During your appointment, your doctor will ask about your medical history and symptoms. You may also need a physical exam or tests to further evaluate the cause of your condition.
Your doctor may recommend blood, urine or other lab tests to see if your sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Thermoregulatory sweat test
Moisture-sensitive powder indicates the presence of excessive sweating (top) compared with normal-appearing hands (bottom) after hyperhidrosis surgery.
A number of tests are available to pinpoint the areas of sweating and estimate the severity of your condition, including an iodine-starch test, skin conductance and a thermoregulatory sweat test.
If an underlying medical condition is contributing to the problem, that condition will be treated first. If no clear cause can be found, treatment focuses on controlling excessive sweating. Sometimes you may need to try a combination of treatments. And even if your sweating improves after treatment, it may recur.
Drugs used to treat hyperhidrosis include:
- Prescription antiperspirant. Your doctor may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac Ac). This product can cause skin and eye irritation. It's usually applied to the affected skin before you go to bed. Then you wash the product off when you get up, taking care to not get any in your eyes. If your skin becomes irritated, hydrocortisone cream might help.
- Prescription creams. A prescription cream that contains glycopyrrolate may help hyperhidrosis that affects the face and head.
- Nerve-blocking medications. Some oral medications block the chemicals that permit certain nerves to communicate with each other. This can reduce sweating in some people. Possible side effects include dry mouth, blurred vision and bladder problems.
- Antidepressants. Some medications used for depression can also decrease sweating. In addition, they may help decrease the anxiety that worsens the hyperhidrosis.
- Botulinum toxin injections. Treatment with botulinum toxin (Botox, Myobloc, others) temporarily blocks the nerves that cause sweating. Your skin will be iced or anesthetized first. Each affected area of your body will need several injections. The effects last six to 12 months, and then the treatment needs to be repeated. This treatment can be painful, and some people experience temporary muscle weakness in the treated area.
Surgical and other procedures
Other hyperhidrosis treatments include:
- Microwave therapy. With this therapy, a device that delivers microwave energy is used to destroy sweat glands. Treatments involve two 20- to 30-minute sessions, three months apart. Possible side effects are a change in skin sensation and some discomfort. This therapy may be expensive and not widely available.
- Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. A minimally invasive technique called suction curettage may be an option, too, if you aren't responding to other treatments.
- Nerve surgery (sympathectomy). During this procedure, the surgeon cuts, burns or clamps the spinal nerves that control sweating in your hands. In some cases, this procedure triggers excessive sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure interrupts the nerve signals without removing the sympathetic nerve (sympathotomy).
Lifestyle and home remedies
The following suggestions may help you cope with sweating and body odor:
- Use antiperspirant. Nonprescription antiperspirants contain aluminum-based compounds that temporarily block the sweat pore. This reduces the amount of sweat that reaches your skin. This type of product may help with minor hyperhidrosis.
- Apply astringents. Apply over-the-counter products containing tannic acid (Zilactin) to the affected area.
- Bathe daily. Regular bathing helps keep the number of bacteria on your skin in check. Dry yourself thoroughly, especially between the toes and under the arms.
- Choose shoes and socks made of natural materials. Shoes made of natural materials, such as leather, can help prevent sweaty feet by allowing your feet to breathe. When you're active, moisture-wicking athletic socks are a good choice.
- Change your socks often. Change socks or hose once or twice a day, drying your feet thoroughly each time. You may want to try pantyhose with cotton soles. Use over-the-counter foot powders to help absorb sweat.
- Air your feet. Go barefoot when you can, or at least slip out of your shoes now and then.
- Choose clothing to suit your activity. Generally, wear natural fabrics, such as cotton, wool and silk, which allow your skin to breathe. When you exercise, you might prefer fabrics designed to wick moisture away from your skin.
- Try relaxation techniques. Consider relaxation techniques such as yoga, meditation and biofeedback. These can help you learn to control the stress that triggers sweating.
Coping and support
Hyperhidrosis can be the cause of discomfort and embarrassment. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.
Besides talking with your doctor, you may want to talk with a counselor or a medical social worker. Or you may find it helpful to talk with other people who have hyperhidrosis.
Preparing for your appointment
You may start by seeing your primary care provider. He or she may refer you to a specialist in skin diseases (dermatologist). If your condition is not responding to initial treatments, your care may also involve a neurologist or a surgeon.
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment, you might want to list answers to the following questions:
- Has anyone in your immediate family ever had similar symptoms?
- Does your sweating stop when you're asleep?
- What medications and supplements do you take regularly?
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
- When did you first experience heavy sweating?
- Where on your body does it occur?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Aug. 18, 2020