Hyperhidrosis - Treatment 

Treating hyperhidrosis 

Treatment for hyperhidrosis may include lifestyle changes to improve symptoms, prescription antiperspirant or referral to a dermatologist for specialist treatment.

Lifestyle changes

Changing your lifestyle and daily activities cannot cure primary hyperhidrosis, but it can improve your symptoms and make you feel more self-confident.

The advice listed below may help to improve your symptoms.

  • Avoid known triggers that make your sweating worse, such as spicy foods and alcohol.
  • Use antiperspirant spray frequently, rather than deodorants.
  • Avoid wearing tight, restrictive clothing and man-made fibres, such as nylon.
  • Wearing black or white clothing can help to minimise the signs of sweating.
  • Armpit shields can help to absorb excessive sweat and protect your clothes.
  • Wear socks that absorb moisture, such as thick, soft socks that are made of natural fibres, or sports socks that are designed to absorb moisture. Avoid wearing socks that are made out of man-made materials and change your socks at least twice a day.
  • Buy shoes that are made of leather, canvas or mesh, rather than synthetic material.

Prescription antiperspirant

If a regular antiperspirant has failed to control your sweating, your GP may prescribe a more powerful one for you. Aluminium chloride is often used to treat hyperhidrosis, and it works by plugging up the sweat glands.

You will need to apply aluminium chloride at night just before you go to sleep. To avoid irritation, make sure that the area of skin is dry before you apply it. You will need to wash off the aluminium chloride in the morning.

It is not recommended that you apply aluminium chloride to your face as it can severely irritate your eyes.

The most common side effect of aluminium chloride is mild skin irritation or itching and tingling where it is applied. However, these types of side effects should pass quickly.

Referral to a dermatologist

If lifestyle changes and prescription antiperspirants do not control your symptoms, your GP should refer you to a dermatologist (a specialist in treating skin conditions). This is because you may require access to additional treatments that your GP will be unable to provide, such as iontophoresis, botulinum toxin or surgery (see below).

Iontophoresis

Iontophoresis is an effective treatment if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.

If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water.

If your armpits need treating, a wet contact pad is placed against each armpit and then a current is then passed through the pad.

The current is thought to help block the sweat glands.

The treatment is not painful but the electric current can cause some mild, short-lived discomfort and skin irritation.

Each session of iontophoresis lasts between 20 and 30 minutes, and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one to four week intervals, depending on how severe your symptoms are.

Iontophoresis has proved to be effective in 80% to 90% of cases. However, you will need to make regular visits to your local hospital’s dermatology clinic to receive treatment. Alternatively, iontophoresis kits that you can use at home are also available, with prices in the range of £325-500.

Botulinum toxin

Botulinum toxin is a relatively new treatment for people with hyperhidrosis. Botulinum toxin is a powerful protein that can be used safely in minute doses. Around 12-20 injections of botulinum toxin are given in the affected areas of the body, such as the armpits, hands, feet or face.

The procedure takes about 30-45 minutes. The toxin works by blocking the signals from the brain to the sweat glands, reducing the amount of sweat that is produced.

The availability of botulinum toxin on the NHS can vary widely depending on the policy of your clinical commissioning group (CCG), and many people can only access the treatment by going to a private clinic. Costs for private treatment depend on which part of the body needs to be treated. For example, injecting the forehead costs around £150-200, while treating both armpits costs around £400-450.

The effects of botulinum toxin usually last from two to eight months, after which time further treatment will be needed.

Surgery

VATS

Video-assisted thoracic sympathectomy (VATS) is the most widely used type of surgery to treat hyperhidrosis. VATS is usually recommended to treat cases of hyperhidrosis that have failed to respond to other types of treatment.

During the procedure, a surgeon makes two small incisions on the side of your chest and remove some of the nerve tissue that runs from your sympathetic nervous system to the affected sweat glands.

VATS can be used to treat excessive sweating of the armpits, face and hands. However, treating excessive sweating of the feet it is not recommended because the operation carries a risk of causing permanent sexual dysfunction, such as impotence. This is because damage to the part of the sympathetic nervous system that runs down the back and into the legs could also damage the nerves connected to the genitals.

