Hyperhidrosis is excessive and uncontrollable sweating most commonly experienced in the armpit (Axillary), hands (Palmar) or feet (Plantar).
It is understood to be caused by overactivity of the nervous system (sympathetic nervous system), with the sympathetic chains (the nerves that control sweating) being overactive, thereby prompting the sweat glands to produce more sweat than is necessary. This situation is frequently referred to as primary hyperhidrosis.
While the condition cannot be cured, it can be treated.
Treatment Options
Non-Surgical
- Medications – Prescription medications used to treat conditions such as high blood pressure, anxiety and depression are sometimes prescribed for hyperhidrosis. The side effects of those medications are the main reason for their use in this context. The success rate is relatively low and the effect stops as soon as they are discontinued.
- Topical antiperspirants – Several products are available to treat excessive sweating, particularly affecting the armpits. These products generally contain a high content of aluminium, which slows down sweat gland function. Their effectiveness remains variable. Not infrequently, skin irritation is the main reason why patients discontinue these products.
- Iontophoresis – This procedure is predominantly used to treat hyperhidrosis of the hands or feet, and involves their immersion in a tray containing an electrolyte solution activated by a battery-operated device to deliver a low electrical current. Treatment sessions usually last 20 minutes, and treatment often involves three sessions each week for up to eight weeks. Results are variable and temporary only. This is a safe first-line option to try prior to considering more advanced strategies.
- Botulinum Toxin (Botox) Injections – Botulinum toxin is injected to paralyse the area of application, impairing the nerves that control the muscles. Injections into areas affected by hyperhidrosis impair the nerves that control the sweat gland, with results lasting from four to six months. Injections can be repeated. This option is predominantly used for axillary (armpit) hyperhidrosis, but plays some role in palmar (hand) hyperhidrosis. The results of using Botox for excessively sweating feet (plantar hyperhidrosis) are poor.
Surgical
- Axillary Skin Resection – This older surgical method is rarely used today as it carries a significant risk of poor wound healing and armpit skin scarring. The surgeon excises hair-bearing skin from the armpit which contains sweat glands.
- Axillary Fossa Liposuction – A less invasive option where only a small incision is required to introduce a surgical instrument which removes subcutaneous fat from the armpit. The results of this approach are mixed and it can only treat armpit sweating.
- Thoracoscopic Sympathectomy – This surgical option addresses the constant stimulation of sweat glands by sympathetic nerves. It remains the only permanent treatment option. Frequently referred to as Video-Assisted Thoracoscopic Sympathectomy (VATS), this procedure has a very high success rate in treating palmar hyperhidrosis (90–97%). It has also been used for axillary (armpit) sweating, with a success rate of 70–80%. The main concern relates to a side effect of excessive sweating elsewhere (compensatory hyperhidrosis). Approximately 40–50% of patients will develop some compensatory sweating, though it is usually mild, with only 5–10% describing a significant problem. Typical locations affected include the chest, back, thighs and feet.
- Chemical Lumbar Sympathectomy – Here the sympathetic nerves are destroyed by X-ray guided injection into the back region. This procedure addresses excessively sweating feet (plantar hyperhidrosis) only. Its success rate is variable and, due to possible side effects, it is only used in very selected patients.
Related Resources
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Treatments Available for Hyperhidrosis
Below are some of the treatments we have available for Hyperhidrosis. Click on the below to learn more or get in touch with us to request a consultation.
miraDry
Perth Vascular Clinic offers miraDry, a non-invasive electromagnetic treatment for excessive underarm sweating (hyperhidrosis), providing long-lasting reduction in sweating in a single outpatient session.
Thoracoscopic Sympathectomy (VATS)
Thoracoscopic sympathectomy is a minimally invasive keyhole operation that permanently stops excessive sweating of the palms and, in some cases, the face. It targets the nerve signals responsible for overactive sweat glands and provides long-lasting relief for severe hyperhidrosis.
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Frequently Asked Questions
Hyperhidrosis is a medical condition characterised by excessive sweating beyond what is needed for normal temperature regulation. It can affect specific areas such as the underarms, hands, feet, and face, or the body more broadly. It can significantly impact quality of life, social interactions, and daily activities.