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134442920_1If you are like the 15 million Americans who experience excessive sweating, a condition known as hyperhidrosis, you know that this greatly affects your quality of life. Dr. Michele Green has been successfully helping patients suffering from hyperhidrosis in her private New York City office for over 25 years. Severe sweating can occur across your whole body but occurs most commonly in the armpits, on your hands, feet, and forehead. Hyperhidrosis can dictate how you live your life – keeping you inside during the summer months. It can limit your clothing options for fear of sweating and staining your shirts. It can prevent you from enjoying social obligations to the fullest as you may worry about the potential embarrassment of lifting your arms or shaking hands. There are a variety of causes of hyperhidrosis, and excessive sweating may be the result of a genetic predisposition, an overactive thyroid, anxiety, neurological conditions, or as a side effect of medications.  Hyperhidrosis can even put you at an increased risk for skin infections. Living with hyperhidrosis can negatively affect your self-confidence. Luckily, there are a variety of dermatological treatments available now to combat excessive sweating.

Treatment options are wide ranging and work to inhibit the sweat glands by various mechanisms. Many patients begin with prescription antiperspirants like Drysol. There are also oral or topical nerve-blocking medications, which block the eccrine nerve endings chemically to stop excessive sweating. Botox has become one of the most popular and effective methods of addressing hyperhidrosis. Botox works by inhibiting the sweat glands with injections of botulinum toxin directly into the affected area. Other options include systemic treatments, such as antidepressants and beta blockers – which serve to treat hyperhidrosis  by interacting directly with the central nervous system. MiraDry® is another mechanism which treats excessive sweating in the axillae through controlled electromagnetic energy, resulting in direct thermolysis of the sweat glands.

With so many treatment options available for hyperhidrosis, it is important to consult with an experienced dermatologist, such as Dr. Michele Green in NYC. Dr. Green will review your current medical and surgical history, medication profile, and create an individualized treatment plan to best treat your specific type of hyperhidrosis. Whether your excessive sweating is limited to your underarms or hands, or involves your entire body, Dr. Green will help design the best treatment protocol for you. Dr. Green has been a leader in dermatology in New York City for over two decades, and an expert in Botox injections, cosmetic lasers, skin care, dermal fillers, microneedling, and more.

What is axillary hyperhidrosis? (Excessive Sweating)

Excessive sweating, also called hyperhidrosis, can be characterized as an uncontrollable amount of sweating which can occur due to hormonal imbalances, menopause, hyperthyroidism, or over-active sweat glands. While it is normal for people to sweat to regulate the body’s temperature, excessive sweating due to hyperhidrosis can occur at any time – not just as a result of heavy exercise or heat – and can be disruptive to everyday living, causing social anxiety and embarrassment. While hyperhidrosis can affect any part of the body, axillary hyperhidrosis is excessive sweating that occurs specifically in the underarm region of the body.

What causes excessive sweating?  

Sweating is actually good for our health as it is our body’s natural process for excreting toxins and helps to regulate our body’s natural base temperature. Your body temperature will rise when you are somewhere warm, you are exercising, or you are feeling nervous or stressed. In these circumstances, your sweat glands will secrete water and minerals to keep your body temperature regulated. Once you are removed from the situation, (you walk into an air-conditioned building or you finish your presentation), the signal to secrete sweat is turned off. However, for those who suffer from excessive sweating, the signal to “turn off” the sweating never happens. Excessive normal can be a sign of an underlying medical condition. When excessive sweating occurs without an unknown reason it is important to meet with an experienced healthcare provider, like Dr. Michele Green in NYC, to analyze the possible causes.

What are the Causes of Hyperhidrosis?

The cause of hyperhidrosis varies depending on what type of hyperhidrosis you have: primary hyperhidrosis or secondary generalized hyperhidrosis. Primary hyperhidrosis is when you suffer from overactive sweat glands in specific areas of your body, such as your armpits, hands, feet, or face. The cause of primary hyperhidrosis is still debated although researchers are beginning to show that there could be a genetic component to this condition.

