Health A to Z
Hyperhidrosis is a common condition in which a person sweats excessively.
The sweating may affect the whole of your body, or it may only affect certain areas. Commonly affected areas include the:
Both sides of the body are usually affected equally – for example, both feet or both hands.
The sweating doesn't usually pose a serious threat to your health, but it can be embarrassing and distressing. It can also have a negative impact on your quality of life and may lead to feelings of depression and anxiety.
Read more about the complications of hyperhidrosis.
There are no guidelines to determine what "normal" sweating is, but if you feel you sweat too much and your sweating has started to interfere with your everyday daily life, you may have hyperhidrosis.
For example, you may have hyperhidrosis if:
Visit your GP if you feel that your sweating is interfering with your daily activities, or you suddenly start sweating excessively.
Many people with hyperhidrosis are too embarrassed to seek medical help or believe that nothing can be done to improve it. But treatment is available.
Also visit your GP if you are having night sweats, because it can sometimes be a sign of something more serious.
Your GP will usually be able to diagnose hyperhidrosis based on your symptoms, although occasionally you may need blood and urine tests to check for an underlying cause (see below).
In many cases, hyperhidrosis has no obvious cause and is thought to be the result of a problem with the part of the nervous system that controls sweating. This is known as primary hyperhidrosis.
Hyperhidrosis that does have an identifiable cause is known as secondary hyperhidrosis. This can have many different triggers, including:
Read more about the causes of hyperhidrosis.
Excessive sweating can be challenging to treat and it may take a while to find a treatment right for you.
Doctors usually recommend starting with the least invasive treatment first, such as powerful antiperspirants. Lifestyle changes may also help, including:
If this doesn’t help, you may be advised to try treatments such as iontophoresis (the affected area is treated with a weak electric current passed through water or a wet pad), botulinum toxin injections, and even surgery in a few cases.
Hyperhidrosis is usually a long-term condition, but some people experience an improvement with time and the treatments available can often keep the problem under control.
Read more about treating hyperhidrosis.
Hyperhidrosis is common. It's been estimated to affect between one and three in every 100 people which means there are likely to be hundreds of thousands of people living with it in the UK.
Hyperhidrosis can develop at any age, although primary hyperhidrosis typically starts during childhood or soon after puberty.
Hyperhidrosis can be divided into two types, depending on whether an obvious cause can be identified. These are known as primary and secondary hyperhidrosis.
Hyperhidrosis that has no obvious cause is known as primary hyperhidrosis.
Although it's not clear why it develops, it's thought to be the result of a problem with part of the nervous system called the sympathetic nervous system, and it's possible your genes may also play a role.
The sympathetic nervous system controls most of your body’s functions that do not require conscious thought, such as movement of food through your body and the movement of urine out of your kidneys and into your bladder.
The sympathetic nervous system also acts like a thermostat. If it senses you are getting too hot, it will send a signal from your brain to the millions of sweat glands in your body to produce sweat. The sweat cools on your skin and reduces the temperature of your body.
A specific type of sweat gland, known as the eccrine glands, appears to be involved in hyperhidrosis. There are more eccrine glands on your armpits, hands, feet and face, which may explain why these areas are often affected by hyperhidrosis.
It's thought that in cases of primary hyperhidrosis, the brain sends signals to the eccrine glands, even though there is no need to cool the body.
Some cases of primary hyperhidrosis appear to run in families, which suggests a genetic mutation may be the cause.
A genetic mutation is where the instructions in your cells become scrambled, which can disrupt the normal workings of the body. Some genetic mutations can be passed down from parents to their children.
If a cause of hyperhidrosis can be identified, it's known as secondary hyperhidrosis.
Secondary hyperhidrosis can have a number of different triggers, including:
Secondary hyperhidrosis often starts more suddenly than primary hyperhidrosis and tends to affect the whole body.
Hyperhidrosis can be challenging to treat and it may take a while to find the best treatment for you. Less invasive treatments will usually be recommended first.
Changing your lifestyle cannot cure primary hyperhidrosis (hyperhidrosis with no obvious cause), but it can improve your symptoms and help your confidence.
The advice below may help.
If a regular antiperspirant doesn't control your sweating, your GP may prescribe or suggest a stronger one for you.
Antiperspirant containing aluminium chloride is often used to treat hyperhidrosis. This works by plugging the sweat glands. You will need to apply it at night just before you go to sleep and wash it off in the morning.
The most common side effect of aluminium chloride is mild irritation or itching and tingling where it is applied. Using the antiperspirant less frequently can help reduce irritation. Using emollients (moisturisers) regularly and soap substitutes instead of soap may also help.
You may be prescribed a type of medicine called an anticholinergic or antimuscarinic. These work by blocking the effects of a chemical called acetylcholine, which the nervous system uses to activate the sweat glands.
Anticholinergics are available as tablets or solutions that are applied to affected areas. They're not widely used to treat hyperhidrosis and most types are not licensed to treat it, but some people find them helpful.
