Hyperhidrosis

Simple changes such as loose, breathable clothing and moisture-absorbing socks can help you feel drier and more comfortable. They do not stop the sweat glands from working.

Often considered as a starting point alongside any other approach, or when sweating is mild.

There are few downsides. These steps may not be enough on their own when sweating is heavy.

Skin irritation from damp clothing or shoes. Sweat stains and odor may still happen.

Many people can tell within a few weeks whether they feel more comfortable.

• Which fabrics and shoe materials might suit me best?
• Could any of my medicines or habits be adding to my sweating?

Antiperspirants use aluminum salts to temporarily block the openings of sweat glands. Clinical-strength products with aluminum chloride are sold over the counter and by prescription.

Often considered as a first step for underarm sweating, and sometimes for palms and soles.

Less suitable when skin is broken, very irritated, or has a rash in the area. People with sensitive skin may react to stronger products.

Stinging, itching, redness, or dryness. Aluminum salts can also stain clothing. On brown and Black skin, ongoing irritation may leave darker patches.

Often judged over a few weeks. Results may fade if the product is stopped.

• Which type of antiperspirant fits my skin and my sweating pattern?
• How can I lower the chance of irritation?
• When would we move on to something else?

These are medicated cloths wiped on the underarms that block the signal telling sweat glands to work. Glycopyrronium tosylate cloth is FDA approved for primary underarm sweating in adults and children 9 years and older.

Often considered for underarm sweating when antiperspirants have not been enough.

Less suitable for people with certain eye conditions such as glaucoma, urinary retention, or some bowel or heart conditions. Clinicians weigh pregnancy and breastfeeding carefully.

Dry mouth, dilated pupils, blurred vision, sore throat, headache, and skin irritation. Because the medicine can reduce sweating, it is wise to be careful in very hot conditions. Wash hands after use so none gets in the eyes.

Often judged over a few weeks.

• Is a prescription cloth a good fit for my underarm sweating?
• Do my health conditions or medicines raise the risk of side effects?
• How do I stay safe in hot weather or during exercise?

A device passes a mild electrical current through water while the hands or feet rest in it. It is thought to reduce sweat gland activity, though how it works is not fully understood.

Often considered for sweaty palms and soles, especially when antiperspirants are not enough or are poorly tolerated.

Less suitable for people with pacemakers or other implanted electronic devices, metal implants in the treated area, or during pregnancy. A clinician can review safety.

Tingling, mild discomfort, dryness, or skin irritation. Home devices exist, but the routine takes ongoing effort.

Many people need several sessions before they can judge it, and benefit may fade if sessions stop.

• Is iontophoresis safe for me given my health history?
• Could I use a device at home, and how would I be trained?
• What results are realistic?

Tiny injections of botulinum toxin temporarily block the nerve signals that turn on sweat glands in the treated area. In the U.S. it is FDA approved for severe underarm sweating and is also used for palms, soles, and other areas.

Often considered when sweating is bothersome and creams or antiperspirants have not been enough.

Less suitable during pregnancy or breastfeeding, with certain nerve or muscle diseases, or with an allergy to the product or an infection at the injection site.

Pain during injections, bruising, headache, and temporary muscle weakness, which matters most in the hands. Results wear off and treatment may be repeated.

Results often appear within about a week or two and commonly last several months.

• Which areas could be treated, and what might it cost, and could insurance cover it?
• What would the injections feel like?
• How would we decide when to repeat?

A device delivers microwave energy through the skin of the underarm to heat and destroy sweat glands there. Sweat glands do not usually grow back.

Often considered for lasting relief of underarm sweating when other treatments were not enough or not wanted long term.

Less suitable during pregnancy, with implanted devices in the area, or when skin there is infected or damaged.

Swelling, soreness, numbness, and temporary skin color changes. Less often, nerve pain or burns can occur. Some underarm hair loss may happen.

Some people notice a change right away, while swelling settles over days to weeks.

• Am I a good candidate, and how many sessions might I need?
• What are the chances of lasting numbness or nerve problems?
• Is this covered by insurance?

Endoscopic thoracic sympathectomy (ETS) cuts or clamps nerves in the chest that signal sweating, mainly for severe palm and underarm sweating. Other surgeries remove sweat glands from the underarm.

Often discussed only for severe, disabling sweating after other treatments have not helped enough.

Less suitable for milder cases, for facial or foot sweating in many situations, and when someone is not ready to accept a permanent change. This is a major decision to take slowly.

Compensatory sweating, meaning new or heavier sweating on the trunk, back, belly, or legs, can happen and may be permanent. Other risks include pain, bleeding, infection, and scarring.

Sweating at the treated site often changes right away, but compensatory sweating may appear over weeks to months.

• How common and how bothersome is compensatory sweating after this surgery?
• What less permanent options should I try first?
• Can I speak with a surgeon who treats many people with hyperhidrosis?

These are pills that reduce sweating across the whole body by blocking the signals to sweat glands. Several different medicines are used this way.

Often considered when sweating affects many areas, or when local treatments are not practical or have not worked.

Less suitable for older adults, and for people with glaucoma, urinary retention, certain bowel conditions, or heart rhythm problems. Pregnancy and breastfeeding need careful review.

Dry mouth, constipation, blurred vision, trouble urinating, drowsiness, and trouble tolerating heat. Some people stop because of side effects.

Often judged over a few weeks, with ongoing check-ins about side effects.

• Could my other medicines interact with these pills?
• How would we balance benefit and side effects?
• What should I do if I feel overheated?

Relaxation, breathing practice, and counseling may help some people feel more in control when stress sets off sweating. Tracking triggers can also reveal patterns.

Often considered alongside other treatments, especially when worry about sweating makes it worse.

These approaches are less likely to be enough alone for heavy primary sweating.

Little risk. Some people feel frustrated if stress skills do not change sweating much.

Skills often take weeks of practice before you can judge them.

• Could counseling or stress skills be a useful add-on for me?
• How can I track my triggers in a simple way?