Hyperhidrosis – Diagnosis and Treatment

Diagnosis

Laboratory Screening

Health care providers run different lab tests to figure out if another health issue, like hyperthyroidism or hypoglycemia, is behind excessive sweating. They might order blood tests, urine tests, or other routine checks.

If they find another medical problem, you might have secondary hyperhidrosis instead of primary.

Here’s a quick table of common tests:

Test Type	Purpose
Blood	Thyroid function, glucose, and other markers
Urine	Hormonal or metabolic checks

Assessing Areas and Severity of Sweat

Doctors often use sweat-specific tests to measure exactly where and how much you sweat. The iodine-starch test shows sweat patterns by changing color when sweat is present.

Other methods, like sweat collection or electronic devices, check the amount or pattern of sweat. These tools help diagnose different types like palmar, plantar, axillary, or focal hyperhidrosis.

Treatment

Medicines That Can Help

Several medicines can help control extra sweating. Some you put on your skin; others you take by mouth.

Here’s a list of common types:

Medicine Type	How It Works	Where Used
Topical antiperspirant	Blocks sweat glands	Underarms, hands, feet
Creams and wipes with glycopyrrolate	Blocks nerve signals	Face, head, body
Oral anticholinergic pills	Blocks nerve signals	Whole body
Antidepressants	May lower sweating & anxiety	Whole body
Botulinum toxin injections	Blocks signals to sweat glands	Targeted areas

Prescription antiperspirants usually come first. You put them on at night to dry skin, then wash them off in the morning.

It’s best to keep them away from your eyes. Some people feel mild burning or irritation, so if that happens, it’s smart to talk to your doctor.

Glycopyrrolate-based creams and special wipes target sweating on the face, head, or specific spots like hands, feet, or armpits. You might get mild skin problems or dry mouth from these.

Oral anticholinergics block the nerves that tell sweat glands to work. These pills can cause side effects—blurry vision, dry mouth, even bladder trouble. Sometimes, antidepressants help, especially if anxiety is also making things worse.

Botulinum toxin injections are a key option for very sweaty areas—armpits, hands, or feet. Doctors inject it into the skin, stopping nerves from telling sweat glands to work.

You’ll probably need several injections per area. Some folks feel a little pain, but doctors can numb the skin first with ice or cream. Results show up in a few days, but they don’t last forever. You’ll need new shots every six months or so.

Short-term muscle weakness can happen where you get the shots.

Operations and Other Special Options

If medicines and skin care don’t help enough, you have some procedures and surgeries that can lower or stop heavy sweating.

Electrical Treatments (Iontophoresis)

Iontophoresis is a popular way to treat sweaty hands and feet at home. You soak your hands or feet in water, and a gentle electrical current runs through for 20 to 40 minutes.

This process stops nerves from triggering sweating.

• Most people do it 2–3 times a week at first.
• Later, you can space it out to once a week or month.
• You’ll need a special machine, which you can buy if your doctor says it’s okay.

Pros	Cons
Can be done at home	May cause skin irritation
No surgery needed	Not for all body parts

Microwave-Based Treatment

Microwave therapy is a newer method that destroys sweat glands in the armpits using microwave energy.

• You get two sessions, about three months apart.
• Each session takes 20–30 minutes.
• Side effects can include numbness or discomfort in the area.
• Nobody knows the full long-term effects just yet.

Removing Sweat Glands

If your worst sweating is in the armpits, removing sweat glands might help. There are a few ways to do this:

• Curettage (scraping them away)
• Liposuction (suctioning them out)
• Suction curettage (a mix of both)

These are outpatient procedures, so you can go home the same day.

Nerve Surgery for Sweating (Sympathectomy or Sympathotomy)

If nothing else works, doctors might suggest nerve surgery. Surgeons cut or remove the nerves in your chest that trigger sweating, usually for sweaty hands.

