Excessive Sweating / Hyperhidrosis

Primary vs. Secondary Hyperhidrosis

Primary focal hyperhidrosis — excessive sweating of specific areas (palms, soles, axillae, face/scalp, groin) with no identifiable medical cause. Often familial. Starts in childhood or adolescence.

Secondary generalized hyperhidrosis — caused by medications, menopause, obesity, hyperthyroidism, diabetes, or infections. Tends to be nocturnal.

Hyperhidrosis Disease Severity Scale (HDSS)

Scoring 1–4; score ≥ 3 (sweat "barely tolerable" or "intolerable") indicates need for treatment escalation.

Treatment Options

Topical

• Prescription-strength aluminum chloride (Drysol, Hypercare) — applied nightly; first-line for mild-moderate axillary, palmar, plantar hyperhidrosis
• Qbrexza (glycopyrronium) wipes — once-daily anticholinergic wipe for axillary hyperhidrosis; FDA-approved

Procedural

• Iontophoresis — electrical current through water to block sweat glands; for palms and soles; requires 6–10 initial sessions + maintenance
• Botulinum toxin (Botox) injections — highly effective for axillary, palmar, and plantar hyperhidrosis; results last 6–12 months
• miraDry — microwave energy permanently destroys sweat (and odor) glands in the axillae; ~80% sweat reduction; done once or twice

Oral

• Oxybutynin, glycopyrrolate — anticholinergics for generalized hyperhidrosis; second-line due to systemic side effects

Quality of Life

Hyperhidrosis is associated with significant anxiety, social withdrawal, and occupational impairment. Treatment is highly effective and profoundly improves quality of life.