Your Essential Guide to Hyperhidrosis/Sweating
Doctor’s Note
As dermatologists, we understand that excessive sweating (AKA hyperhidrosis) can cause significant anxiety and disruption of daily activities. Many hyperhidrosis patients experience stress when performing mundane tasks, like writing, sitting, gripping, raising your arm, and choosing what color clothing to wear. Some patients are too embarrassed to talk to their physician. To read about the science of sweating, read on! To skip to the recs, click here!
What is Hyperhidrosis?
Hyperhidrosis is a medical condition characterized by excessive sweating that goes beyond the body's physiological needs for temperature regulation.
This condition can significantly impact daily activities, emotional well-being, and social interactions. It is important to note how sweating affects your daily life, as this is useful for determining you treatment (see below!).
Contrary to popular belief, hyperhidrosis is not a rare condition; it is estimated to affect about 3% of the population.
Despite its impact on daily life, nearly half of those with hyperhidrosis do not seek medical advice, often because they are unaware that it's a treatable condition.
Types of Hyperhidrosis
Hyperhidrosis is categorized into two main types: primary and secondary. These two forms of hyperhidrosis are treated differently. The main differences include:
Primary Hyperhidrosis
This type often starts in childhood or as a teenager and affects specific places like the palms, feet, armpits, face, and groin. Doctors aren't sure exactly what causes it, but it might happen because sweat glands become too active, especially when a person feels hot or stressed.
Secondary Hyperhidrosis
This type happens because of another health issue or medication. It can affect bigger areas of the body and usually appears later in life. Reasons for this type can include changes in hormones, problems with the nerves, infections, or certain medicines.
Lifestyle Changes
Primary hyperhidrosis has no cure, but it's commonplace to suggest avoiding triggers. Common triggers include heat, physical exertion, alcohol, spicy foods, stress and/or strong emotions. There are many patients, though, with no apparent triggers.
Other management pearls include wearing loose-fitting clothing made of natural fibers and keeping the environment cool.
Hyperhidrosis Treatment Basics
When it comes to treating hyperhidrosis, we actually only have a few key ingredients for treatment. They fall into two different categories: whether it blocks the TOP of the sweat gland (aluminum chloride) or the BOTTOM of the sweat gland (glycopyrrolate + oxybutynin). Here is a basic breakdown:
Aluminum Chloride
-Reduces sweat production by blocking sweat gland pores.
Glycopyrrolate + Oxybutynin
-Reduce sweat production from the source.
Rx = Prescription, OTC = Over-the-Counter
Over-the-Counter Treatments
Antiperspirants (usually containing aluminum chloride) are the most common over-the-counter treatments for hyperhidrosis. When applied to the skin, the aluminum chloride and sweat combine to form a very tiny superficial plug inside each sweat gland. This blocks sweat from reaching the surface of the skin. This process takes 6-8 hours, so your antiperspirant should be applied before bed on completely dry skin. (It will sting if you apply to damp skin!) You can use this nightly as tolerated. Side effects include skin rash, itching, irritation, and burning. Here's few favorite OTC antiperspirants:
CertainDri
-12% Aluminum Chloride
Duradry PM Antiperspirant
-15% aluminum chloride
-Similar to CertainDri, but stronger and with added salicylic acid to increase effectiveness
Carpe Antiperspirant Underarm Lotion
-Contains aluminum sesquichlorohydrate (NOT aluminum chloride), which is milder and less irritating
NOTE: Antiperspirant is NOT the same thing as deodorant!
Deodorant = reduces odor 👃🏻
Antiperspirant = reduces perspiration AKA sweat 💦
Products can have one or both!
Prescription Topicals for Hyperhidrosis
If over-the-counter products are not strong enough, you can see your physician for prescription treatment. These include:
Drysol
-20% Aluminum Chloride
-Apply nightly at bedtime to dry skin
-Once sweating is reduced (after ~ 3 days), reduce to 1-2x per week
-Side effects: skin rash, itching, irritation, burning
QBrexza Wipes
-2.4% Glycopyrrolate Wipes
-Apply 1 cloth to affected area(s) once daily
-Wash hands after use
-Side effects: skin rash, drowsiness, dry mouth, difficulty urinating, blurred vision
What about the safety of aluminum and its potential health effects? Aluminum is all around us, including in lakes, soil, drinking water, personal care products, and more. For most healthy individuals, exposure to aluminum in day-to-day life, personal care products, and antiperspirants is safe and not a significant cause for concern.
However, as with any health concern, it's essential to discuss specific worries or questions about aluminum exposure with a healthcare professional who can provide personalized advice and guidance.
Prescription Oral Treatment for Hyperhidrosis
Glycopyrrolate and oxybutinin pills "dry you out" so to speak. It can reduce sweating, though it can also cause dry eyes, dry mouth, glaucoma, blurred vision, constipation, and difficulty urinating. Patients start at a low dose and slowly increase until their sweat is adequately controlled without bothersome side effects.
