Hyperhidrosis is sweating beyond what’s needed for cooling—commonly palms, soles, underarms, and face. It’s not dangerous, but it can impact daily life. Treatments work best when stepped up methodically.
Step 1: Optimize basics
- Antiperspirants (not just deodorant):
- Over-the-counter clinical strength at night on dry skin; reapply in morning if needed.
- Underarms: aluminum zirconium compounds; for palms/soles: look for higher-strength sticks/gels.
- Clothing/footwear:
- Breathable, moisture-wicking fabrics; black/white patterns hide marks.
- For feet: moisture-wicking socks; rotate shoes to dry 24 hours; use absorbent insoles.
Tip: Night application allows plugs to form in sweat ducts; wash off in the morning if irritation.
Step 2: Prescription topicals and devices
- Aluminum chloride 20% solution (e.g., for underarms, hands, feet):
- Apply nightly for 1–2 weeks, then 1–3× weekly for maintenance. Use on completely dry skin to reduce sting; a hairdryer on cool can help.
- Glycopyrronium cloths/gel (Rx) for underarms; sofpironium gel in some regions.
- Iontophoresis for hands/feet:
- A home device passes a mild current through water trays to reduce sweating. Use 3–5 sessions/week initially, then weekly maintenance. Can add a teaspoon of baking soda or a crushable anticholinergic tablet per clinician guidance for tough cases.
Step 3: Oral medications (anticholinergics)
- Options: glycopyrrolate, oxybutynin (start low, go slow).
- Pros: Help multiple body areas simultaneously.
- Cons/side effects: dry mouth, dry eyes, constipation, blurry vision, heat intolerance. Not for everyone; discuss with your clinician.
Step 4: Botulinum toxin injections (especially underarms)
- Very effective for axillary hyperhidrosis; lasts 4–6+ months.
- Also used for palms/soles/face, but can be more painful and may cause temporary hand weakness.
- Performed by trained clinicians; downtime is minimal.
Step 5: Device and surgical options
- Microwave thermolysis (e.g., miraDry) for underarms:
- Destroys sweat and odor glands with targeted energy; long-lasting reduction after 1–2 sessions.
- Endoscopic thoracic sympathectomy (ETS):
- Surgical interruption of sympathetic nerves; generally reserved for severe palmar cases unresponsive to other treatments due to risk of compensatory sweating elsewhere.
Special situations
- Craniofacial sweating: consider topical anticholinergic wipes/creams and low-dose oral meds.
- Night sweats or sudden new sweating: evaluate for medical causes (thyroid, infections, medications, menopause, anxiety).
- Coexisting bromhidrosis (odor): add antibacterial washes and fabric strategies as in the body-odor guide.
Skin comfort and irritation prevention
- If antiperspirants sting: apply over completely dry skin; use hydrocortisone 1% for 1–3 days on irritated areas; switch formulations (gel/solid).
- For hands/feet after iontophoresis: moisturize; treat any eczema proactively.
When to see a clinician
- Sweating causes social, school, or work problems; slips from hands/feet; skin infections; or treatments aren’t enough.
- To discuss tailored combinations and insurance coverage for devices/injections.
Quick ladder summary
- Night antiperspirant and fabric choices
- Rx aluminum chloride or glycopyrronium; iontophoresis for hands/feet
- Oral anticholinergics
- Botulinum toxin injections
- Microwave therapy (underarms) or, rarely, surgery