So far, VATS has been moderately successful in treating hyperhidrosis. However, the operation does carry a significant risk of associated side effects.

The most common side effect is excessive sweating in another part of the body, usually the lower back or upper thighs. This is known as compensatory sweating.

It is thought that almost all people who have the VATS procedure will experience some degree of mild compensatory sweating. However, an estimated 1 in 20 people will develop a more severe form of compensatory sweating. This is more likely to happen if you are obese.

Other side effects of VATS include:

  • sweating of the face and neck after eating food – this is known as gustatory sweating and it is thought to affect around 1 in 20 people
  • phantom sweating – an unusual side effect where a person feels like they are about to break out in a sweat but never actually do (this affects just under half of people who have VATS and usually improves with time)
  • increased sensitivity to cold
  • dry hands
  • changes in how things taste

It is unclear exactly how common the last three side effects are, because reports vary widely. 

Complications developing as a result of VATS are much less common. However, there is a 1 in 250 chance of developing Homer's syndrome following surgery. This is caused by damage to the nervous system which affects one side of the face, causing the eye to droop. This may not be possible to repair.

Other complications of VATS can include:

  • Air that becomes trapped between the layers of the lung, which can cause chest pain and breathing difficulties. This is known as pneumothorax and it usually resolves without the need for treatment. If treatment is required, a tube can be inserted into the lung to draw the air out.
  • Post-operative infection – a rare complication occurring in around only 1 in 1,000 cases.

Removing sweat glands

People who experience excess sweating under the arms may be considered for a newer treatment known as Shelley's procedure.

This procedure takes around an hour and is done under local anaesthetic. The plastic surgeon locates the sweat glands in your armpit and makes a 3mm incision to carefully removes them. In some cases, the surgeon may remove a small section of skin.

A dressing is worn over the area for a few days until it heals and after a few weeks you can return to normal exercise and physical activity.

Complications are rare but may include some bleeding after the procedure or infection.

Anxiety

Feelings of anxiety are not directly responsible for causing primary hyperhidrosis, but they can make a bad situation worse and create a vicious cycle.

A person may feel self-conscious due to their sweating, which can trigger anxiety in certain situations, such as when meeting new people or being in a crowded room. The anxiety can make the sweating worse.

If you feel that your anxiety is making your sweating worse, you may want to seek additional treatment for it. A type of talking therapy called cognitive behavioural therapy (CBT) is considered reasonably effective in helping people with hyperhidrosis-associated anxiety.

Read more information about treatment for anxiety.

Page last reviewed: 10/01/2013

Next review due: 10/01/2015

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Comments

The 11 comments posted are personal views. Any information they give has not been checked and may not be accurate.

FMW93 said on 08 January 2014

I've suffered from general HH for years. Got given different powders and deoderants by the GP with no result apart from irritating my skin. I then finally got referred and tried the iontophoresis for the underarms. That didn't work either and in my first session I got a burn under one arm which hurt quite a lot. I then finally got prescribed Glycopyrrolate. They work sometimes, not always. I was told not to make it a regular thing, taking them only when desperate like for a party, presentation, etc. But I never found out why. I've only found side effects to be dry mouth/throat and occasionally dry eyes if I have too much. Sometimes one pill work, sometimes I'll need more. It's very confusing. And I'm still curious as to what the long term side effects are because so far I've seen no reason not to take them every day other than being told not to with no explanation.

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Sunnysan said on 05 November 2013

I too have suffered from craniofacial hyperhydrosis and the summer of 2013 made my life hell as it was very humid. I googled the complaint myself and then went with my iPad to my GP, who was fantastic ! She did some research and later phoned me with a prescription of Oxybuttynin to be taken twice a day. I take the tablets an hour before I need them to work. After years of not getting up to dance at my Xmas do this year I will be able to dance my feet off and have dry hair (although for something so rigorous I will have to double my dose) which I have checked with my GP and this is ok.

