Many people with hyperhidrosis have lived with it for years before learning that there is a lot that can be done. Here are the options I discuss with patients, roughly in the order we usually try them, with my honest view of each.
The options at a glance
- Best for
- Underarms, hands, feet
- How long it lasts
- While you keep using them
- Main downside
- Skin irritation; may not be strong enough
- Best for
- Hands and feet
- How long it lasts
- While you keep using it
- Main downside
- Several sessions a week; time-consuming
- Best for
- Sweating in many areas
- How long it lasts
- While you take them
- Main downside
- Dry mouth and dry eyes; rarely practical long term
- Best for
- Underarms, palms, forehead
- How long it lasts
- Up to about 6 months
- Main downside
- Cost; must be repeated
- Best for
- Underarms
- How long it lasts
- Permanent
- Main downside
- Temporary swelling and soreness
- Best for
- Hands and underarms
- How long it lasts
- Permanent
- Main downside
- Compensatory sweating
1. Clinical-strength antiperspirants
Antiperspirants work by temporarily plugging the sweat glands so less sweat reaches the skin. Ordinary drugstore products often aren’t strong enough for hyperhidrosis, but clinical-strength ones can make a real difference.1 Products I like include Drysol, Perspirex and a newer one called Carpe. They work best applied at night to completely dry skin, and some people find them irritating, so start a few nights a week and build up.
2. Iontophoresis
Iontophoresis uses a gentle electrical current, passed through a shallow tray of water, to temporarily stun the sweat glands. It works well for many people with sweaty hands and feet.1 The catch is commitment: treatments have to be repeated several times a week, especially at the start, which can be time-consuming and difficult to fit into everyday life.
3. Pills (anticholinergic medications)
Medications such as glycopyrrolate and oxybutynin block the nerve signal that switches on sweating. Their big advantage is that they reduce sweating across the whole body, which helps people who sweat in many places at once.2 The downside is side effects: dry mouth and dry eyes are common, and for some people they aren’t tolerable.
4. Botox injections
Botox (botulinum toxin) blocks the nerve signals to the sweat glands in a specific area, and it can be used almost anywhere on the body.3 It works best in areas without much muscle beneath the skin, such as the underarms, the palms and the forehead. It wears off and has to be repeated, usually within about six months. It can also be expensive: OHIP doesn’t cover it, and private insurance plans usually cover it only for the underarms.
5. miraDry
miraDry uses microwave energy to permanently destroy the sweat and odour glands, and in Canada it is approved for the underarms. It is an excellent option. In my experience, patients see about a 70% reduction in sweating after one treatment and about an 85–90% reduction after a second, and published trials show similar long-lasting results.4 It also reduces underarm odour and hair growth, and it doesn’t cause compensatory sweating. Read my full miraDry pros and cons.
6. ETS surgery
Endoscopic thoracic sympathectomy (ETS) is a keyhole operation that interrupts the nerve that drives sweating. It is very effective for sweaty hands (palmar hyperhidrosis) and underarms (axillary hyperhidrosis), with excellent success rates for those two areas. It does not work as well for the feet.5 For sweaty hands in particular, ETS is my preferred treatment. The other options either need constant upkeep or wear off, so I consider ETS early for people whose hand sweating affects their daily life, rather than only after everything else has failed. The main risk is compensatory sweating elsewhere on the body, so careful patient selection is essential. ETS is covered by OHIP when it is an appropriate option. See Is ETS surgery covered by OHIP? and my detailed approach in Dr. Irshad’s Take.
Which option for which area?
- Underarms: clinical-strength antiperspirant first, then Botox or miraDry. ETS is also an option for selected patients.
- Hands: for significant hand sweating, ETS is my preferred treatment, and I consider it early rather than as a last resort. A clinical-strength antiperspirant is reasonable to try first; iontophoresis and Botox are alternatives for people who aren’t candidates for surgery or prefer to avoid it.
- Feet: antiperspirant and iontophoresis are the mainstays, with Botox as a next step. ETS is less reliable for the feet.
- Face or scalp: Botox can treat the forehead. Pills reduce sweating everywhere, but their side effects mean they are rarely a practical long-term option.
Not sure how severe your sweating is? Take the free HDSS self-assessment. Non-surgical treatments such as Botox and miraDry are available at the Toronto Sweat Clinic.
Common questions
What is the best treatment for hyperhidrosis?
Is Botox for sweating covered by insurance in Ontario?
Does iontophoresis work for sweaty hands and feet?
Can hyperhidrosis be cured permanently?
What pills are used for excessive sweating?
References
- Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review. Part II: therapeutic options. J Am Acad Dermatol. 2019;81(3):669–680.
- Wolosker N, de Campos JR, Kauffman P, Puech-Leão P. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg. 2012;55(6):1696–1700.
- Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. 2001;323(7313):596–599.
- Glaser DA, Coleman WP 3rd, Fan LK, et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg. 2012;38(2):185–191.
- Cerfolio RJ, De Campos JR, Bryant AS, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642–1648.