Diagnosis
Diagnosing hyperhidrosis may start with your health care provider asking about your medical history and symptoms. You may also need a physical exam or tests to further evaluate the cause of your symptoms.
Lab tests
Your health care provider may recommend blood, urine or other lab tests to see if your sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Sweat tests
Or you may need a test that pinpoints the areas of sweating and evaluates how severe your condition is. Two such tests are an iodine-starch test and a sweat test.
Treatment
Treating hyperhidrosis may start with treating the condition causing it. If a cause isn’t found, treatment focuses on controlling heavy sweating. If new self-care habits don’t improve your symptoms, your health care provider may suggest one or more of the following treatments. Even if your sweating improves after treatment, it may recur.
Medications
- Prescription antiperspirant. Your health care provider may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac AC). Apply it to dry skin before going to bed. Then wash the product off when you get up, taking care to not get any in your eyes. Once you start seeing results from using it daily for a few days, you can scale back to once or twice a week to maintain the effect.This product can cause skin and eye irritation. Talk with your health care provider about ways to reduce side effects.
- Prescription creams and wipes. Prescription creams that contain glycopyrrolate may help hyperhidrosis that affects the face and head. Wipes soaked in glycopyrronium tosylate (Qbrexza) may ease symptoms of the hands, feet and underarms. Possible side effects of these products include mild skin irritation and dry mouth.
- Nerve-blocking medications. Some pills (oral medications) block the nerves that trigger sweat glands. This can reduce sweating in some people. Possible side effects include dry mouth, blurred vision, and bladder problems.
- Antidepressants. Some medications used for depression can also decrease sweating. They may also help decrease anxiety.
- Botulinum toxin injections. Treatment with botulinum toxin (Botox) blocks the nerves that trigger the sweat glands. Most people don’t feel much pain during the procedure. But you may want your skin numbed beforehand. Your health care provider might offer one or more of the methods used to numb the skin. These include topical anesthesia, ice, and massage (vibration anesthesia).Each affected area of your body will need several injections. It may take a few days to notice results. To retain the effect, you’ll likely need repeat treatments about every six months. A possible side effect is short-term muscle weakness in the treated area.
Surgical and other procedures
- Iontophoresis. With this home treatment, you soak your hands or feet in a pan of water while a device passes mild electric current through the water. The current blocks the nerves that trigger sweating. You can buy the device if you have a prescription from your health care provider.You’ll need to soak the affected areas for 20 to 40 minutes. Repeat the treatment 2 to 3 times a week until your symptoms improve. After you get results, you can reduce treatments to once a week or once a month to maintain the effect. Talk with your health care provider if you experience side effects.
- Microwave therapy. With this therapy, a handheld device (miraDry) delivers microwave energy to destroy sweat glands in the armpits. Treatments involve two 20- to 30-minute sessions, three months apart. Possible side effects are a change in skin sensation and some discomfort. Long-term side effects are unknown.
- Sweat gland removal. If you sweat heavily only in your armpits, your health care provider may suggest removing those sweat glands. This may be done through scraping them away (curettage), suctioning them out (liposuction), or using a combination of the two (suction curettage).
- Nerve surgery (sympathectomy). During this procedure, the surgeon removes a small section of the spinal nerves that control sweating in your hands. A possible side effect is permanent heavy sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure treats the palms. It interrupts the nerve signals without removing the sympathetic nerve (sympathotomy), which reduces the risk of compensatory sweating.Because nerve surgery has a risk of side effects and complications, it is usually only considered for people who have tried many other treatments without good results.