Hyperhidrosis (Excessive Sweating): Causes, Diagnosis and Treatment Options

Sweating is a normal function that keeps body temperature in balance. Sweating without heat or exertion, at a level that disrupts social and working life, is called hyperhidrosis. It concentrates on the armpits, palms, soles and face, affects roughly 3% of the population, and most people live with it for years without seeing a dermatologist because they do not know it is a treatable medical condition.

Primary or secondary?

• Primary (focal) hyperhidrosis: no underlying disease. It usually starts in adolescence, is bilateral and symmetrical, stops during sleep, and often runs in families. The great majority of patients belong to this group.

• Secondary hyperhidrosis: caused by thyroid disease, diabetes, infections, menopause, certain drugs (antidepressants, painkillers) or, rarely, more serious illness. Generalised, one-sided, adult-onset sweating or night sweats must always be investigated for this group.

How is it diagnosed?

Diagnosis rests largely on the history: age of onset, sites, frequency, whether it occurs at night, and medications. If a secondary cause is suspected, thyroid function, blood sugar and other relevant tests are requested. Severity and its impact on daily life are graded with a standard scale (HDSS), and the treatment step is chosen accordingly.

Treatment options, step by step

• Aluminium chloride antiperspirants: the first step, applied to dry skin at night. Often sufficient for mild to moderate underarm sweating; frequency is adjusted if irritation occurs.

• Iontophoresis: low electrical current through a water bath for sweaty hands and feet. Needs regular sessions and can be continued with a home device.

• Botulinum toxin injections: temporarily block the nerve signals to the sweat glands in the armpits, palms and soles. The effect lasts 4–8 months and can be repeated. See our hyperhidrosis botox page.

• Oral anticholinergic drugs: for generalised or multi-site sweating; dose is titrated carefully because of side effects such as dry mouth.

• Topical anticholinergic preparations: newer options for underarm sweating.

• Microwave sweat-gland ablation and surgery (sympathectomy): considered in selected cases not controlled by other methods.

Frequently asked questions

Is sweat botox permanent? No; the effect lasts on average 4–8 months, after which sweating gradually returns and the treatment can be repeated.

Does excessive sweating go away on its own? Primary hyperhidrosis may ease with age, but in most patients it persists unless treated.

Are body odour and excessive sweating the same thing? No. Odour (bromhidrosis) is produced when bacteria break down sweat; it can occur in people with normal sweat volume and is treated differently.

Consultation in Kırklareli

Our practice is in central Kırklareli, in Turkish Thrace — about an hour from Edirne, with the Kapıkule (Bulgaria) and İpsala (Greece) border crossings within easy reach. We are open Monday to Saturday, 10:00–18:15, and see patients from Bulgaria and Greece under our international health tourism authorisation. To book, use our contact page.

This article is for general information; diagnosis and treatment are decided after an examination.