Secondary generalized hyperhidrosis, on the other hand, is caused by an underlying medical condition or as a side effect of a medication. Secondary generalized hyperhidrosis is characterized by excessive sweating that occurs over large swathes of the body rather than confined to a specific area. Conditions that are known to have hyperhidrosis as a side effect include infectious diseases such as malaria, tuberculosis, and HIV; neurological conditions such as anxiety, stress, and panic attacks; as well as diabetic low blood sugar, heat exhaustion, and leukemia. When you meet with Dr. Green to address your hyperhidrosis, it is very important to disclose potential underlying medical conditions to Dr. Green in order to create the best treatment plan for you.

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The Types of Hyperhidrosis: primary vs secondary

Primary focal hyperhidrosis

Primary hyperhidrosis is defined by excess sweating with no underlying medical cause. This condition usually starts to manifest in early childhood, and is typically familial with more than 30 percent of sufferers having a family history of excessive sweating.

Primary focal hyperhidrosis mainly arises from the eccrine sweat glands. The eccrine sweat glands accounts for 2 to 4 million of the sweat glands in the body and are mainly found in the feet, hands, and underarms.

There is no known etiology for this type of excessive sweating. However, most patients who suffer from primary hyperhidrosis typically have a specific area on the body in which the excessive sweating occurs.

Examples of primary hyperhidrosis include axillary hyperhidrosis or primary axillary hyperhidrosis.  Primary axillary hyperhidrosis is characterized by excessive underarm sweating. Other types of primary hyperhidrosis include palmar hyperhidrosis which is excessive sweating on the palms and palmoplantar hyperhidrosis which is excessive sweating on both the palms and the soles of the feet.

Secondary hyperhidrosis

Secondary Hyperhidrosis, which is sometimes also referred to as generalized hyperhidrosis, is characterized by sweating which can occur in a specific part of the body but more often occurs in a more generalized way throughout the body. In other words, there is no primary or focal area of the body in which sweating occurs. This type of excessive sweating usually occurs because of an underlying medical issue. For example, if you suffer from hyperthyroidism, one of your symptoms of the disease may be excessive sweating. Excessive sweating can also during menopause, other hormonal imbalances, or as a consequence of obesity. Excessive sweating can be a symptom of an underlying health issue and if you suffer from hyperhidrosis you should consult with Dr. Green to determine the potential underlying condition. There are several other health conditions which can cause excessive sweating or hyperhidrosis and listed below.

The following conditions are also known to cause hyperhidrosis or excessive sweating:

  • Vitamin D deficiency
  • High Fever
  • Anxiety and panic attacks
  • Diabetic hypoglycemia
  • Endocarditis
  • Heat exhaustion
  • Leukemia
  • Malaria and other infections
  • Stress
  • Tuberculosis
  • Cancer
  • Side effects of various medications

What is Gustatory Hyperhidrosis?

Gustatory hyperhidrosis is described as sweating while eating, which typically occurs on the forehead, neck, scalp, and upper lip. Gustatory hyperhidrosis can be the result of parotid gland damage, among other medical causes.

The Best Treatment Options for Hyperhidrosis

Botox treatment for excessive sweating or hyperhidrosis

Botox, a neurotoxin composed of botulinum toxin, has been approved by the FDA for the medical treatment of excessive sweating or hyperhidrosis. Botulinum toxin injections  are used to disable the sweat glands. Botox acts by blocking the release of acetylcholine and shuts down the action of the sweat glands at the site of injection. The effects of Botox injections can last from 4 to 6 months, depending on the area being treated. Botox injections have been shown to reduce sweating by 82-87% according to

