Home / Conditions / Hyperhidrosis
Sweating far beyond what heat or effort would explain — enough to soak through clothes, drip from the hands, and shape what you will and will not do. It is a recognised medical condition, and it is treatable.
Hyperhidrosis is sweating that goes well beyond what the body needs for cooling. It happens without heat, without exertion, and often without any emotional trigger — sitting still in an air-conditioned room.
Everyone has around three million sweat glands, concentrated most densely in the palms, soles, underarms and groin. In hyperhidrosis the nerves controlling those glands signal them to work when there is no reason to, which is why the problem is a nerve problem rather than a skin one.
The practical cost is rarely the sweat itself. It is the handshake avoided, the paper that smudges, the shirt changed at lunchtime, the interview declined. On average people live with it for around nine years before asking anyone about it — usually because nobody told them it was treatable.
Three things together, rather than any one alone:
Episodes of excessive sweating at least once a week.
Going on for six months or more, without an obvious explanation.
Getting in the way of work, daily activity or relationships.
Primary hyperhidrosis typically affects both sides of the body equally, occurs during waking hours rather than in sleep, and often began in childhood or adolescence.
Secondary hyperhidrosis is excessive sweating caused by another condition or a medication, and it behaves differently. It is worth having assessed rather than treated as primary if:
Thyroid problems, blood sugar problems, infection, hormonal changes and certain medications can all cause it — and treating the cause treats the sweating. That is why assessment starts with excluding these rather than reaching for a treatment.
Hyperhidrosis is often described by site, because what works differs between them.
Palmar hyperhidrosis. The most socially disabling, and the site where surgery is most established and most effective. Often accompanied by sweaty feet.
Axillary hyperhidrosis. The densest concentration of sweat glands on the body, and the site with the widest range of non-surgical options.
Plantar hyperhidrosis. Frequently occurs alongside palmar sweating, and carries a higher risk of fungal skin problems.
Craniofacial hyperhidrosis. Less common, harder to conceal, and treated cautiously because the nerves involved sit close to others.
Diagnosis is clinical. What matters is the pattern — which areas, how often, whether it happens during sleep, when it started, and what it stops you doing.
A severity scale is often used — not to label you, but because treatment decisions depend on how much it interferes rather than on how much you sweat.
Treatment works in steps, and most people are helped well before the last one. Surgery is considered when the earlier steps have not worked, not instead of trying them.
Stronger than anything sold over the counter, and applied differently — usually at night, to dry skin. The first step for most people and effective for many.
Loose natural fabrics, moisture-absorbing socks changed twice daily, leather shoes alternated between days, and avoiding the triggers that worsen it — alcohol and spicy food among them. Modest on their own, useful alongside the rest.
Passing a weak electrical current through water to the hands or feet, which reduces sweating with repeated sessions. Particularly suited to palms and soles, and something you can continue at home.
Tablets that block the nerve signal to the sweat glands. They can work well, but the same mechanism produces dry mouth, blurred vision and other effects, so the dose is built up gradually and they are not suitable for everyone. Some conditions, including glaucoma, rule them out.
Injections that block the nerve signal locally, lasting several months before needing repeating. Well established for underarm sweating in particular.
For severe palmar sweating that has not responded to the above, the sympathetic nerve chain carrying the signal can be interrupted through two very small incisions. It is the most definitive treatment available for sweaty palms, and Dr Mathew Tung performs it. The sweaty palms page covers what it involves and its trade-offs.
Sweating is controlled by the sympathetic nervous system — a chain of nerves running alongside the spine. Hyperhidrosis is that system signalling when it should not, which makes it a nerve problem expressed through the skin.
That is also why the definitive surgical treatment is a nerve operation rather than a skin one. Endoscopic thoracic sympathectomy interrupts the chain that carries the signal, and it is performed by surgeons who work on nerves. It is listed among Dr Tung's procedures.
Yes. Hyperhidrosis is a recognised condition with established treatments. The most common reason people do not seek help is not knowing that — on average they live with it for around nine years first.
Almost certainly not. Most people are helped by antiperspirants, iontophoresis, medication or injections. Surgery is for severe cases, mainly palmar, where those have not worked.
Sometimes. Sweating that started suddenly, happens at night, affects one side, or comes with weight loss or feeling unwell should be assessed for an underlying cause rather than treated as primary hyperhidrosis.
Primary hyperhidrosis usually begins in childhood or adolescence and tends to persist, though it can ease somewhat with age. It responds well to treatment, which matters more than whether it resolves.
Anxiety makes it worse, as it does for anyone. But primary hyperhidrosis is not caused by anxiety — the relationship usually runs the other way, with the sweating causing the social anxiety rather than the reverse.
No. You can book directly. It helps to note which areas are affected, how often, whether it happens in your sleep, and what you have already tried.
Sweaty palms · Excessive underarm sweating · Neuropathic pain · Neurosurgery
Most people wait years before asking about this, usually because nobody told them it could be treated. It can.
