Management of Hyperhidrosis – Excessive Sweating

Craig Kraffert, MD

Hyperhidrosis is a medical term that, simply translated, means excessive sweating. Excessive sweating serves no significant temperature regulatory or excretory function. Hyperhidrosis has its basic origin in the nervous system architecture. The tendency towards hyperhidrosis arises as a result of unique circumstances during development of the nervous system in utero.

Symptoms and Challenges of Hyperhidrosis

The symptoms of hyperhidrosis typically begin in early adolescence. They can be socially disturbing and, in extreme cases, can substantially impair a person’s quality of life. Hyperhidrosis is particularly problematic when it involves the palms, soles and underarms. Wet palms create unique issues in social situations when it comes time to shake hands. Excessive underarm sweating can damage clothing and create embarrassment as it provides unwanted visual cues.

Excessive sweating can be triggered by social stress. Accordingly, it is often difficult to control or cover up. Attempts to minimize sweating in social settings by trying to reduce it, hide it, use sweat pads, bring extra clothes, etc. can be done but are cumbersome and awkward. These tricks are typically used as a ‘last resort’ and tend to further ingrain personal feelings of social stigmatization. The social challenges of hyperhidrosis cause many sufferers to seek medical attention or other assistance.

Safe and Effective Medical Treatments for Excessive Sweating

Fortunately, there are reasonably safe and effective medical treatments for excessive sweating. Drysol® is a topical prescription medication that is often the method of first choice in treating hyperhidrosis. It is applied to sweat-prone areas with specific instructions at bedtime. It’s important to consult with a dermatologist regarding the specific instructions for application of this medicine so as to minimize the chance of irritation and maximize treatment success.

Iontophoresis utilizes a machine that creates electric current, which can result in pore closure and subsequent sweat control. Results vary. Drionic iontophoresis machines can be purchased at

Robinul Forte (glycopyrrolate), an oral anticholinergic drug, decreases sweat gland stimulation. Robinul Forte works well in many patients with hyperhidrosis despite lacking FDA approval for this indication. Side effects include dry mouth, dizziness and problems with urination. Also, because this product decreases overall sweat output, it’s important that patients avoid activities such as strenuous exercise.

Botox® (purified botulinum toxin) has been shown to be safe and effective in the treatment of excessive sweating of palms, soles and, especially, underarms. Botox’s effects last between six and twelve months – sometimes longer. The downside is that this treatment is expensive and can be tedious especially for palms and soles.

Surgery is an extreme elective measure to control hyperhidrosis. A refined minimally invasive surgical procedure called endoscopic thoracic sympathectomy is an increasingly popular way to manage hyperhidrosis, particularly of the palms. This procedure is generally safe, but like all surgeries, not without some risk. One post-op issue is the potential to develop compensatory hyperhidrosis elsewhere – a bitter side effect for many hyperhidrosis sufferers.

Newer therapies such as laser or microwave treatment of apocrine glands are used in some centers but are still generally considered experimental.