Botox injections are the preferred treatment by Dr. Michele Green, and widely recommended by experienced dermatologists and healthcare professionals, for the  treatment of axillary hyperhidrosis, or armpit sweating. The typical dosage of Botox injections to treat hyperhidrosis of the axilla is 50 units per underarm. The exact units of Botox injections may vary, depending on the need of the individual patient. Relief from sweating in the treated area will happen in just a few days after your Botox injections and there is no recovery time following the procedure. You can return to your regular daily activities immediately following the Botox injections. Botox injections have been proven to be a quick and extremely effective means of treating axillary hyperhidrosis. Dr. Green is also very experienced at utilizing Botox injections for the treatment of palmoplantar hyperhidrosis for patients suffering from excessive sweating of the hands and feet.

Myobloc (Botulinum Toxin type B) for the treatment of Hyperhidrosis

Myobloc is another form of botulinum toxin which is used to treat cervical dystonia and excessive drooling. Myobloc has not yet been clinically approved to treat axillary hyperhidrosis. 

Palmar Hyperhidrosis or sweaty hands

Excessive sweating of the hands is also referred to as palmar hyperhidrosis. Palmar hyperhidrosis can be difficult to cope with, especially in professional settings, where shaking hands is often necessary. There are social ramifications for this issue and can be very embarrassing for patients suffering from this condition. If antiperspirants do not work to decrease sweating, Botox is an extremely safe and effective method for addressing palmar hyperhidrosis. Patients suffering from excessive sweating of the palms can receive injections of onabotulinumtoxinA (also known as Botox®), which blocks the secretion of sweat. Botox treatment can keep palms dry for up to 6 months and can be repeated for lasting dryness. Dr. Michele Green was one of the first dermatologists to incorporate Botox injections for cosmetic and medical use in her private NYC dermatology office.

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Botox injections for Plantar hyperhidrosis or Sweaty Feet

Plantar hyperhidrosis, or sweaty feet, affects many individuals and can be the cause of fungal infections of the feet. The initial symptoms of palmoplantar hyperhidrosis is a slight foot odor, a white hued residue on your feet, or socks or stockings which are damp. This condition can be very embarrassing for individuals who suffer from it. Botox injections are a very effective  treatment for plantar hyperhidrosis and several injections across the foot surface can safely and effectively be used to alleviate this problem.

Other treatment options for moderate and severe cases of hyperhidrosis includes:

Nerve-blocking medications

Nerve-blocking medications are oral medications which chemically block the nerve endings in the eccrine system preventing excessive sweating. While these medications work well and are effective in the treatment of hyperhidrosis they are not without side effects. These oral medications can cause side effects such as dry mouth and blurred vision among other medical issues.

Aluminum chloride

When over-the-counter deodorants do not do the trick to eliminate severe sweating and body odor, patients can turn to prescription antiperspirants. Drysol Is a topical antiperspirant which is available as a prescription containing 20 percent aluminum chloride. The aluminum chloride is applied at bedtime on clean dry skin. This prescription antiperspirant works by intercepting the sweat glands in the eccrine system. It is not recommended that Aluminum chloride be used as a long term solution as it can cause skin and eye irritation in some individuals. If you do experience skin irritation from using aluminum chloride you should discontinue use and consult Dr. Green. In most instances a prescription for topical hydrocortisone usually clears up the skin irritation in a few days.


Anticholinergic drugs are often used in the treatment and management of hyperhidrosis.  They are not all FDA approved for this condition and many of these medications are used in an “off label” capacity. The most commonly prescribed Anticholinergics include  glycopyrrolate, oxybutynin, benztropine, and propantheline, among others. Anticholinergic medications work systemically in the sweat glands to limit overall sweating. Oral anticholinergic medications are usually prescribed for patients who experience excessive sweating on parts of the body such as the face and scalp, since topical medications aren’t suitable to treat those areas.

