A short treatment history
Surgeons in Europe first cut the thoracic sympathetic nerves to stop sweating in the 1920s, and tap-water iontophoresis was devised in the 1930s. Endoscopic thoracic sympathectomy spread in the 1990s, but compensatory sweating—new sweating elsewhere on the body—proved a major downside. The FDA approved Botox for underarm sweating in 2004, miraDry microwave therapy in 2011, and a prescription anticholinergic wipe (Qbrexza) in 2018, greatly expanding nonsurgical options. A 2016 survey estimated that about 4.8% of Americans have hyperhidrosis, though only half talk to a doctor.
Causes and diagnosis
Most cases are primary focal hyperhidrosis: it starts around adolescence, affects both palms, soles, or underarms symmetrically, eases during sleep, and often runs in families. Sweating all over or heavy night sweats instead suggest a secondary cause—an overactive thyroid, menopause hot flashes, diabetes, infection, or medications—which needs checking first. Trouble shaking hands, writing, or using a phone can lead people to avoid social contact, and social anxiety or depression often follow.
Stepwise treatment
Start with a clinical-strength aluminum chloride antiperspirant applied to dry skin at bedtime. Next come prescription anticholinergic wipes or, for hands and feet, tap-water iontophoresis. Botox injections in the underarms or palms last four to nine months, and miraDry permanently destroys underarm sweat glands. Oral anticholinergics such as glycopyrrolate reduce sweating everywhere but can cause dry mouth and constipation. Sympathectomy works well for sweaty palms, but compensatory sweating can be permanent—think hard and get a second opinion first.
This article is general health information and is not a substitute for diagnosis or treatment. If symptoms persist, see a doctor.
FAQ
- Does insurance cover treatment?
- Often, if you document that over-the-counter options failed; check your plan's prior-authorization rules.
- Is excessive sweating the same as body odor?
- No—odor comes from bacteria breaking down apocrine sweat, not sweat volume.
Sources reviewed: 2026-10-26
References
- Nawrocki, S., & Cha, J. (2019). The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review. JAAD, 81(3), 657–666.
- Strutton, D. R., et al. (2004). US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis. JAAD, 51(2), 241–248.
- Glaser, D. A., et al. (2019). Topical glycopyrronium tosylate for primary axillary hyperhidrosis. JAAD, 80(1), 128–138.