Embarrassing Illnesses

Primary hyperhidrosis

Lifestyle changes

Changing your lifestyle and daily activities cannot cure primary hyperhidrosis, but it can improve symptoms and make you feel more self-confident.

The following may help your symptoms.

• Avoid known triggers that make your sweating worse, like spicy foods or alcohol.
• Frequently use antiperspirant spray (rather than deodorants).
• Avoid tight, restrictive clothing and man-made fibres, such as nylon.
• Wearing white or black clothing can help minimise the signs of sweating.
• Armpit shields are available that absorb excessive sweat and protect your clothes.
• Wear socks that absorb moisture, for example thick, soft socks made of natural fibres or sports socks designed to absorb moisture. Avoid synthetics and change your socks at least twice a day.
• Buy shoes that are made of leather, canvas or mesh rather than synthetic material.

Prescription antiperspirant

If over-the-counter (OTC) antiperspirants have failed to control your sweating, your GP can prescribe a more powerful antiperspirant.

Aluminium chloride is an antiperspirant that is commonly used to treat hyperhidrosis. It works by plugging up the sweat glands.

You will need to apply aluminium chloride at night just before you go to sleep. Make sure that the area of skin you apply it to is dry because your skin may become irritated if it is wet when you apply it. You will need to wash off the aluminium chloride in the morning. 

If you apply aluminium chloride to your face, be careful not to get any in your eyes. Men should avoid shaving 24 hours before and after applying aluminium chloride to their face.

Referral to a dermatologist

If the above advice and treatment fails to control your symptoms, your GP will probably refer you to a dermatologist (a specialist in treating skin conditions).

A dermatologist can provide a number of additional treatments.

Iontophoresis:

Iontophoresis is an effective treatment if sweating affects your hands or feet. It can be used for armpits, though this is usually less effective.

Iontophoresis involves submerging your hands or feet in a bowel of water. A wet contact pad is applied to the armpits. A weak electric current is passed through the water. It is thought that this process blocks the sweat glands. The treatment is not painful but the electric current can cause some mild, short-lived discomfort and skin irritation.

Each session of iontophoresis lasts between 20 and 30 minutes. You will usually need two to four sessions a week. Your symptoms should improve after four to 10 sessions, after which further treatment is required at one to four-week intervals, depending on the severity of your symptoms.

Iontophoresis has proved to be effective in 80 to 90% of cases. However, you will have to make regular visits to a hospital or dermatology clinic to receive treatment.

Iontophoresis kits that you can use at home are also available with prices ranging from £325 to £500.

Botulinum toxin:

Botulinum toxin is a relatively new treatment for people with hyperhidrosis. Botulinum toxin is a powerful poison which can be used safely in minute doses.

Around 12 injections of botulinum toxin are given in the affected areas of the body, such as the armpits, hands, feet or face.

The procedure takes about 30 to 45 minutes. The toxin works by blocking the signals from the brain to the sweat glands, reducing the amount of sweat produced.

The effects of botulinum toxin usually last from two to eight months, after which further treatment is needed.

Endoscopic thoracic sympathectomy (ETS):

Endoscopic thoracic sympathectomy (ETS) is a type of surgery that can be used to treat severe cases of hyperhidrosis which have failed to respond to other types of treatment.

A surgeon makes two small incisions on the side of your chest. A special flexible camera (endoscope) is inserted into your chest cavity. The endoscope allows the surgeon to get a clearer view of your chest cavity without having to make major incisions.

The surgeon will remove some of the nerve tissue that runs from your sympathetic nervous system to the affected sweat glands.

ETS can be used to treat excessive sweating of the armpits, face and hands. However, treating excessive sweating of the feet it is not recommended because the operation carries a risk of causing permanent sexual dysfunction, such as impotence. This is because damage to the part of the sympathetic nervous system that runs down the back and into the legs could also damage nerves connected to the genitals.

ETS has proved moderately successful in treating hyperhidrosis, although the operation does carry a high risk of complications.

The most common complication is excessive sweating in another part of the body (compensatory hyperhidrosis), usually the lower back or upper thighs. However, many people find this type of hyperhidrosis less troublesome than the type they were originally treated for.

Other complications of ETS include:

• sweating on the face and neck after eating food (gustatory sweating),
• inflammation of the nose (rhinitis), and
• air becoming trapped between the layers of the lung (pneumothorax) which can cause chest pain and breathing difficulties (although this usually resolves itself without the need for treatment).

Rarer complications of ETS include:

• Horner’s syndrome, a condition that causes drooping of the eyelids, and
• damage to the phrentic nerve (a nerve that is used to help in breathing).

Phrentic nerve damage can lead to shortness of breath, though it may be possible to repair the nerve during surgery.

Secondary hyperhidrosis

The recommended treatment for secondary hyperhidrosis will depend on the underlying cause. For example, if you have secondary hyperhidrosis that is caused by an overactive thyroid gland, medication can be used to reduce the activity of the gland.

See Useful links for more information about the common causes of secondary hyperhidrosis.