Glycopyrronium tosylate

Glycopyrronium tosylate is a topical anticholinergic treatment, which is  FDA approved, under the brand name Qbrexa. Qbrexa can be used in the management of hyperhidrosis in children as young as 9 years old. The cloths come in a pre-moistened individually wrapped, single use package, making them readily available for use. Qbrexa is convenient, due to its packaging, which makes it easy for teens and adults to carry and use while exercising to minimize excessive sweating. The pre-moistened clothes can be used to treat the underarms and groin area.

Iontophoresis for hyperhidrosis

Iontophoresis treatment entails sitting with your hands and feet in a shallow tray of tap water. As you sit with your hands and feet submerged in the tray of water, a machine delivers low electrical currents which travel through the water. Experts believe that the electric currents block the sweat glands and prevents you from sweating. This treatment needs to be repeated several times to be effective.

Microwave therapy for hyperhidrosis 

Microwave therapy is not a widely popular treatment due to its availability and cost. This treatment entails using a device that utilizes the same energy as a microwave to eliminate the sweat glands. This treatment is not without side effects as it can alter your skin’s sensation. The treatment is delivered in two 30-minute interval treatments, three months apart.

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Surgical Sweat Gland Removal

Surgical sweat gland removal is a treatment of last resort when all other therapies have failed. Sweat gland removal is a minimally invasive surgical treatment for hyperhidrosis. The treatment involves using a suction curettage technique to remove the sweat glands. The use of liposuction has also been used in the treatment of axillary hyperhidrosis.

Endoscopic Thoracic Sympathectomy

Endoscopic thoracic sympathectomy is a surgical procedure. The procedure involves the surgeon clamping  off or burning the sympathetic nerve endings which cause sweating. While this procedure is effective it can cause compensatory sweating in other areas of the body.

Antidepressants for hyperhidrosis

Benzodiazepines are a group of antidepressants which have also been found useful in the treatment of hyperhidrosis. Benzodiazepines work by controlling anxiety which often results in the manifestation of excessive sweating. These systemic medications work by controlling the central nervous system. By doing so, they mitigate the physical aspects of sweating which is often seen during episodes of anxiety.

Beta Blockers for hyperhidrosis

Beta blockers have also been successful in treating excessive sweating. The mechanism of action of beta blockers is similar to that of antidepressants in that its effects work on the central nervous system.  The most common beta blocker used for Hyperhidrosis is propranolol. Propranolol is also commonly prescribed for anxiety disorders. For individuals who suffer from anxiety, sweating is a common physical manifestation of anxiety which is the reason that these drugs works well for excessive sweating.


MiraDry® is an FDA treatment approved to treat hyperhidrosis. Miradry utilizes a handheld device which delivers heat to the affected areas of the underarms, through electromagnetic energy, and destroys the sweat glands. Once the sweat glands are destroyed, they do not regenerate, which eliminates excessive sweating. For many patients, MiraDry reduces excessive sweating in the axillae after only 2 treatment sessions.

Lifestyle and home remedies to control hyperhidrosis

There are lifestyle changes that one can do to control excessive sweating such as frequent showers, the use of topical creams and antiperspirants. Over the years there has been great awareness in the treatment and management of hyperhidrosis resulting in greater research and the development of new treatments and technologies. There are many newer studies which can be accessed in the Journal of Dermatol over the past ten years, which describe the genetics and new treatments for hyperhidrosis. The International Hyperhidrosis Society is the single global non-profit society aimed at improving the lives of patients who are suffering from hyperhidrosis.

There are many new products on the market, such as Carpe, which is a topical product developed to treat excessive sweating. The Carpe line of products include hand creams, antiperspirants, and foot creams, all developed and researched to treat hyperhidrosis. In addition, to Carpe there are other products such as Body Glide among other topical antiperspirant. Body Glide is an excellent product and works well on other parts of the body that may experience excessive sweating such as between the thighs and groin area.

Does hyperhidrosis go away on its own?

