Specialist Excessive Sweating Care
Hyperhidrosis Treatment
Specialist assessment and treatment for excessive sweating affecting the hands, underarms, feet and other areas, with treatment selected according to severity, pattern and individual circumstances.
Hyperhidrosis can have a significant everyday impact
Excessive sweating may affect work, clothing, social situations, confidence and practical activities. Specialist assessment helps identify the pattern of sweating and which treatments are most appropriate.
Understanding Hyperhidrosis
Sweating beyond what the body needs for cooling
Hyperhidrosis is excessive sweating that occurs beyond what is required for normal temperature control.
It can affect a single area or several parts of the body and may occur without an identifiable underlying cause or as a result of another medical condition or medication.
Treatment depends on the site, severity and type of hyperhidrosis, as well as the degree to which it affects daily life.
Hyperhidrosis may affect
- Palms of the hands
- Underarms
- Soles of the feet
- Face or scalp
- Several areas together
- More generalised areas of the body
Understanding the Cause
Primary or secondary hyperhidrosis?
Establishing whether excessive sweating is primary or related to another condition is an important part of assessment.
No underlying cause identified
Primary hyperhidrosis commonly affects particular areas such as the palms, underarms or feet. Treatment is directed at controlling the excessive sweating and its effect on daily life.
Sweating caused by another factor
Excessive sweating can sometimes occur because of another medical condition or as a side effect of medication. In these circumstances, identifying and addressing the underlying cause may be important.
Common Patterns
Where hyperhidrosis occurs
Different areas can respond differently to treatment, so the pattern of sweating helps guide the management plan.
Palmar
Excessive sweating of the hands can affect writing, handshakes, equipment use and everyday tasks.
Axillary
Underarm sweating can cause visible clothing marks and significant practical or social difficulty.
Plantar
Excessive sweating of the feet can lead to persistent dampness and difficulties with footwear.
Other Areas
Sweating may also affect the face, scalp or more generalised areas, requiring a tailored assessment.
Severity is not measured by sweat alone
The effect on work, relationships, clothing, confidence and everyday activities is important when deciding whether treatment is appropriate.
Why Seek Treatment?
Hyperhidrosis can affect much more than comfort
Some people adapt their clothing, avoid hand contact, carry spare clothes or restrict work and social activities because of excessive sweating.
A specialist consultation allows these effects to be considered alongside the distribution and severity of the sweating itself.
Specialist Assessment
Treatment begins by defining the pattern of sweating
Assessment considers which areas are affected, when the sweating occurs, how long it has been present and how much it interferes with everyday life.
Symptoms such as night sweats, more generalised sweating, new onset symptoms or a possible medication-related cause may indicate the need to investigate an underlying condition.
Identify the Pattern
Establish which areas are affected and whether symptoms are focal or more generalised.
Assess the Impact
Consider work, social activities, clothing, confidence and practical limitations.
Exclude Secondary Causes
Medical history and medication are reviewed where another explanation for sweating is possible.
Select Treatment
Treatment is chosen according to site, severity, previous treatment and individual preference.
Treatment Options
A stepwise approach to treatment
Treatment usually progresses from simpler measures towards specialist treatments according to response and severity.
Antiperspirants
Stronger antiperspirants may help control localised excessive sweating and are commonly tried before more invasive treatment.
Iontophoresis
Iontophoresis uses a low electrical current delivered through water or a wet medium and can be particularly useful for sweating of the hands and feet.
Botulinum Toxin
Botulinum toxin injections can temporarily reduce sweating by blocking nerve signals to sweat glands and are commonly used for severe axillary hyperhidrosis.
Oral Medication
Medicines that reduce sweating may be considered for selected patients. Potential side effects and suitability need to be discussed before treatment.
Iontophoresis
A non-surgical option for hands and feet
Iontophoresis involves placing the affected area in water, or against a wet treatment pad, while a low electrical current is passed through the treatment area.
It is particularly associated with treatment of palmar and plantar hyperhidrosis.
Treatment usually requires repeated sessions initially, followed by maintenance according to the response.
Treatment considerations
- Particularly useful for hands and feet
- Non-surgical treatment
- Usually requires repeated sessions
- Maintenance treatment may be needed
- Suitability is assessed individually
Botulinum Toxin Treatment
Temporarily reducing sweat-gland activity
Botulinum toxin can be injected into selected areas of skin to interrupt the nerve signals that stimulate sweating.
It is particularly established for significant underarm sweating and can provide temporary symptom control in suitable patients.
Because the effect is not permanent, repeat treatment may be required when sweating returns.