Propantheline bromide is an anticholinergic medicine licensed for treating hyperhidrosis. However, anticholinergic medicines unlicensed for hyperhidrosis – such as oxybutynin and glycopyrronium bromide – can also be prescribed if your doctor feels they might help.
If lifestyle changes and treatment don't work, your GP may refer you to a dermatologist (a specialist in treating skin conditions) for further treatment, such as iontophoresis, botulinum toxin or surgery.
Iontophoresis may help if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.
Iontophoresis involves treating affected areas of skin with a weak electric current passed through water or a wet pad. This is thought to help block the sweat glands.
If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water. If your armpits need treating, a wet contact pad is placed against each armpit and a current is passed through the pad.
The treatment is not painful but the electric current can cause mild, short-lived discomfort and skin irritation.
Each session of iontophoresis lasts between 20 and 30 minutes, and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one to four week intervals, depending on how severe your symptoms are.
Iontophoresis is often very effective, although you may need to make regular visits to your local hospital’s dermatology clinic to receive treatment.
Alternatively, iontophoresis kits that you can use at home may be recommended, with prices in the range of £250-500.
Botulinum toxin can be injected into the skin in areas of the body affected by hyperhidrosis. This helps reduce sweating in these areas by blocking the signals from the brain to the sweat glands.
Around 15-20 injections are given in the affected areas of the body, such as the armpits, hands, feet or face. The procedure usually takes about 30-45 minutes in total.
The effect of the injections usually lasts for several months, after which time the treatment can be repeated if necessary.
Potential side effects of botulinum toxin injections include:
Most of these side effects are short-lived or will resolve as the effect of the injections wears off.
Availability of botulinum toxin on the NHS can vary widely depending on your clinical commissioning group (CCG), and you may only be able to get it privately. Costs for private treatment depend on the part of the body being treated. For example, injecting the forehead can cost around £150, while treating both armpits could cost up to £450 or more.
In a few cases where hyperhidrosis is particularly severe and treatment hasn't been successful, surgery may be recommended.
Endoscopic thoracic sympathectomy (ETS) is the most widely used type of surgery to treat hyperhidrosis. It's usually used in cases affecting the palms or armpits.
Small incisions are made in the side of the chest and the nerves that control sweating in the affected area are cut or clipped. This means signals can no longer pass along them to the sweat glands. The operation is carried out under general anaesthetic and done on both sides of the body.
The National Institute for Health and Care Excellence (NICE) recommends that ETS can be used to treat excessive sweating of the palms or underarms. However, before the procedure is performed, your clinician should explain:
For this reason, only people with severe hyperhidrosis which hasn't responded to treatment should be considered.
Side effects and complications of ETS can also include:
Excessive sweating under the arms may occasionally be treated with a procedure to remove or destroy the sweat glands in the armpits.
This can be carried out in a number of ways:
These procedures are generally carried out under local anaesthetic, which means you will be awake but your armpit will be numbed.
These procedures can sometimes be a permanent solution to excessive underarm sweating, although they are only carried out by a small number of practitioners. Availability on the NHS is likely to be very limited and you will probably need to pay for private treatment.
These procedures don't work for everyone and some of them are relatively new, which means there isn't always evidence about their long-term safety and effectiveness.
Feelings of anxiety are not directly responsible for causing primary hyperhidrosis, but they can make the situation worse and create a vicious cycle.
You may feel self-conscious, which can trigger anxiety in certain situations, such as when meeting new people or being in a crowded room. The anxiety can make the sweating worse.
If your anxiety is making your sweating worse, a type of talking therapy called cognitive behavioural therapy (CBT) might help. Medication for anxiety is not usually recommended because it can make sweating worse.
Read more information about treating anxiety.
Hyperhidrosis doesn't usually pose a serious threat to your health, but it can sometimes lead to physical and emotional problems.
Hyperhidrosis increases the risk of developing fungal infections, particularly on the feet – most commonly fungal nail infections and athlete’s foot. This is because excessive sweat combined with wearing socks and shoes creates an ideal surrounding for fungi to grow.
Fungal infections can be treated with antifungal creams. More severe cases may require antifungal tablets or capsules.
Excessive sweat can make you more vulnerable to certain skin conditions, such as:
Eczema can also be made worse by excessive sweating.
Although people with hyperhidrosis sweat a lot, most don't have problems with body odour. This is because hyperhidrosis doesn't usually affect the sweat glands responsible for producing unpleasant-smelling sweat – called the aprocrine sweat glands.
However, if bacteria are allowed to break down the sweat, it can start to smell unpleasant. Eating spicy food and drinking alcohol can also make sweat secreted from the eccrine smell.
This can be prevented or eased by following lifestyle advice, such as frequently using antiperspirant spray and using armpit shields to absorb sweat. See treating hyperhidrosis for more information.
The emotional impact of living with hyperhidrosis can be severe. Many people with the condition feel unhappy and, in some cases, depressed. Signs that you may be depressed include:
It is important not to neglect your mental health. Make an appointment to see your GP if you think that you may be depressed.