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  • Hyperhidrosis sufferers find heavy sweating interferes with their enjoyment of life.
  • The condition can be effectively managed with strong antiperspirants or ongoing treatments like Botox or SculpSure.
  • Localized surgery or a device known as miraDry offer a permanent reduction of sweat.

We’re often told not to sweat the small stuff in life. But for almost 5% of Americans, “not sweating” is no easy task, whether stressed or simply going about their daily business.

That’s because according to a recent study, roughly 15.3 million people in the country suffer from hyperhidrosis, a condition that causes them to sweat profusely regardless of any of the usual triggers: heat, physical activity or anxiety.

How Much Sweat Is Normal?

The amount a person sweats varies like any other individual characteristic such as hair color, appetite, or way of walking. For most people, feeling damp on a hot day is a passing annoyance. Hyperhidrosis sufferers feel as if they are sweating constantly.

The problem often begins soon after waking. It may be localized to one or two places on the body while the rest of the body remains dry. The sweat soaks through and stains clothes and is felt in handshakes, with much accompanying embarrassment. In some cases, sweaty palms prevent a person from handling papers or using tools in the workplace.

The severity of the condition varies, but many find their quality of life and overall well-being is affected.

excessive sweating

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The Two Types of Hyperhidrosis

Doctors distinguish between two kinds of hyperhidrosis: primary and secondary.

Patients in the former category have usually experienced symptoms since childhood or adolescence. They may have a blood relative with the same issue, indicating a genetic inheritance.

Those with secondary hyperhidrosis have an underlying medical condition linked to the sweating. Diabetes, gout, or a tumor, are all examples of health problems that may lead to excessive perspiration.

As with any health concern, it’s important that you get a proper diagnosis from a medical specialist before deciding on a course of treatment.

The Best Antiperspirant for Hyperhidrosis

There are many approaches to hyperhidrosis, all of them seeking to either manage the condition or eliminate it entirely.

A dermatologist may first recommend a patient try an over-the-counter or prescription antiperspirant. This is the simplest and cheapest solution, and can be effective if used correctly.

Dr. Gabriele Weichert of Synergy Medical Aesthetics in Nanaimo, British Columbia recommends patients look for one with at least 20% aluminum hexahydrate as the active ingredient, and offers some advice for its application:

“Unlike other antiperspirants, it should be applied to dry skin in the evening for several nights in a row, then twice weekly.”

The American Osteopathic College of Dermatology (AOCD) recommends Drysol as the best prescription antiperspirant for hyperhidrosis.

Unfortunately, strong is not always strong enough. This is particularly true for areas of the body with thicker skin, such as the palms of the hands or soles of the feet. When antiperspirants prove ineffective, Dr. Weichert next recommends injections of botulinum toxin type A, also known as Botox.

Botulinum Toxin (Botox): Effective Ongoing Treatment

Botox is perhaps the world’s best-known cosmetic medicine, widely used to smooth out wrinkles, frown lines and crow’s feet or add volume and definition to lips. What is less known is that the U.S. Food and Drug Administration (FDA) has also approved Botox for treatment of hyperhidrosis.

Applied by injection to the underarms, hands or feet, botulinum toxin works by blocking a chemical in the body that stimulates the sweat glands. Most patients notice results after four or five days, and the effects can last up to six months, sometimes longer.

Recent studies underscore just how effective injections can be. In one study published by the Journal of the American Academy of Dermatology (JAAD), 94% of subjects experienced significant improvement after four weeks. Response was still high after 16 weeks. Almost every subject in the study (98%) said they would recommend the treatment to others.

Still, there are some downsides to botulinum injections. Aside from potential side effects, some of which may be serious or at least inconvenient — for instance, a weakened grip following a hand injection — the therapy requires ongoing visits to a clinic for repeated treatment. For those who wish to avoid all that time and expense, a more long-lasting solution might be more appealing.

Surgery for Excessive Sweating: A Permanent Cure?

Some doctors question the use of Botox when a single intervention can be curative and maybe even less uncomfortable or distressing than multiple needle injections.

Sweat glands can be surgically removed from a patient’s armpit while he or she is under a local or full anesthetic, operations known as subcutaneous curettage or sympathectomy. While these procedures offer permanent results with success rates of over 90%, they have fallen out of favor among doctors in recent times. That’s because the operations can leave scars and/or cause compensatory sweating elsewhere on the body.

Fortunately, technological advances now offer long-term results through non-invasive means.

A Non-Invasive Option: miraDry

miraDry was approved by the FDA in 2011 and is now widely available for treating hyperhidrosis. Doctors use a handheld device to emit electromagnetic energy to the patient’s underarm area. This permanently destroys the sweat glands, resulting in a dramatic reduction in perspiration. It’s a relatively quick procedure with minimal discomfort — most patients resume normal activities directly afterwards.

Dr. George P. Chatson, a board-certified plastic surgeon who treats hyperhidrosis at offices in Massachusetts and New Hampshire, recommends miraDry for its long-term results.

In his words, “Patients usually experience an 80% or more reduction in underarm sweating. Many see a satisfactory benefit after one miraDry procedure, but some may require a second procedure for optimal results.”

Another Recent Advance: Laser Treatments with SculpSure

SculpSure is another recently patented, non-invasive technology for treating hyperhidrosis that is virtually pain-free. With this procedure, a laser is directed at the underarm area, shrinking the sweat glands. Results have been shown to last up to a year, making it a longer-term option than Botox, though still requiring return visits.

As with miraDry, the side effects are limited to some local soreness or irritation and downtime is minimal. Dr. Bruce Katz, director of JUVA Skin and Laser Center in New York City, recommends SculpSure to his patients because “in two short treatments it gives them long-lasting results.”

Sweaty Feet

RELATED: Why Do My Feet Sweat So Much?

Are These Treatments Covered by Health Insurance?

According to the International Hyperhidrosis Society, an HMO may cover treatment. In many cases, a patient will be required to visit a primary care physician first in order to receive a referral to a specialist. No two health plans are the same — a patient should carefully review their contract or speak with a customer service representative for clarity on what is covered and under what conditions.

Choosing the Best Option

There have been various advances in treating hyperhidrosis and doctors will recommend a course of treatment based on preference and in consultation with the patient.

The condition can be permanently treated through a localized surgical procedure, however specialists tend to recommend non-invasive treatments such as Botox, miraDry, or SculpSure. All of these are shown to be quick procedures with minimal side effects and excellent results. Botox and SculpSure require return visits to remain effective, while miraDry offers the most long-lasting results from a single visit.

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