• This helps reduce hand sweating.
• Doctors don’t usually do it for head or neck sweating.
• Surgery is risky: some people end up sweating more in other places (compensatory sweating).
• Sometimes, just cutting (not removing) the nerve lowers that risk.

Only people with severe symptoms and little help from other treatments should consider surgery. A skilled specialist, like a thoracic surgeon, needs to perform it.

Other Options

• Laser treatment can target and destroy sweat glands under the arms.
• Newer devices and methods are still being tested for safety and effectiveness.

Summary table of physical procedures:

Treatment Type	Area Treated	Duration	Notes
Iontophoresis	Hands, feet	Ongoing	Needs repeated sessions
Microwave therapy	Armpits	Two sessions	Destroys sweat glands
Sweat gland removal	Armpits	One time	Curettage, liposuction, or both
Nerve surgery	Hands	One time	Risk of new sweating elsewhere
Laser treatment	Armpits	Varies	Newer option, not yet common

You can talk to your health care provider to see which procedure or device might be right for you. Every approach has its own upsides, risks, and recovery time.

Helpful Daily Habits for Managing Excessive Sweating

Managing sweating and strong body odor, like bromhidrosis, often gets easier with a few changes to daily routines. Many people find relief by using antiperspirants with 6% to 20% aluminum chloride.

These products block sweat glands for several hours. For best results, apply antiperspirant at night to dry skin, then wash it off in the morning.

Clothing and sock choices matter, too. Shoes made from natural materials, like leather, let your feet breathe and cut down on moisture.

Athletic socks that pull moisture away from your skin (moisture-wicking) help during exercise or hot weather. If you check the packaging, you can pick the right socks.

Try to keep your feet as dry as possible to limit sweat and odor. Change socks once or twice a day, dry your feet each time, and wear cotton-soled pantyhose if you use them.

Foot powder and shoe inserts help absorb extra moisture.

Wearing loose clothing made of cotton, wool, or silk lets your skin breathe and might reduce sweating during the day. If you’re active, try clothing designed to move sweat away from your body.

Trigger	Helpful Response
Physical activity	Moisture-wicking clothes
Hot weather	Natural fabrics
Stress	Strong antiperspirant

Small changes in these habits can make you more comfortable and help with hygiene.

Ways to Manage and Get Help

People with hyperhidrosis often feel stressed or lose confidence because of sweating. It can get in the way of daily routines, work, or social events.

Compensatory sweating might show up if you’ve had treatment for the condition.

Tips for coping:

• Talk to a doctor, counselor, or mental health specialist if stress or worry gets tough to handle.
• Therapies like psychotherapy can support emotional well-being and reduce anxiety.
• Connecting with others who have the same condition may be helpful.

Challenge	Support Option
Stress or worry	Talk to a counselor
Social discomfort	Join a peer support group
Compensatory hyperhidrosis	Discuss with a health provider

Some people face related issues, like Horner’s syndrome or new sweating in different areas, so regular check-ins with health professionalscan help.

Getting Ready for Your Visit

Before your appointment, it helps to think about the details. You can write down:

• Any family history of similar symptoms
• If sweating stops during sleep
• All medicines and supplements you use
• Times when sweating affects your daily life

Bringing a list of questions or notes makes the visit smoother. Sometimes, a family member or friend can join for support or help you remember important points.

If you have diabetic neuropathy, jotting down nerve-related symptoms might help, too.

What Your Healthcare Provider Will Ask

Your healthcare provider—maybe your primary care doctor or a dermatologist—will probably ask questions like these:

Question	Purpose
When did sweating start?	They want to get a sense of your symptom history.
Which areas of the body sweat most?	They’re trying to figure out where the symptoms actually show up.
Is the sweating constant or occasional?	They’re checking for any patterns.
Does anything make symptoms better or worse?	They want to know about possible triggers or what brings relief.

If treatments haven’t helped, your provider might send you to a neurologist or even a surgeon.