Hyperhidrosis

Treatment

Several treatment options are available for primary hyperhidrosis. Your doctor will work with you to find the least invasive treatment that relieves symptoms.

Medical treatments may include:

• Topical medications. These include over-the-counter and prescription antiperspirants.
• Iontophoresis. A battery-powered device delivers a low current of electricity to the hands or feet, and sometimes the armpits, through water-saturated wool pads.
• Oral medications. These may include medicines that block nerve impulses to sweat glands, inhibit sweating or reduce sweat output. A antidepressant or anti-anxiety medicine is sometimes prescribed.
• Botox. Botox (onabotulinumtoxinA) temporarily blocks the nerves that trigger your sweat glands.

Surgery

Surgery is generally reserved for severe cases of hyperhidrosis in which other treatments have been unsuccessful. At Mayo Clinic, surgery is generally highly successful in treating palm (palmar) and underarm (axillary) hyperhidrosis, but much less successful in treating foot (plantar) hyperhidrosis. Mayo doctors don't advise surgery if only your feet are affected.

There are three main approaches to surgery:

• Sympathectomy. This surgery, available for more than 70 years, involves interrupting the nerve signals to the skin. In the minimally invasive version done today, the surgeon either uses clips on the sympathetic nerve to block nerve impulses or cuts or burns the affected area of the nerve. The procedure is better for stopping excessive sweating on your palms than on your underarms and feet. Rarely, people develop excessive new sweating elsewhere on the body (compensatory sweating) as a side effect. The advantage of clipping is that, if compensatory sweating occurs within a month of the surgery, surgeons can reverse the procedure by removing the clips.

  The traditional form of sympathectomy, also called a ganglionectomy, is not reversible. It involves removing most or all of the upper thoracic sympathetic nerve chain. A common complication of this surgery is compensatory sweating, in which people experience new excessive sweating elsewhere that can be as much of a problem as the original symptoms. Mayo Clinic doctors do not recommend traditional sympathectomy.

• Sympathotomy. This surgery, called endoscopic transthoracic sympathotomy, is a relatively new procedure developed and pioneered at Mayo Clinic. It interrupts the nerve signals without removing the sympathetic nerve and controls hyperhidrosis without causing compensatory sweating. This procedure is performed at Mayo Clinic in Minnesota and Florida.

  In a sympathotomy, the surgeon disconnects two clusters of nerve cells (ganglions) on the sympathetic nerve, blocking the nerve pathway that causes excessive sweating. More than 120 people have had this surgery with excellent results, which included relief of palmar hyperhidrosis and some improvement in plantar hyperhidrosis. After surgery, no one has had severe compensatory hyperhidrosis at average room temperatures; two people have had it during exercise or working in hot conditions.

• Local excision. In this surgery for underarm (axillary) hyperhidrosis, surgeons remove certain sweat glands. The procedure requires small cuts and you'll need only local anesthesia. Most people report significant, permanent reduction in sweating. A possible side effect is scarring, which may restrict how well you can move your shoulder. For less scarring, doctors may use liposuction.

Like all surgeries, surgery for hyperhidrosis carries some risks:

• Increased sweating when eating (gustatory sweating). This occurs in approximately 5 to 10 percent of people who have this surgery, but is rarely severe.
• Horner's syndrome. This results from damage to a close-by nerve that can occur during surgery. Symptoms are decreased facial sweating, drooping of the eyelid and a smaller pupil in the eye on one side of the body. Horner's syndrome is rare and unlikely to occur when an experienced surgeon performs the procedure.
• Compensatory sweating. This happens when other areas of the body start sweating after surgery prevents the hyperhidrosis sweating of the hands, underarms, head or feet. It is usually mild and occurs in the lower back, abdomen and groin.

Read more about treatment of hyperhidrosis.