, dry mouth, flushing, drowsiness, dizziness, insomnia, confusion, vision changes, nausea, vomiting, and constipation. Rare but serious side effects listed for these medications include psychosis, intestinal obstruction, and increased risk for heat prostration (fever and heatstroke).
Benzodiazepines such as Xanax (alprazolam), Valium (diazepam), and Ativan (lorazepam) are used to treat anxiety and other issues. Benzodiazepines work by suppressing the activity of nerves in the brain. Benzodiazepines may be prescribed in cases of hyperhidrosis when social anxiety disorder or another type of anxiety disorder contributes to sweating. Addiction is a common and serious side effect of benzodiazepines.
Beta blockers such as Inderal (propranolol), InnoPran (propranolol), and Lopressor (metoprolol) are used to treat high blood pressure, migraines, and other issues. Beta blockers work by suppressing the effects of the hormone epinephrine, also called adrenaline. Beta blockers may be prescribed in cases of hyperhidrosis where social anxiety disorder or another type of anxiety disorder contributes to sweating.
In cases where antiperspirants and medications do not work well enough to stop sweating, there are several medical procedures that can be effective in treating hyperhidrosis. Health insurance will not usually cover hyperhidrosis procedures, which can be expensive.
Iontophoresis is a procedure used to treat some types of hyperhidrosis, especially palmoplantar (hands and feet) hyperhidrosis. During iontophoresis, hands and feet are submerged in shallow containers of water. An iontophoresis device generates a mild electrical current through the water, causing ionized particles to penetrate the skin. Iontophoresis treatment produces a mild tingling sensation. To achieve effectiveness, iontophoresis generally needs to be performed three times a week for 15 to 40 minutes each time. Once sweating is reduced, one treatment per week is usually sufficient to maintain improvement. Medications including Botox or anticholinergics such as Glycopyrrolate may also be added to the water. Iontophoresis can be performed at home.
Botox is an injectable form of the neurotoxin produced by the bacterium Clostridium botulinum. In cases of severe underarm sweating in adults, Botox may be injected into the underarms to reduce sweating. Botox is believed to work by inhibiting the release of certain molecules that trigger sweating.
miraDry is a type of noninvasive outpatient surgery cleared by the U.S. Food and Drug Administration (FDA) to treat axillary (underarm) hyperhidrosis. miraDry uses microwave energy to permanently destroy sweat glands under the arms and decrease sweating.
Sweat gland removal may be considered in severe cases of excessive underarm sweating when other treatments have proven ineffective. During sweat gland excision surgery, sweat glands under the arms are surgically removed and/or damaged. Techniques for sweat gland excision include liposuction, curettage, lasers, and excision.
Laser therapy is type of surgery that can permanently destroy sweat glands under the arms and decrease sweating.
Endoscopic thoracic sympathectomy (ETS) is a surgery used to treat severe hyperhidrosis when no other treatments are effective. ETS is most commonly considered in cases of severe palmar (hand) sweating but may be considered for other types of sweating. Due to significant and permanent side effects, ETS is rarely recommended. Apart from the risks of undergoing surgery, a sympathectomy results in compensatory hyperhidrosis — other large areas of the body may become excessively sweaty to compensate — in 98 percent of those who undergo the procedure.
Some people with hyperhidrosis participate in clinical trials studying new treatments for excessive sweating. Eligibility may be based on specifics of your condition, such as whether you have primary focal or secondary generalized hyperhidrosis, which areas are affected, your medical history, and any other health conditions you might have. Clinical trials may test new drugs, new procedures, new dosages of existing drugs, or new combinations of existing drugs. Some clinical trials also test the effects of lifestyle changes such as diet, exercise, or complementary therapies.
There is at present no cure for hyperhidrosis.