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134442920_1Hyperhidrosis, or excessive sweating, is a medical condition which affects up to 2% of the world’s population according to the International Hyperhidrosis Society.

Dr. Michele S. Green is dedicated to the treatment of hyperhidrosis of the palms, axillae (underarms), and feet. Sweat glands are found in the skin throughout the body, and is a salt produced by the body’s eccrine glands.  Higher numbers of eccrine  glands are present in the hands, feet, and armpits. Stressful situations can stimulate the body to produce increased amounts of sweat. Many patients suffer from increased sweating and it can be disruptive to both one’s quality of life and daily activities. The good news is that there are simple and effective treatments options now available.

Excessive Sweating

Excessive sweating can be characterized as an uncontrollable amount of sweating which occurs due to hormonal imbalances, menopuase, hyperthyroidism, or over-reactive sweat glands.  There are patients who suffer from hyperhidrosis without any for unexplainable etiology. Excessive sweating can be disruptive to everyday living and can cause social anxiety and embarrassment.

What causes excessive sweating?  

Sweating is actually good for our health as it is our body’s  natural process for excreting toxins. Sweating  also helps to regulate our body’s natural base temperature. However, excessive sweating is not normal and is often an indication of an underlying health issue. When excessive sweating occurs without an unknown reason it is important to check with your doctor to identify its etiology.

Conservative treatment options include deodorants containing aluminum chloride and antiperspirant like Drysol applied directly to the affected area. Some patients may require oral medications such as, anticholinergic drugs. Anticholinergic drugs block the signal to the nervous system, preventing you from sweating. Anticholinergic drugs include Oxybutynin, Qbrexa and Glycopyrrolate among others.  These drugs have side effects including dry mouth, skin irritation, and blurry vision. Iontophoresis machines have also been utilized for the treatment of hyperhidrosis but these are time consuming and need to be repeated daily or weekly with only minimal benefits.

Types of Hyperhidrosis

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 excess sweating of the palms and palmoplantar hyperhidrosis which is excess sweating of both the palms and the soles of the feet.

Secondary hyperhidrosis

Secondary Hyperhidrosis is characterized by generalized sweating which can occur in a specific part of the body or in a more generalized way throughout the body. There is no primary or focal area of the body in which sweating occurs. This type of  excessive sweating usually  occurs as a result 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 a an underlying health issue and if you suffer from hyperhidrosis you should consult your physician. 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 is typically the result of parotid gland damage.

What are the treatment options for hyperhidrosis?

Botox treatment for excessive sweating or hyperhidrosis

BOTOX®, is a neurotoxin and is 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 in any site which is injected. The effects of the BOTOX® injections can last up to 6 months depending on the area treated.

Botox injections are the preferred treatment in healthcare and widely used in dermatology for the  treatment of axillary hyperhidrosis, or sweating of the armpits.  The usual dosage of Botox injections to treat hyperhidrosis in the axilla is 50 units per axilla. There may be a variable amount of BOTOX® injections required depending on the individual patient. Relief from sweating in the treated area will happen in just a few days after your BOTOX® injections. BOTOX® injections have been proven to be a quick and effective means of treatment.  Dr. Michele Green also utilizes Botox injections for the treatment of palmoplantar hyperhidrosis.

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

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

Palmar Hyperhidrosis or Sweating of the hands

Excessive sweating of the hands is also referred to as palmar Hyperhidrosis. Palmar hyperhidros can be difficult and to cope with, especially in professional settings, where shaking hands is necessary. There are social ramifications for this issue and can be very embarrassing to patients suffering from this condition.  Botox injections is one of the most effective treatments for palmar hyperhidrosis and has proven success for this condition.

Botox injections for Palmoplantar hyperhidrosis or Sweaty Feet

Palmoplantar hyperhidrosis or sweaty feet affects many individuals and is the etiology of many fungal infections on the feet. The initial symptoms of  palmoplantar hyperhidrosis is a slight foot order, whitish residue on your feet, or socks or stockings which are damp. This condition can be very embrassing for individuals who suffer from it.

Botox injections are very effective in the treatment of Palmoplantar hyperhidrosis and several injections across the plantar surface can safely and effectively be used to alleviate this problem.

Other treatment options for Moderate and severe cases of hyperhydrosis includes:

Nerve Blocking medications

Nerve-blocking medications are oral and topical 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

Aluminum chloride Is a topical antiperspirant which is available as a prescription containing 20 percent aluminum chloride. The aluminum chloride is usually applied at bedtime on clean dry skin.  The 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 irritation in some individuals.  If you do experience skin irritation from using aluminum chloride you should discontinue use and consult your dermatologist. In most instances a prescription for topical hydrocortisone usually clears up the skin irritation in a few days.


Anticholinergic medications 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 them 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 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 current which travels somehow block the sweat glands and prevents you from sweating. This treatment needs to be repeated several times in order to be effective.

Microwave therapy for hyerhidrosis 

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 treatment three months apart.

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 entails  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 control 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 why these types of drugs works well for excessive sweating.


MiraDry is also an FDA treatment approved to treat hyperhidrosis. A machine delivers heat to the affected areas. This heat destroys the the sweat glands. Once the sweat glands are destroyed they do not regenerate, which eliminates your excessive sweating.

Lifestyle and home remedies to control hyperhidrosis

There are lifestyle changes that one can do to control excessive sweating such as frequent showers in addition to the use of topical creams and antiperspirants. Over the years there has been much awareness in the treatment and management of hyperhidrosis resulting in greater research and development of new treatments and technologies.

There are many 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 amongst other topical antiperspirant. Body Glide is a remarkable product and works well on other parts of the body that may experience excessive sweating such as between the thighs and groin area.

If you suffer from excessive sweating and would like to learn more about treatment for hyperhidrosis, including Botox for hyperhidrosis, please don’t hesitate to contact us online today or call 212-535-3088. Dr. Michele S. Green, a board certified NYC dermatologist, and practices the latest techniques at the forefront of dermatology to give you the best treatment results.

Find out more about the use of Botox for Hyperhidrosis

*Disclaimer: Results may vary with each patient.

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