Sweating is a perfectly normal response to rising temperatures—on an especially blistering day, or after a really hard workout, it’s natural to break out into a sweat. But for some people, excessive sweating is a chronic issue, regardless of the season or temperature. This condition is known as hyperhidrosis.

Hyperhidrosis isn’t life-threatening, but it can have profound social and emotional impacts, due to its visible symptoms on the skin and the stigma attached to excessive sweating. 

So what are the causes behind this condition and how can you tell if you have it? Here, our experts will walk you through what hyperhidrosis is, how it affects your skin, and the possible treatment options you can explore to manage this condition.

What is hyperhidrosis?

Think of it like this: Our bodies have an internal thermostat that helps regulate our temperature. When it gets too hot, we sweat to cool down. But in some people, this ‘thermostat’ is always cranked up, leading to excessive and unnecessary sweating. This is more than just a case of getting a bit clammy when it’s warm; it’s like being in a perpetual state of a high-pressure job interview or an intense workout. That’s the daily reality for the 3% of people in the United States dealing with hyperhidrosis.¹ It’s not a life-threatening condition, but it can make life uncomfortable and embarrassing, impacting your social life, work, and emotional well-being.

There are two types of hyperhidrosis: Primary hyperhidrosis usually has an unknown cause and typically is characterized by sweating of the underarms, face, palms, and feet. Secondary hyperhidrosis may be in a specific area but may also be more generalized throughout the body. A distinguishing characteristic is that secondary hyperhidrosis is often caused by side effects from medication or other health conditions.²

How do medical providers figure out if someone has hyperhidrosis? Listening to their patient’s experiences and symptoms, they may run tests to understand how severe their sweating is and where it happens most commonly. This may include lab tests to rule out other reasons for the sweating, such as infections, diabetes, or medication side effects.³

Hyperhidrosis symptoms

One of the most telling symptoms of hyperhidrosis is when the sweating episodes last for at least a week. Sweating is most common in specific areas, such as the underarms, palms, feet, and face. Interestingly, despite the struggles of trying to work and carry out daily tasks while sweating profusely, those with hyperhidrosis may find some respite during the night. A hallmark of this condition is decreased sweating during sleep.⁴

Is hyperhidrosis dangerous?

Hyperhidrosis itself is not an inherently dangerous condition. However, its effects go beyond physical discomfort and cosmetic concerns; it can have profound emotional and psychological impacts on those who live with it. Hyperhidrosis can make commonplace situations sources of anxiety and distress, which can significantly diminish an individual's quality of life.

When it comes to managing the condition, unfortunately, no treatment has been found to reliably and permanently eliminate hyperhidrosis. It can often feel like a never-ending battle as recurrence is common with all currently available treatment options, which range from topical treatments and oral medications to Botox injections.⁵

What causes hyperhidrosis?

As mentioned above, there are two main types of hyperhidrosis, each with different causes:

Primary Hyperhidrosis: This condition is usually not caused by another medical condition. It’s more common in people 25-64 and a positive family history has often been reported by patients affected, suggesting genetics may play a role. For instance, a person whose parent has primary hyperhidrosis is more likely also to have the condition. The sweat glands in certain parts of your body (like hands, feet, armpits, and the facial area) seem to be overactive or more sensitive, possibly from a dysfunction of the sympathetic nervous system.⁶

Secondary Hyperhidrosis: This type is caused by other health conditions or as side effects of certain medications. Some of these health conditions include infections, thyroid disease and diabetes. It's essential to identify and treat the underlying health condition to manage the symptoms of secondary hyperhidrosis.⁷

Hyperhidrosis and your skin 

Hyperhidrosis, while primarily known for its excessive sweating symptoms, can also have a significant impact on your skin health. The reason? Your skin protects your body from environmental factors, and excessive sweating can interfere with these natural protective mechanisms. When your body produces too much sweat, it creates a damp and warm environment ideal for the growth of microorganisms, leading to an increased risk of skin conditions. This includes bacterial and fungal infections, which can thrive in moist conditions. Viral infections, while less common, can also occur.⁸

Managing hyperhidrosis is more than just managing sweat—it’s also about managing your skin health. It involves professional attention, personal hygiene, lifestyle adjustments, and modern treatment methods. 

Treatments for Hyperhidrosis

Fortunately, there are several treatment options available, ranging from topical treatments to surgical procedures, with each option offering its own set of advantages and potential side effects.

Here’s a closer look at these treatments:⁹

Topical treatments: As a first line of defense, you might use over-the-counter antiperspirants containing 5.0% - 25% aluminum chloride. This treatment is applied directly to areas where you sweat excessively, creating a ‘plug’ that stops sweat from reaching your skin surface.

Oral medication: If topical treatments prove ineffective or excessive sweating is more widespread, oral anticholinergic medications may be considered. These drugs work by blocking the chemicals that allow certain nerves to communicate with each other, reducing sweating. However, they can cause side effects like dry eyes, mouth, urinary retention, and constipation.

Iontophoresis and Botulinum Toxin A injections: For more severe cases of hyperhidrosis, iontophoresis or botulinum toxin A (Botox) injections may be utilized. Iontophoresis involves passing a mild electrical current through water to your skin and you may require 6-15 treatment sessions for your hyperhidrosis symptoms to be alleviated. Botulinum toxin A injections are also a viable option. They have been shown to reduce perspiration by 50-80% and the effects can last up to 9 months.

Surgery: If other treatments fail to provide relief, surgical procedures such as a thoracic or lumbar sympathectomy, subcutaneous liposuction, or surgical excision of the sweat glands might be considered. These are invasive measures that come with potential complications like compensatory sweating (where you start sweating more in other areas).

Treatment of the underlying cause: For secondary hyperhidrosis, where excessive sweating is caused by another health condition or medication, treating the underlying cause or discontinuing the problematic medication is part of the management approach.

Each case of hyperhidrosis is unique, and the treatment that works best will depend on the person and the severity of their condition. It's important to consult with a healthcare provider to get personalized advice and discuss potential treatment strategies.

Remember, while hyperhidrosis might be a long-term condition, it’s manageable, and advancements in treatment continue to provide hope for relief.

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PS. We did the homework so you don’t have to:

1. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing.(2022, October 3)

2. McConaghy, J. and Fosselman, D. Hyperhidrosis: Management Options. American Family Physician (2018).

3. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

4. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

5. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

6. Stashak, A. B., & Brewer, J. D. Management of hyperhidrosis. Clinical, Cosmetic and Investigational Dermatology. (2022, December 18)

7. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

8. Kisielnicka, A., et al. Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities. Postepy Dermatol Alergol. (April, 2022)

9. Kisielnicka, A., et al. Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities. Postepy Dermatol Alergol. Ibid.

10. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

11. Brackenric, J, and Fagg, C. Hyperhidrosis. StatPearls Publishing. Ibid.

Donna McIntyre is a board-certified nurse practitioner at Curology. She obtained her Master of Science in Nursing at MGH Institute of Health Professions in Boston, MA.

*Cancel anytime. Subject to consultation. Results may vary.

Written by

Curology Team

Medically reviewed by

Donna McIntyre, NP-BC