Botulinum toxin treatment
- Local treatment to the affected area
- Commonly used for axillary hyperhidrosis
- Does not involve major surgery
- Effect is temporary
- Repeat treatment may be required
- Suitability depends on the area being treated
Medication
Tablets may be useful in selected patients
Medicines that reduce sweat production can sometimes be considered when topical or local measures are insufficient or when sweating affects several areas.
These treatments can cause side effects and are not suitable for everyone, so the potential benefits need to be balanced against tolerability and individual medical circumstances.
Medication planning considers
- Areas affected
- Severity of sweating
- Previous treatment
- Other medical conditions
- Current medication
- Potential side effects
Surgical Treatment
Surgery is reserved for carefully selected cases
Endoscopic thoracic sympathectomy can be considered for severe and debilitating primary hyperhidrosis of the upper limb when appropriate non-surgical treatments have not provided adequate control.
The operation interrupts part of the sympathetic nerve pathway involved in stimulating excessive sweating.
Because the procedure can produce significant and sometimes troublesome changes in sweating elsewhere on the body, careful selection and informed discussion are essential.
Compensatory sweating
After sympathectomy, sweating may increase in other areas of the body. This is known as compensatory sweating and can be significant. The possibility, severity and permanence of this effect need to be discussed carefully before considering surgery.
Treatment Pathway
Treatment progresses according to response
The aim is to achieve useful control using treatment appropriate to the severity and pattern of symptoms.
Assess
Identify the pattern, severity and effect of excessive sweating.
Start Conservatively
Appropriate topical, lifestyle or other simple measures are considered first.
Escalate Treatment
Iontophoresis, injections or medication may be considered according to site and response.
Consider Surgery
Surgical treatment is reserved for carefully selected severe refractory cases.
Specialist Hyperhidrosis Care
Consultant-led treatment for complex hyperhidrosis
Mr Shanka Benaragama is a Consultant Vascular and Endovascular Surgeon at Royal Free London and University College London Hospitals.
He has a specialist interest in complex hyperhidrosis and is Service Lead for Hyperhidrosis management at the Royal Free London NHS Foundation Trust.
Specialist assessment includes
- Primary hyperhidrosis
- Complex or severe hyperhidrosis
- Palmar sweating
- Axillary sweating
- Plantar sweating
- Review of previous treatment
- Assessment for advanced treatment where appropriate
When Further Assessment Matters
Not all excessive sweating is primary hyperhidrosis
Sweating that is new, widespread, occurs prominently at night, develops alongside other unexplained symptoms or begins after a change in medication may require assessment for an underlying cause. Treatment for secondary hyperhidrosis depends partly on what is causing the sweating.
Frequently Asked Questions
Hyperhidrosis treatment questions
What is hyperhidrosis?
Hyperhidrosis is excessive sweating beyond what the body needs for normal temperature regulation. It may affect one particular area or several areas of the body.
What is the difference between primary and secondary hyperhidrosis?
Primary hyperhidrosis occurs without an identifiable underlying cause. Secondary hyperhidrosis occurs because of another medical condition, medication or other identifiable factor.
What treatments are available?
Options can include stronger antiperspirants, iontophoresis, botulinum toxin injections, selected oral medication and, in carefully selected severe refractory cases, surgery.
Is iontophoresis suitable for sweaty hands?
Yes. Iontophoresis is commonly associated with treatment of excessive sweating affecting the hands and feet.
Can botulinum toxin treat excessive sweating?
Botulinum toxin can temporarily reduce sweating by interrupting nerve signals to sweat glands. It is particularly established for axillary hyperhidrosis.
Is the effect of botulinum toxin permanent?
No. The effect is temporary, so repeat treatment may be required when sweating returns.
When is surgery considered?
Surgery is generally reserved for selected patients with severe and debilitating primary hyperhidrosis that has not responded adequately to appropriate non-surgical treatment.
What is compensatory sweating?
Compensatory sweating is increased sweating elsewhere on the body after sympathectomy. It is an important potential consequence that needs careful discussion before surgery.
Should night sweats be investigated?
Persistent night sweating can indicate that another cause should be considered. It is therefore important to discuss this with an appropriate clinician rather than assuming it is primary hyperhidrosis.
Hyperhidrosis Consultation
Request a specialist hyperhidrosis consultation
If excessive sweating is affecting everyday life or previous treatments have not provided adequate control, please contact the practice for a specialist assessment and individual treatment plan.
Email to Request a Consultation → benaragama.admin@lips.org.uk