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Hyperhidrosis

Hyperhidrosis is excessive sweating that disrupts daily life, with treatments ranging from topical antiperspirants to medications and procedures.
Dr. Joni Sago

Dr. Joni Sago, MD

Board-Certified Dermatologist

What Is It?

Hyperhidrosis is excessive sweating that disrupts daily life. While not dangerous, it can cause social, emotional, and practical challenges. Below are evidence-based management options, including topical treatments, medications, procedures, and lifestyle adjustments.

Topical Treatments

Drysol® (20% aluminum chloride) can be bought over-the-counter.

  • Apply at night to bone-dry skin.
  • 3 nights/week (Mon/Wed/Fri).
  • Wash off in the morning; use regular deodorant for odor control.
  • Avoid post-shower application to prevent irritation.
  • If irritation occurs, reduce frequency or take a break.
  • Best for underarms; less effective for hands/feet due to thicker skin.

Oral Medications

Glycopyrrolate

  • Use: reduces sweating by blocking sweat gland stimulation.
  • Dosage: start at 1–2 mg/day, up to 8 mg per day.
  • Side effects: dry mouth, blurred vision, urinary retention.

Oxybutynin

  • Use: an anticholinergic for axillary hyperhidrosis.
  • Dosage: begin with 2.5 mg/day, increase to 5 mg twice daily.
  • Studies show over 80% improvement.

Procedures

Botox® injections

  • Process: tiny injections in a grid pattern under the skin.
  • Results: reduces sweating within 1 week; lasts 7–16 months.
  • Best for: underarms, palms, face.

MiraDry®

  • Process: non-invasive microwave energy destroys sweat glands in the armpits only.
  • Results: 82% average sweat reduction; 94% of patients see improvement.
  • Risks: rare permanent numbness or tingling of the armpit.
  • Duration: permanent after 1–2 sessions.

Endoscopic thoracic sympathectomy (ETS)

  • Use: last-resort surgery for severe cases unresponsive to other treatments.
  • Process: cuts sympathetic nerves via small chest incisions.
  • Risks: compensatory sweating (excessive sweating elsewhere).

Medications to Avoid

Some drugs may worsen sweating. Consult your doctor if you are taking:

  • Antidepressants: SSRIs (Prozac®, Zoloft®, etc.), SNRIs (Effexor®, Cymbalta®, etc.)
  • ADHD medications: stimulants (Adderall®, Vyvanse®, etc.)
  • Blood pressure drugs: beta-blockers, calcium channel blockers
  • Antibiotics: ciprofloxacin, metronidazole
  • Hormonal therapies: tamoxifen, aromatase inhibitors

Lifestyle Tips

  • Use clinical-strength antiperspirants (like Drysol) at night.
  • Wear breathable, moisture-wicking fabrics.

Have questions about excessive sweating, or want to talk through your options? You can book online or call the office at 423-528-8833. This page is for general education, not a substitute for a personal exam.