What’s Normal vs. What’s Not?

Most people sweat during exercise, hot weather or stressful moments. Hyperhidrosis is different. It often happens without a clear trigger and may soak through clothing or drip from your hands, even when your body doesn’t need to cool down.

A key sign is sweating that is difficult to manage and interferes with your everyday life.

What It Looks Like in Daily Life

Hyperhidrosis often shows up during everyday activities, such as typing, shaking hands or sitting still. Hands may feel clammy or wet, feet may slip in shoes, and armpits may show visible sweat marks. Some people with hyperhidrosis avoid certain clothing colors, carry extra shirts or hold back from handshakes and hugs.

Stress, heat and spicy foods may worsen symptoms, but sweating often occurs without a clear cause.

There are two types of hyperhidrosis:

• Primary focal hyperhidrosis: This type usually starts in childhood or the teen years, affects specific areas on both sides of the body, and may run in families. It is not caused by another medical condition. People with this type typically do not experience excessive sweating during sleep.
• Secondary hyperhidrosis: This type is caused by an underlying health condition or certain medications. Conditions may include diabetes, thyroid disease, Parkinson’s disease, lymphoma or menopause. It often affects larger areas of the body, begins later in life and may cause night sweats.

Medications that may contribute to hyperhidrosis include:

Antidepressants

• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and fluoxetine
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine
• Tricyclic antidepressants

Stimulants

• Central nervous system stimulant medications, such as mixed amphetamine salts

 Opioid pain medications

• Morphine
• Oxycodone
• Fentanyl

Diabetes medications that cause low blood sugar

• Insulin
• Sulfonylureas, such as glyburide and glipizide

Hormonal therapies

• Thyroid hormones, such as levothyroxine
• Selective estrogen receptor modulators, such as tamoxifen

Heart and blood pressure medications

• Beta blockers
• Calcium channel blockers

Neurologic and psychiatric medications

• Cholinesterase inhibitors, such as donepezil
• Antipsychotics, such as clozapine

Pain and fever medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen

“The most common trigger by far is the use of certain medications; most commonly, antidepressant and stimulant medications, as well as hormonal therapies,” says Paras P. Vakharia, MD, PharmD, a dermatologist at Northwestern Medicine.

If you think a medication may be causing your sweating, don’t stop taking it on your own. Talk with your doctor first.

When Sweating Becomes a Problem

Sweating becomes a medical condition when it disrupts your quality of life. Signs include:

• Sweating without heat or physical activity
• Changing clothes often due to excessive sweating
• Avoiding social or work situations
• Skin irritation, rashes or infections in areas that stay damp

Sweating at night or across the entire body may signal an underlying condition and should be evaluated by a doctor.

Why Hyperhidrosis Happens

Sweat glands (eccrine glands) are controlled by your nerves. In hyperhidrosis, the nerves overactivate the glands, leading to excess sweat.

The cause of primary hyperhidrosis is not fully understood, but it often runs in families, while secondary hyperhidrosis has a clear medical or medication-related cause. Knowing the type helps guide the right treatment.

Common areas affected:

• Underarms (axillary hyperhidrosis)
• Palms (palmar hyperhidrosis)
• Soles of your feet (plantar hyperhidrosis)
• Forehead and cheeks (craniofacial hyperhidrosis)
• Over most of the body (generalized hyperhidrosis)

When To Seek Care

If excessive sweating affects your daily activities, emotional well-being or quality of life, talk with your primary care doctor or dermatologist. You should also make an appointment right away if you notice:

• Sweating that starts suddenly or gets worse
• Unexplained night sweats
• Sweating with fever, fatigue or unexplained weight loss

A doctor can review your symptoms, sweating patterns and medical history. They may also order tests to check for an underlying condition.

Go to the nearest emergency department or call 911 if sweating occurs with chest pain, trouble breathing, dizziness or other serious symptoms.

How Hyperhidrosis Is Diagnosed

Doctors often diagnose hyperhidrosis through a physical exam and your medical history.

It is more likely if symptoms have lasted six months or longer and include at least two of the following:

• Affects your underarms, palms, soles of your feet or face
• Occurs on both sides of the body
• Does not happen or is reduced during sleep
• Occurs at least once a week
• Runs in the family
• Interferes with daily activities

Sometimes, additional tests may be done:

• Starch-iodine test: Areas of heavy sweating turn blue when iodine and starch are applied.
• Paper test: Special paper measures how much sweat is produced.
• Blood or imaging tests: These help check for underlying conditions.

How To Prepare for Your Appointment

Before your visit, jot down:

• When your sweating started and whether it’s getting worse
• Which parts of your body are affected
• Whether you sweat during sleep
• All the medications and supplements you take
• Any family history of heavy sweating
• What you’ve already tried, including over-the-counter antiperspirants
• How sweating affects your work, relationships or mood

Tracking your symptoms for a week or two can help your doctor spot patterns.

Treatment Options

• Prescription antiperspirants: These contain more aluminum chloride (often 20%) than over-the-counter products, so they block sweat glands more effectively.
• Topical medications: These medications are applied directly to the affected area to help reduce sweating. They’re often one of the first treatments recommended for sweating in a specific area and are less likely to cause side effects throughout the body.
• Oral medications: These medications are taken by mouth and can help when sweating affects several areas of the body or most of your body. They may cause side effects, such as dry mouth, dry eyes or constipation.
• Botulinum toxin: These injections block nerve signals to sweat glands. Results can last several months.
• Iontophoresis: This treatment uses a mild electrical current in water to reduce sweating, usually for the hands and feet. Your dermatologist may also recommend adding a medication to the water.
• Microwave therapy: A device uses heat to permanently destroy sweat glands in the treated area. It’s used for underarm sweating.
• Surgery: For severe cases, surgical treatment like endoscopic thoracic sympathectomy (nerves are cut to stop signaling) or sweat gland removal may be considered. This is usually a last resort due to the risk of complications and may lead to increased sweating in other areas (compensatory sweating).
• Treating an underlying condition: If another health issue or medication is the cause, managing that condition or adjusting medication may reduce symptoms.

Treatment depends on symptom severity, location and your overall health, and may require ongoing care. It’s common to try more than one treatment option before finding what works best for you.

“Prescription topical medications, such as glycopyrrolate or sofpironium, are a great first treatment for many patients,” says Dr. Vakharia. “They’re relatively safe and are applied only to the affected area, so they’re a good option for treating a specific spot or for patients who’d like to start with a topical. If topicals aren’t working, or if sweating affects many areas of the body, oral glycopyrrolate can be effective, though some patients notice dry mouth or dry eyes.”

Dr. Vakharia also recommends botulinum toxin as a safe, effective option for localized sweating or when other treatments haven’t worked. “Its benefits can last for months,” he says.

At-Home Tips To Manage Symptoms

You may find relief with these simple steps:

• Wear breathable fabrics like cotton or moisture-wicking athletic fabrics.
• Choose loose-fitting clothes, and try wearing darker colors or patterns that hide sweat marks.
• Shower daily and dry off completely before getting dressed.
• Use absorbent shoe inserts.
• Wash your feet daily and change socks often.
• Rotate your shoes so each pair dries out completely between wears.
• Apply over-the-counter clinical-strength antiperspirant at night to clean, dry skin. Sweat glands are less active while you sleep, which gives the product time to work.
• Notice if what you’re eating or drinking, such as caffeine, alcohol or spicy foods, is increasing your sweating and try to limit or avoid these foods.

If over-the-counter treatments aren’t helping or sweating is starting to affect your day-to-day life, talk with a dermatologist. There are safe, effective treatments for hyperhidrosis and you don’t have to deal with it on your own.