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MaudyGrunch said on 03 August 2013

YES! There IS a treatment!
Please ask your GP about Oxybutynin. It is a table that is used to treat overactive bladder, but it is also an acceptable treatment for Craniofacial Hyperhidrosis. I have been using it for 2 months and my life has returned to normal. If your GP needs convincing, show him this article:
http://www.ncbi.nlm.nih.gov/pubmed/21738960
(A medical research paper)
It is not addictive or harmful and the only side effect I have is a very dry mouth. When you consider that my life was in ruins due to being constantly drenched in sweat, the dry mouth is no trouble at all.

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jeffry123 said on 18 July 2013

I have primary cranio-facial hyperhydrosis. I too have been told there is effectively nothing the NHS will do. It is an absolute disgrace that a condition considered to be idiopathic, partly genetic and hugely damaging psychologically, with effective and not hugely expensive treatment options is not funded on the NHS. Whereas many diseases caused by lifestyle with ineffective and hugely expensive treatments are routinely funded. All the GP's I consulted tried to give me anti-depressants like they were candy... rather than an effective drug/treatment for the sweating... Eventually I've had to take them up on their offer as over two years the condition obliterated my self-confidence, career and life causing a deep depression. What a joke. I feel for anybody out there with this condition, don't let them fob you off- campaign for appropriate treatment, this condition can rob you of your life (no matter who you are) and it need not happen.

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harvey21 said on 13 July 2013

I have also been told that there is no treatment available for my facial hyperhidrosis. Has anyone tried the iontophoresis treatment and do you know if it is available on the NHS?

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Bealings48 said on 03 June 2013

My main problem is excessive head sweating - I end up looking like I have come out of a swimming pool. What on earth helps with this?

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squemonk said on 02 June 2013

I dyed my hair a bright pink colour, and then realised quite how bad my condition had got after the dye ran out of my hair and stained my clothes from being sweated out.
I went to my GP and he told me it was because I was overweight. I admit that I am indeed overweight, but I have had excessive sweating problems since I was a toddler, my parents had to change the sheets every day, and I was smack bang in the middle of the "perfect" weight range and very healthy until a few years ago, and I was still sweating excessively.
Even after I explained that the weight hadn't made a difference to the problem, the G just insisted it was because I was overweight, even going as far as to say maybe if I wasn't fat I wouldn't sweat.
I was horrified to be spoken to in that way, especially as while I'm overweight, I'm not massively so.
Online forums really ARE the absolute best way to get help!

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sugababes06 said on 07 April 2013

I know how you feel. It was really embarrassed by my condition that I ended up isolated and unable to socialize and even when that happened, I had to always wear a jacket no matter what the weather. I tried everything but nothing happened aside getting some reaction due to sensitive skin. Not long ago a friend of mine told me about this product called AHC. Since I have started it works wonders and I am very pleased with it and I will highly recommend it.

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khizon said on 11 March 2013

@Juliesheat42
I am in a similar situation as yours, my dermatologist advised to try Glycopyyrolate facial wipes through a website which is quite expensive and my GPs havent been much supportive. It is shame that patients have to go traumatic period for number of years to get know that their excessive sweating isn't just because they are 'nervous' but due to a medical condition. The awareness is so poor even amongst medical fraternity.

I have generalised HH but more cranio-facial which has left me crippled. I am 35 now just coming to enjoy whats life like without sweating. I use a combination of topical Aluminium Hcl 20% and Glycopyrrolate wipes. I am not branding anyone here but found after number of trails, i find ''Driclor'' and 3% wipes most effective from facial and head sweating.

I have heard about ETS and Laser treatment, hope this or any new treatments becomes availabe for this terrible franiofacial sweating problem.

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Juliesheat42 said on 16 October 2012

I was told by my NHS trust that there was no treatment that they could offer my facial hyperhidrosis , they told me I could go on the Internet and buy treatment from abroad. To say the least I was upset. Has anyone else been told that ??

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User587263 said on 27 August 2011

VATS is exactly the same as ETS - which has been banned in Sweden (who pioneered the surgery) and also in Pakistan. I wish I had a pound for each time someone has told me they wished they could have their 'old sweating' back.

It's not noted above but you can google ets deaths or Louise Field or Irish solicitor in relation to ets.

This has been banned in Sweden - who pioneered the technique - and now also in Pakistan.

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