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.

Propantheline bromide

Propantheline bromide is a type of medication known as an antimuscarinic. It works by blocking the effects of a chemical in the body called acetyl-choline in certain places in the body.

Propantheline bromide may be prescribed to treat excessive sweating, but it is not suitable for everyone. Your GP or specialist prescribing this medication should discuss any risks with you.

Read detailed information about propantheline bromide for excessive sweating in the hyperhidrosis medicines guide.

Referral to a dermatologist

If lifestyle changes, prescription antiperspirants or medication 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.

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

The National Institute for Health and Care Excellence (NICE) recommends that VATS can be used to treat excessive sweating of the upper limbs.

However, NICE also recommends that before the procedure is performed, your clinician should explain:

  • VATS carries a risk of serious complications
  • it is very common for excessive sweating to occur in another part of the body after the procedure, which causes some people to regret the procedure
  • the procedure is not always successful at reducing excessive sweating

For this reason, only people with very severe hyperhidrosis which hasn't responded to other treatments should be considered.

Read the full NICE guidelines on endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb.

Other side effects of VATS can 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.

Other complications of VATS can include:

  • 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.
  • 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