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Sweating, excessive (hyperhidrosis) - Treating hyperhidrosis

NHS Choices Medical Reference

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Lifestyle changes

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

The advice listed below may help to improve your symptoms.

  • Avoid known triggers that make your sweating worse, such as spicy foods and alcohol.
  • Use antiperspirant spray frequently, rather than deodorants.
  • Avoid wearing tight, restrictive clothing and man-made fibres, such as nylon.
  • Wearing black or white clothing can help to minimise the signs of sweating.
  • Armpit shields can help to absorb excessive sweat and protect your clothes.
  • Wear socks that absorb moisture, such as thick, soft socks that are made of natural fibres, or sports socks that are designed to absorb moisture. Avoid wearing socks that are made out of synthetic (man-made) materials 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 a regular antiperspirant has failed to control your sweating, your GP may prescribe a more powerful one for you. Aluminium chloride is often used to treat hyperhidrosis, and it works by plugging up the sweat glands.

You will need to apply aluminium chloride at night just before you go to sleep. To avoid irritation, make sure that the area of skin you apply it to is dry before you apply it. You will need to wash off the aluminium chloride in the morning.

It is not recommended that you apply aluminium chloride to your face as it can cause severe irritation to your eyes.

The most common side effect of aluminium chloride is some mild skin irritation or itching and tingling at the site where it is applied. However, these types of side effects should pass quickly.

Referral to a dermatologist

If lifestyle changes and prescription antiperspirants do not control your symptoms, your GP should refer you to a dermatologist (a specialist in treating skin conditions). This is because you may require access to additional treatments that your GP will be unable to provide, such as iontophoresis, botulinum toxin or surgery (see below).

Iontophoresis

Iontophoresis is an effective treatment if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.

If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water.

If your armpits need treating, then a wet contact pad is placed against each armpit and then a current is then passed through the pad.

The current is thought to help block 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 and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one-to-four week intervals, depending on how severe your symptoms are.

Iontophoresis has proved to be effective in 80% to 90% of cases. However, you will need to make regular visits to your local hospital's dermatology clinic to receive treatment. Alternatively, 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 protein that can be used safely in tiny (minute) doses. Around 12 to 20 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 that is produced.

The availability of botulinum toxin on the NHS can vary widely depending on the policy of your primary care trust (PCT), and many people can only access the treatment by going to a private clinic. Costs for private treatment depend on which part of the body needs to be treated. For example, injecting the forehead costs around £150 while treating both armpits costs about £400.

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

Surgery

Video-assisted thoracic sympathectomy (VATS) is the most widely used type of surgery to treat hyperhidrosis. VATS is usually recommended to treat cases of hyperhidrosis that have failed to respond to other types of treatment.

During the procedure, a surgeon will make two small incisions on the side of your chest and remove some of the nerve tissue that runs from your sympathetic nervous system to the affected sweat glands.

VATS 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 the nerves that are connected to the genitals.

So far, VATS has been moderately successful in treating hyperhidrosis. However, the operation does carry a significant risk of associated side effects as outlined below.

The most common side effect of VATS is excessive sweating in another part of the body, usually the lower back or upper thighs. This is known as compensatory sweating.

It is thought that almost all people who have the VATS procedure will experience some degree of mild compensatory sweating. However, an estimated 1 in 20 people will develop a more severe form of compensatory sweating. This is more likely to happen if you are obese.

Other side effects of VATS include:

  • sweating of the face and neck after eating food - this is known as gustatory sweating and it is thought to affect around 1 in 20 people
  • phantom sweating - an unusual side effect where a person feels like they are about to break out in a sweat but never actually do (this affects just under half of people who have VATS and usually improves with time)
  • increased sensitivity to cold
  • dry hands
  • changes in how things taste

It is unclear exactly how common the last three side effects listed above are, because reports vary widely. 

Complications that develop as a result of VATS are much less common. However, one possible complication is known as Homer's syndrome. This affects one side of the face and makes the eye droopy, which can sometimes make it difficult to open. The affected half of the face is also unable to sweat.

Homer's syndrome is caused by accidental damage to the nervous system, which may not be possible to repair. It is thought that people who have the VATS procedure have a 1 in 250 chance of developing Homer's syndrome following surgery.

Other complications of VATS can include:

  • Air that becomes trapped between the layers of the lung, which can cause chest pain and breathing difficulties. This is known as pneumothorax and it usually resolves without the need for treatment. If treatment is required, a tube can be inserted into the lung to draw the air out.
  • Post-operative infection - a rare complication occurring in around only 1 in a 1,000 cases.
Anaesthetic
Anaesthetic is a drug used to numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Local anaesthetic
A local anaesthetic is a drug injected by needle or applied as a cream which causes a loss of feeling in a specific area of the body.
Medical Review: January 10, 2013
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