Hyperhidrosis

Diagnosis

Diagnosing hyperhidrosis usually begins with a review of your medical history and symptoms. Your healthcare provider may perform a physical examination and order tests to identify any underlying causes of excessive sweating.

Lab tests
Blood, urine, or other lab tests may be used to determine whether another medical condition is contributing to your symptoms. Conditions such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia) can sometimes cause increased sweating.

Sweat tests
To identify and measure the areas of excessive sweating, your healthcare provider may recommend specialized tests such as:

• Iodine-starch test – This involves applying iodine and starch to the skin, which turns dark in areas with heavy sweating.

• Thermoregulatory sweat test – This test evaluates the amount and distribution of sweat production by exposing the body to controlled heat conditions.

These tests help assess the severity of hyperhidrosis and guide treatment decisions.

Treatment

Treatment for hyperhidrosis depends on whether the excessive sweating is due to an underlying condition. If no cause is identified, treatment focuses on controlling symptoms and improving quality of life.

Medications
Several types of medicines can help reduce sweating:

• Prescription antiperspirants containing aluminum chloride (such as Drysol or Xerac AC) are applied to dry skin before bedtime and washed off in the morning. They may cause temporary skin or eye irritation.

• Prescription creams and wipes containing glycopyrrolate can be used for facial sweating or applied to hands, feet, and underarms.

• Nerve-blocking medications in pill form can help reduce sweating but may cause dry mouth, blurred vision, or bladder issues.

• Antidepressants may be prescribed to reduce sweating and help manage anxiety associated with the condition.

• Botulinum toxin (Botox) injections block the nerves that trigger sweat glands. Results appear after a few days, and repeat treatments are typically needed every six months. Temporary muscle weakness in the treated area is a possible side effect.

Surgical and other procedures
When medications do not provide sufficient relief, your healthcare provider may recommend one of the following treatments:

• Iontophoresis – A home-based therapy where hands or feet are soaked in water while a mild electric current passes through, blocking sweat gland activity. Treatments usually last 20 to 40 minutes and are repeated two to three times a week until improvement occurs.

• Microwave therapy (miraDry) – This treatment uses microwave energy to destroy sweat glands in the underarms. Two sessions spaced three months apart are typically required.

• Sweat gland removal – For localized underarm sweating, glands can be removed through curettage, liposuction, or suction curettage.

• Nerve surgery (sympathectomy or sympathotomy) – This procedure involves cutting or interrupting the spinal nerves that control sweating in the hands. It may cause compensatory sweating in other areas and is reserved for severe cases that don’t respond to other treatments.

Most procedures are done under local anesthesia with sedation or, in some cases, general anesthesia. Because nerve surgery carries a higher risk of complications, it is usually considered only after all other treatment options have been explored.