Excessive Sweating
Hyperhidrosis
Specialist assessment and treatment for excessive sweating, including complex hyperhidrosis affecting the hands, underarms and other areas of the body.
Treatment tailored to the pattern of sweating
Hyperhidrosis can affect different areas and vary considerably in severity. Treatment is therefore guided by the location of sweating, its impact on daily life, previous treatment and whether an underlying cause is suspected.
Understanding Hyperhidrosis
What is hyperhidrosis?
Hyperhidrosis is excessive sweating that occurs beyond what is normally required to regulate body temperature.
It may affect one particular part of the body, such as the palms or underarms, or may be more widespread.
For some people the condition begins in childhood or adolescence and persists for many years. Although it is not usually dangerous, excessive sweating can have a significant effect on confidence, work, relationships and everyday activities.
Hyperhidrosis may affect
- The palms of the hands
- The underarms
- The soles of the feet
- The face or scalp
- More than one body area
- Daily work and social activities
Patterns of Sweating
Hyperhidrosis can affect different areas of the body
The location and pattern of excessive sweating help guide investigation and treatment.
Palmar Hyperhidrosis
Excessive sweating of the hands can interfere with writing, computer use, handling objects and social contact.
Axillary Hyperhidrosis
Excessive sweating from the underarms may cause visible clothing marks and significant disruption to daily life.
Plantar Hyperhidrosis
Excessive sweating of the feet may affect footwear, comfort and skin health.
Facial & Craniofacial
Sweating involving the face or scalp can be particularly noticeable and socially difficult for some patients.
Multiple Areas
Some people experience excessive sweating in several different areas, requiring a broader treatment strategy.
Generalised Sweating
More widespread sweating may require assessment for another medical condition or medication-related cause.
Identifying the Cause
Primary and secondary hyperhidrosis
One of the first steps is establishing whether excessive sweating appears to be a primary condition or a symptom of another underlying problem.
Excessive sweating without another obvious medical cause
Primary hyperhidrosis commonly affects focal areas such as the palms, underarms or feet and often begins during childhood or adolescence.
Sweating associated with another condition or medication
Excessive sweating can sometimes be caused by an underlying medical problem or medication. More generalised sweating, a new change in symptoms or significant night sweating may warrant further investigation.
Hyperhidrosis is more than simply “sweating a lot”
Severe excessive sweating can have a profound effect on everyday activities, confidence and quality of life. The impact of the condition is therefore an important part of deciding whether treatment is appropriate.
Quality of Life
Everyday activities can become unexpectedly difficult
The severity of hyperhidrosis is not judged only by the amount of sweating, but also by how much it interferes with normal life.
Specialist Assessment
Choosing treatment starts with understanding the pattern
Assessment considers when the sweating began, which parts of the body are affected, how severe the symptoms are and how they interfere with daily life.
It is also important to consider whether another medical condition, medication or other factor may be contributing.
Symptom History
Review of when sweating began, its pattern, frequency and triggers.
Areas Affected
Identifying whether symptoms involve the hands, underarms, feet, face or multiple areas.
Impact on Daily Life
Understanding how sweating affects work, social activity, confidence and practical tasks.
Previous Treatment
Review of antiperspirants, medication, iontophoresis, injections or other treatments already tried.
Treatment Options
A stepwise approach to treatment
Treatment is individualised according to where sweating occurs, its severity, previous treatment and personal preference.
Antiperspirants
Stronger antiperspirant preparations can help some people with localised excessive sweating and are often tried before procedural treatments.
Iontophoresis
Iontophoresis uses a weak electrical current applied through water or a wet pad and is particularly used for excessive sweating of the hands and feet.
Botulinum Toxin
Botulinum toxin injections can temporarily reduce excessive sweating by blocking the nerve signals that stimulate sweat glands.
Medication
Medicines that reduce sweating may be considered in selected patients, taking into account potential benefits, side effects and individual suitability.
Lifestyle Measures
Identifying triggers, choosing appropriate clothing and using practical measures to manage sweating can form part of the overall treatment plan.
Surgical Treatment
Surgery is reserved for selected patients with severe symptoms when less invasive treatments have not provided adequate control.
Surgical Treatment
Endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy, often abbreviated to ETS, is an operation that interrupts part of the sympathetic nerve pathway responsible for stimulating sweating.
It may be considered for carefully selected patients with severe primary upper-limb hyperhidrosis when other treatments have not been successful.
Surgery requires careful discussion
Sympathectomy can significantly alter sweating and is not appropriate for everyone. Potential benefits need to be considered alongside important possible side effects.
In particular, compensatory sweating in other parts of the body can occur following sympathectomy and should be discussed before deciding on treatment.
Complex excessive sweating
Mr Benaragama has a specialist interest in complex hyperhidrosis and leads the hyperhidrosis service at Royal Free London NHS Foundation Trust.
Mr Shanka Benaragama
Specialist assessment for persistent and complex hyperhidrosis
Mr Benaragama is a Consultant Vascular and Endovascular Surgeon at Royal Free London and University College London Hospitals.
Hyperhidrosis is one of his principal specialist interests. He is Service Lead for Hyperhidrosis management at Royal Free London and leads a specialist service managing patients with complex excessive sweating.
His approach is based on identifying the pattern and severity of symptoms, reviewing previous treatments and selecting the least invasive effective option appropriate to the individual.
When Further Assessment Is Important
New or unexplained sweating may need investigation
Excessive sweating that begins suddenly, is generalised rather than localised, occurs predominantly at night or is associated with other unexplained symptoms should be discussed with a doctor.
In these circumstances it is important to consider whether another health condition or medication may be contributing to the sweating.
New night sweating, unexplained weight loss, fever or a significant change from your usual pattern should not automatically be assumed to be primary hyperhidrosis.
Frequently Asked Questions
Hyperhidrosis questions
What is hyperhidrosis?
Hyperhidrosis is excessive sweating beyond what is normally required for temperature regulation. It may affect a single area or several parts of the body.
Is excessive sweating always caused by another illness?
No. Primary hyperhidrosis can occur without another underlying medical cause. Secondary hyperhidrosis, however, may result from another condition or medication.
Which areas can be treated?
Hyperhidrosis commonly affects the hands, underarms and feet, but other patterns can occur. Treatment depends on the areas affected and the severity of symptoms.
What is iontophoresis?
Iontophoresis is a non-surgical treatment that uses a weak electrical current, usually through water, to reduce excessive sweating. It is commonly used for the hands and feet.
How does botulinum toxin help sweating?
Botulinum toxin temporarily blocks nerve signals that stimulate sweat glands, reducing sweating in the treated area.
Is hyperhidrosis surgery always necessary?
No. Most treatment pathways begin with non-surgical measures. Surgery is generally considered only for carefully selected patients with severe symptoms that have not responded adequately to other treatments.
What is compensatory sweating?
Compensatory sweating describes increased sweating in other areas of the body after sympathectomy. It is an important consideration when discussing surgical treatment.
Should night sweats be investigated?
New or unexplained night sweating can have causes other than primary hyperhidrosis and should be discussed with a doctor, particularly when associated with other symptoms.
Hyperhidrosis Consultation
Request a specialist consultation
If excessive sweating is affecting your daily life, previous treatment has not been successful or you would like a specialist opinion about hyperhidrosis treatment, please contact the practice by email.
Email to Request a Consultation → benaragama.admin@lips.org.uk