In-Office Procedures for Hyperhidrosis
Botox
It's not just for The Real Housewives! Botox is commonly used to treat excessive sweating of the armpits, palms, and soles. In this procedure, Botox is injected into the affected area(s), which temporarily disables sweat glands. The timeframe of decreased sweat production varies from person to person, but on average, / it typically lasts 4 - 12 months. This non-invasive procedure is relatively quick with minimal discomfort and no downtime. Our patients typically LOVE their hyperhidrosis Botox treatments, though it is not always covered by insurance! Check with your physician!
lontophoresis
lontophoresis is like a mini spa for your hands and feet! It uses water and a gentle electrical current to temporarily "block" sweat glands. It is a device that you use at home: place your hands or feet into a shallow tray of water.
The tray is connected to a small device that delivers a mild electrical current.
Don't worry - it's not enough to shock you! You'll need to repeat the process a few times a week initially. Once you've achieved the level of dryness you want, you can switch to a maintenance schedule, usually just once every few weeks. lontophoresis is typically not covered or only partially covered by insurance.
Microwave thermolysis (miraDry)
miraDry is a non-invasive and FDA-approved procedure that targets the sweat and odor glands in your underarms, giving you long-lasting results. During the procedure, a handheld device is used to deliver precise electromagnetic energy to your armpits, which zaps your sweat and odor glands. The best part? It's usually a one-time treatment! One thing to note: miraDry is typically not covered by health insurance.
Hyperhidrosis FAQ
Is Botox Covered By Insurance For Hyperhidrosis?
Yes, Botox can be covered by insurance for hyperhidrosis. When it's severe and other treatments don't work, insurance might pay for Botox injections. However, you need to check with your specific insurance plan to see if they cover this treatment and what steps you need to take to get it approved.
Can I Get Morpheus8 for Hyperhidrosis?
Morpheus8, primarily known for skin tightening, uses microneedling and radiofrequency energy to reduce sweat gland activity and may help treat hyperhidrosis. This minimally invasive treatment offers the benefit of reduced downtime compared to more invasive procedures.
Does Insurance Cover Botox for Hyperhidrosis?
Yes, it can! Insurance coverage for Botox to treat hyperhidrosis typically requires:
Medical Necessity: Documentation proving that hyperhidrosis significantly impacts daily life.
Failed Treatments: Evidence that other treatments (like antiperspirants or oral medications) were ineffective or poorly tolerated.
Diagnosis Confirmation: A formal diagnosis from a healthcare provider, often supported by tests like the starch-iodine test.
Severity: Does your sweating affect your work, social life, etc? We typically use the HDSS (see next!).
What is the Hyperhidrosis Disease Severity Scale (HDSS)?
The Hyperhidrosis Disease Severity Scale (HDSS) helps patients assess how much hyperhidrosis affects their daily activities. The scale has four levels:
Grade 1: My sweating is never noticeable and never interferes with my daily activities.
Grade 2: My sweating is tolerable but sometimes interferes with my daily activities.
Grade 3: My sweating is barely tolerable and frequently interferes with my daily activities.
Grade 4: My sweating is intolerable and always interferes with my daily activities.
What is the Typical Oxybutynin Dose for Hyperhidrosis?
For hyperhidrosis, people usually start taking 2.5 mg of oxybutynin twice a day. If needed, the doctor might increase the dose to 5 mg two or three times a day. Always follow the doctor's instructions and let them know if you have any side effects (such as dry mouth, constipation, blurred vision, dizziness, drowsiness, and difficulty urinating).
Why Do My Feet Sweat So Much?
Feet sweating a lot can be caused by a condition called hyperhidrosis, which makes your sweat glands overactive. It can also happen due to wearing tight shoes, socks made of synthetic materials, or simply having sweaty feet as a genetic trait.
Why Are My Feet Sweating but Are Cold?
When your feet are cold and sweaty, it could be due to poor circulation or anxiety. Sometimes, the body overcompensates by sweating more when it’s trying to regulate temperature, which can leave your feet feeling both cold and clammy.
How to Stop Perspiration on Face?
To stop sweating on your face, use a gentle antiperspirant specifically designed for the face. Washing with a mild cleanser and avoiding heavy creams can also help reduce facial sweating. In some cases, treatments like Botox may be recommended by a dermatologist.
How to Stop Sweating on the Face?
Stopping face sweating can involve using a facial antiperspirant, staying hydrated, and avoiding spicy foods or caffeine that can trigger sweating. Keeping your environment cool and using blotting papers can also help manage facial sweat.
Why Are My Feet Sweating All of a Sudden?
Sudden foot sweating can be triggered by stress, hormonal changes, or a change in temperature. If you notice this happening, consider whether any recent changes in your life might be contributing and try to address them.
How Can I Stop Face Sweating?
To stop face sweating, you can use an antiperspirant that’s safe for the face, stay hydrated, and avoid triggers like spicy foods or hot drinks. Regularly washing your face with a gentle cleanser can also help manage sweat.
How to Heal Sweaty Feet?
Healing sweaty feet involves keeping them clean and dry. Use an antiperspirant on your feet, wear moisture-wicking socks, and choose breathable shoes. Foot powders can also help absorb excess moisture.
How to Stop Nervous Sweating?
Nervous sweating can be managed by practicing relaxation techniques like deep breathing or meditation. Wearing breathable clothing and using an antiperspirant can also help reduce sweating during stressful situations.
Why Are My Feet Cold and Sweaty?
Cold and sweaty feet might be a result of poor circulation, anxiety, or simply the body’s way of regulating temperature. Keeping your feet dry and wearing moisture-wicking socks can help manage this condition.