hyperhidrosis excessive sweating - man looking at sweat from underarm on light blue shirt
hyperhidrosis excessive sweating - man looking at sweat from underarm on light blue shirt
hyperhidrosis excessive sweating - man looking at sweat from underarm on light blue shirt


Hyperhidrosis is excessive sweating that occurs on the:

  • Underarms

  • Palms

  • Face

  • Scalp

  • Feet

What is hyperhidrosis?

The body uses sweat as a form of temperature control, in order to cool itself. Hyperhidrosis is excessive sweating, which means sweating more than normal.

People with hyperhidrosis report feelings of social isolation and withdrawal from others in order to avoid touching others. This includes dating, business activities (where shaking hands is commonplace) and other activities for fear of body odor and damp clothing.

People with hyperhidrosis don’t have more sweat glands than other people. Rather, the nerve that controls sweating—the sympathetic nerve—is oversensitive and causes the overproduction of sweat.

Who gets hyperhidrosis?

There are two types of hyperhidrosis (excessive sweating): primary hyperhidrosis and secondary hyperhidrosis.

Primary hyperhidrosis is usually inherited, which means one of your family members may have had it. Primary hyperhidrosis begins in childhood and worsens with puberty, especially in women.

Secondary hyperhidrosis is caused by some other condition or behavior. Some of these might include:

  • Neurologic syndromes

  • Thyrotoxicosis

  • Diabetes mellitus

  • Gout

  • Menopause

  • Medications that may cause sweating

  • Chronic alcoholism

  • Spinal cord injury

Some cancers are known to cause night sweats, so if you only sweat at night, see your doctor as soon as possible to rule out a serious disease.

Hyperhidrosis Symptoms

Depending  where on your body you experience hyperhidrosis will determine your symptoms. Typically, symptoms include:

  • Excess sweat on your palms, hands, underarms, face and trunk (body)

  • Some patients may experience extreme flushing on their faces

Hyperhidrosis Diagnosis

Our doctors diagnose hyperhidrosis by doing a physical examination and listening to a patient’s history. We can also measure the level of sweating in two different ways:

  1. Starch Iodine Test: This is a test that turns the sweat brown and is used to detect excessive sweating (hyperhidrosis)

  2. Vapometer: This device measures transepidermal water loss and measures the amount of sweat that the hands, underarms, feet and scalp make. Measuring the amount of sweat gives your doctor an objective way to compare the amount of sweat before and after treatment.

Hyperhidrosis Treatment

There are different treatments for hyperhidrosis, depending on the severity of the condition. These include:


Drying Topical Creams

Daily topical creams that dry the skin are usually the first introduced treatment. Aluminum chloride or aluminum chloride hexahydrate are the most common of these creams.

Applied daily, usually at night, and then covered to encourage absorption, these creams can be very effective. However, some people find that they have uncomfortable side effects, including burning and skin reactions.

Oral Medications

Oral medications are known as systemic therapies, meaning they affect your entire body. These medications are called anticholinergics, which mean they cause a drying reaction in the body. These oral medications can be a good option for patients who sweat in multiple locations. There are some side effects, like dry mouth and dry eyes. Sometimes, after using these medications for a while, patients find these medications lose their effectiveness.

Dietary Changes

New research suggests changes in diet, such as adopting a vegetarian diet, and dietary supplements may reduce the severity of hyperhidrosis.

Botulinum Toxin

This treatment involves administering injections into affected areas. These injections cause a very reliable temporary decrease in sweating, typically lasting from three to six months.

Microwave thermolysis of sweat glands

This treatment directs energy at the sweat glands in the underarm. By destroying the sweat glands in the underarm, excessive sweating in that area stops immediately. Only 2% of the sweat glands in the body are located in the underarm area, so destroying them in this area does not affect the body’s ability to cool.

Before the procedure, your doctor will numb the underarm area. Then your underarm skin is lifted into the system and microwave energy is directed to the sweat glands. The procedure typically takes an hour and involves no incisions or cuts.


Sympathectomy is often used as a last resort for treating hyperhidrosis after other methods have shown no effect. This procedure involves cutting the sympathetic nerve, which is the nerve that controls the sweat reaction.

Behavioral Medicine

Patients diagnosed with hyperhidrosis may experience increased stress associated with excessive sweating. Although topical and oral medications are the first steps of treatment for the physical symptoms of hyperhidrosis, behavior medicine techniques may provide relief from stress, anxiety and other negative emotional reactions which can be experienced with this condition. Behavior medicine consultation is recommended for all patients to improve emotional, social and occupational/academic functioning in youth and adults with hyperhidrosis.

The Johns Hopkins Center for Sweat Disorders

hyperhidrosis excessive sweating - Dr. Malcom Brock treating a patient

The Johns Hopkins Center for Sweat Disorders provides a holistic approach to treating hyperhidrosis and other dysautonomia conditions through innovative genetic research and multiple treatment options for patients to restore their confidence.

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