Excessive Sweating: Are Patients Suffering Unnecessarily?


      • Three percent of Americans suffer from hyperhidrosis (excessive sweating).
      • Hyperhidrosis is not well-discussed among primary care providers and patients.
      • Hyperhidrosis impacts sufferer's occupation, emotions, and causes disruptions of daily life.
      • There are solutions ranging from topical antiperspirants to surgery.
      • There is a new minimally invasive FDA-cleared device that will disable sweat and odor glands permanently in 1 or 2 treatments.


      Primary axillary hyperhidrosis is a disorder characterized by excessive axillary sweating. An underdiagnosed and underreported issue, this disorder affects almost 8 million people in the United States. The condition often impacts an individual's occupation and emotional well-being and can even cause physical impairment. The purpose of this study is to educate primary care providers about the need for routine screening during annual physical exams, which will allow referral for appropriate treatment. We also describe options for management such as noninvasive, temporary topical solutions, oral medication, botulinum toxin A injections, surgery, and microwave energy.


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        • Strutton D.R.
        • Kowalski J.W.
        • Glaser D.A.
        • Stang P.E.
        Us prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey.
        J Am Acad Dermatol. 2004; 51: 241-248
        • Gross K.M.
        • Schote A.B.
        • Schneider K.K.
        • Schulz A.
        • Meyer J.
        Elevated social stress levels and depressive symptoms in primary hyperhidrosis.
        PLoS One. 2014; 9: e92412
        • Dalton P.
        • Maute C.
        • Jaen C.
        • Wilson T.
        Chemosignals of stress influence social judgments.
        PLoS One. 2013; 8: e77144
        • Wilke K.
        • Martin A.
        • Terstegen L.
        • Biel S.S.
        A short history of sweat gland biology.
        Int J Cosmet Sci. 2007; 29: 169-179
        • Lonsdale-Eccles A.
        • Leonard N.
        • Lawrence C.
        Axillary hyperhidrosis: eccrine or apocrine?.
        Clin Exp Dermatol. 2003; 28: 2-7
        • Solish N.
        • Bertucci V.
        • Dansereau A.
        • et al.
        A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian hyperhidrosis advisory committee.
        Dermatol Surg. 2007; 33: 908-923
        • Moraites E.
        • Vaughn O.A.
        • Hill S.
        Incidence and prevalence of hyperhidrosis.
        Dermatol Clin. 2014; 32: 457-465
        • Sato K.
        • Ohtsuyama M.
        • Samman G.
        Eccrine sweat gland disorders.
        J Am Acad Dermatol. 1991; 24: 1010-1014
        • Hurley H.J.
        • Shelley W.B.
        Axillary hyperhidrosis.
        Br J Dermatol. 1996; 78: 127-140
        • Worle B.
        • Rapprich S.
        • Heckmann M.
        Definition and treatment of primary hyperhidrosis.
        J Deutsch Dermatol Gesellschaf. 2007; 5: 625-628
        • Amir M.
        • Arish A.
        • Weinstein Y.
        • Pfeffer M.
        • Levy Y.
        Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results.
        Israel J Psychiatry Rel Sci. 2001; 37: 25-31
        • Chalmers T.M.
        • Keele C.A.
        The nervous and chemical control of sweating.
        Br J Dermatol. 1952; 64: 43-54
        • Schneier F.R.
        • Heimberg R.G.
        • Liebowitz M.R.
        • Blanco C.
        • Gorenstein L.A.
        Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis.
        Compr Psychiatry. 2012; 53: 1181-1186
        • Baskan E.B.
        • Karli N.
        • Baykara M.
        • Cikman S.
        • Tunali S.
        Localized unilateral hyperhidrosis and neurofibromatosis type 1: case report of a new association.
        Dermatology. 2005; 211: 286-289
        • Hornberger J.
        • Grimes K.
        • Naumann M.
        • et al.
        Recognition, diagnosis, and treatment of primary focal hyperhidrosis.
        . J Am Acad Dermatol. 2004; 51: 274-286
        • Park E.J.
        • Han K.R.
        • Choi H.
        • Kim do W.
        • Kim C.
        An epidemiological study of hyperhidrosis patients visiting the Ajou University Hospital Hyperhidrosis Center in Korea.
        J Korean Med Sci. 2010; 25: 772-775
        • Kowalski J.W.
        Abstracts of the American Academy of Dermatology 62nd annual meeting. February 6-11, 2004, Washington, DC.
        J Am Acad Dermatol. 2004; 50: P1-P197
        • Singh S.
        • Davis H.
        • Wilson P.
        Axillary hyperhidrosis: a review of the extent of the problem and treatment modalities.
        Surgeon. 2015; 13: 279-285
        • Brown A.L.
        • Gordon J.
        • Hill S.
        Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis.
        Curr Opin Pediatr. 2014; 26: 460-465
        • Semkova K.
        • Gergovska M.
        • Kazandjieva J.
        • Tsankov N.
        Hyperhidrosis, bromhidrosis, and chromhidrosis: fold (intertriginous) dermatoses.
        Clin Dermatol. 2015; 33: 483-491
        • Flanagan K.H.
        • Glaser D.A.
        An open-label trial of the efficacy of 15% aluminum chloride in 2% salicylic acid gel base in the treatment of moderate-to-severe primary axillary hyperhidrosis.
        J Drugs Dermatol. 2009; 8: 477-480
      1. Schollhammer M, Brenaut E, Menard-Andivot N, et al. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. Br J Dermatol.

        • Ibrahim O.
        • Kakar R.
        • Bolotin D.
        • et al.
        The comparative effectiveness of suction-curettage and onabotulinumtoxin-a injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial.
        J Am Acad Dermatol. 2013; 69: 88-95
        • Currie A.C.
        • Evans J.R.
        • Thomas P.R.
        An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy.
        Int J Surg. 2011; 9: 437-439
        • Johnson J.E.
        • O'Shaughnessy K.F.
        • Kim S.
        Microwave thermolysis of sweat glands.
        Lasers Surg Med. 2012; 44: 20-25
        • Glaser D.A.
        • Coleman 3rd, W.P.
        • Fan L.K.
        • et al.
        A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study.
        Dermatol Surg. 2012; 38: 185-191
        • Lupin M.
        • Hong H.C.
        • O'Shaughnessy K.
        Long-term efficacy and quality of life assessment for treatment of axillary hyperhidrosis with a microwave device.
        Dermatol Surg. 2014; 40: 805-807
        • Pariser D.M.
        Incorporating diagnosis and treatment of hyperhidrosis into clinical practice.
        Dermatol Clin. 2014; 32: 565-574
        • Flanagan K.H.
        • King R.
        • Glaser D.A.
        Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis.
        J Drugs Dermatol. 2008; 7: 221-227


      Kami Owen, MSN, FNP-BC, is co-owner of You Only Younger, a medical spa in Sugar Land, TX. She can be reached at [email protected].