Hyperhidrosis does not typically go away on its own. If your hyperhidrosis is being caused by an underlying medical condition or medication that you are taking, it is necessary to address those issues in order to treat the excessive sweating. It is important that you discuss with an experienced health care provider, like Dr. Michele Green, to determine the cause of the condition. After a careful medical review, she can recommend the best course of action for your treatment. Depending if your hyperhidrosis is being caused by an underlying medical condition, you can target the symptoms using one of the many treatment methods available. Dr. Green will recommend, based on your individual situation, what would be the best method of treatment for you.

Is there a cure for hyperhidrosis?

Patients often ask how to stop hyperhidrosis and the answer varies depending on the type of hyperhidrosis you have. If you are suffering from primary hyperhidrosis, there is no cure. However, the symptoms of the condition can be treated using the treatments described in the section above. This can include prescription antiperspirants, oral medications, Botox injections, or MiraDry to inhibit the sweat glands. If you suffer from secondary hyperhidrosis, which can be the result of a medical condition or medication, when you address the underlying medical condition, the excessive sweating can be better controlled. When you meet with Dr. Green to discuss your hyperhidrosis, she will determine the best treatment method that addresses your specific case.

Is hyperhidrosis genetic?

Research has started to emerge that would suggest that primary hyperhidrosis is passed down genetically. There are two types of hyperhidrosis: One is generalized secondary hyperhidrosis, which is caused by an underlying medical condition such as hyperthyroidism, menopause, or stress and anxiety, and is characterized by sweating that can occur across a large portion of the body. The second type is primary hyperhidrosis, which is characterized by sweating that is concentrated in one part of the body – typically the armpits, hands, feet, or face. Primary hyperhidrosis usually begins to show itself during childhood and is a result of overactive sweat glands. Researchers believe that the condition is genetic and linked to a dominant gene.

Do I have hyperhidrosis?

If you find that you are sweating excessively on any part of your body much of the time even when not working out or experiencing heat, you don’t need a “Do I Have Hyperhidrosis Quiz” to tell you that you are living with hyperhidrosis. If you are experiencing severe sweating on your hands, feet, underarms, face, or across other parts of your body, there is safe and effective treatment available to greatly reduce your sweating. When you make an appointment with Dr. Michele Green in New York, she will create a treatment plan to address your specific needs.

How common is hyperhidrosis?

Hyperhidrosis is a common condition that affects nearly 3 percent of people in the United States, which is the equivalent of about 15 million Americans. While individuals who suffer from excessive sweating may feel alone in their embarrassment, there has been an increase in media coverage discussing hyperhidrosis. Prominent figures such as Chrissy Teigen have taken to social media to discuss their experience with hyperhidrosis, increasing the visibility of the condition. Chrissy Teigen revealed how she used Botox to eliminate her severe underarm sweating, which has helped to de-stigmatize treatment.

Does insurance cover Botox for hyperhidrosis?

Botox is an FDA-approved treatment for hyperhidrosis and there are some private health insurance companies which will cover Botox treatment for hyperhidrosis. If your insurance company does cover Botox injections for excessive sweating, it will typically be for axillary hyperhidrosis (excessive underarm sweating), only after you have tried other treatments like prescribed antiperspirants, topical treatments, or oral medications. It is important to consult with your specific health insurance provider to determine if your individual plan covers Botox injections for hyperhidrosis.

How do I get started with treatment for my hyperhidrosis today?

If you are like millions of other patents who have hyperhidrosis and it is affecting your quality of life, Dr. Michele Green is here to help. Dr. Michele Green is a board certified NYC cosmetic dermatologist, and practices the latest techniques at the forefront of dermatology. Dr. Green has been consistently voted as one of the best dermatologists in NYC by Castle Connolly, The New York Times, Super Doctors, and New York Magazine. If you suffer from excessive sweating and would like to learn more about treatments for hyperhidrosis, including Botox injections for hyperhidrosis, please call us today at 212-535-3088 or contact us online to help you with the best treatment results.

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