Hyperhidrosis: Excessive Sweating

While it’s perfectly normal to sweat in hot weather, during strenuous activities, and in response to certain situations, it’s not normal to sweat excessively for no apparent reason. Approximately 2 – 3% of Americans suffer from excessive sweating, which is known as hyperhidrosis. These individuals are most likely to experience excessive wetness in the underarms, palms of their hands, and/or soles of their feet.

Hyperhidrosis can be extremely inconvenient and embarrassing. It can impact self-esteem and affect professional performance and romantic relationships. Those who suffer from sweating on their palms may find it difficult to grip objects and feel embarrassed to offer a handshake when meeting new people.

With a variety of treatments available, there is no reason to continue suffering from excessive sweating. Our New York dermatologist, Dr. Paul Jarrod Frank, specializes in the treatment of excessive sweating and offers the most cutting-edge options to his NYC patients.

Causes of Hyperhidrosis

Most cases of hyperhidrosis occur in patients who are otherwise healthy. In some cases, it can be linked to other diseases and occasionally, heat and emotions are the cause. Most people who suffer from hyperhidrosis sweat heavily at all times, regardless of activity level, emotions, or the weather.

Doctors and scientists have yet to uncover the cause of hyperhidrosis. They are aware that certain factors, including diet, caffeine, emotional state, and substance abuse, can trigger or worsen hyperhidrosis, but it has been difficult to identify the originating cause of the condition.

Diagnosing Hyperhidrosis

When assessing patients for treatment, our team will first review the medical history to eliminate the possibility that any systemic diseases or conditions are causing hyperhidrosis. Next, we will assess the amount of sweat that is produced and determine if it is considered normal or excessive. This is done by examining the areas of the body that sweat excessively. In some cases, additional tests are needed to determine the amount of sweat produced. Then, we will recommend the best course of treatment for you, along with any modifications to diet or behavior that may help improve hyperhidrosis.

Treatments for Excessive Sweating

Traditionally, topical or oral prescription medications are the go-to treatment for hyperhidrosis. In less severe cases, medication can be used to control hyperhidrosis, but it may not work for all individuals. Many of these medications also cause skin irritation and cannot be used long term as a result.

When recommending treatment for hyperhidrosis to his NYC patients, Dr. Frank prefers to identify solutions that will provide long-term results with few side effects. Among these, he has identified VASER® hyperhidrosis therapy, neuromodulator injections, and certain anticholinergic oral medications as the best treatments for excessive sweating.

VASER® Hyperhidrosis Therapy

VASER® is a treatment for underarm hyperhidrosis that uses ultrasonic energy to alter the activity of sweat glands beneath the skin’s surface. The treatment is performed in our state-of-the-art New York City facility using only a local anesthetic. Dr. Frank makes a tiny incision in the underarm skin and then inserts a thin wand through the incision to target the axillary sweat glands. The results of VASER® therapy for hyperhidrosis are long lasting. The patient is able to resume normal activities after 24 hours.

Before the development of VASER® Hyperhidrosis Therapy, Dr. Frank frequently recommended Botox to treat excessive sweating. Botox, however, requires ongoing treatment – if the patient stops receiving injections, the sweating will return.

Botox for Hyperhidrosis

For individuals who cannot undergo VASER® or would prefer something less invasive, Dr. Frank may recommend Botox or another neuromodulator product. We regularly use Botox, Dysport, Jeuveau, and Xeomin treatments to reduce hyperhidrosis.

The active ingredient in these neuromodulators is botulinum toxin type A. It inhibits the release of sweat in the treatment area by blocking nerve signals to the targeted sweat glands. It can be used locally to stop sweating in the underarms, palms, or soles of the feet without affecting sweat glands anywhere else on the body.

Neuromodulator injections are very quick and easy to perform and requires no downtime or recovery time afterwards. Dr. Frank simply injects the chosen neuromodulator in a specific pattern to the targeted area. To maintain results, neuromodulator injections are required every 6 months.

Anticholinergic Oral Medications

Anticholinergic oral medications, like glycopyrrolate and oxybutynin, are a completely non-invasive option for treating hyperhidrosis. They are often combined with other methods of hyperhidrosis management.

These medications prevent nerve signals from reaching overactive sweat glands. As a result, sweating is greatly decreased in the soles, palms, underarms, and anywhere else experiencing excessive sweating. Both primary and secondary hyperhidrosis can be addressed using anticholinergic medications.

Patients experience results over time, and it will be necessary to continue taking the chosen medication in order to maintain results.

Normally, these medications are used for issues like peptic ulcer disease and an overactive bladder. Using them to treat hyperhidrosis is an off-label use that has proven to be quite effective in numerous cases.

It is important to remember that anticholinergic oral medications may increase a person’s chance of overheating, since sweating is greatly reduced. Because of this, it is best to stay well hydrated while taking these medications and to avoid sun overexposure and overexertion.


Can Botox for excessive sweating weaken the arm muscles if I do it in the armpit?

It relaxes muscles as well as it does sweat glands, but if you inject it in the right place, you shouldn’t have any problems.

If I use Botox for excessive sweat, where does the sweat go?

This is the most common question. Under the arms, soles of the feet, and the hands only represent about 1-3% of the total body surface area, so the body can handle that decrease without any compensation.

Is it dangerous not to sweat?

It is dangerous not to sweat, but, we aren’t decreasing the amount of total sweat by so much that it would create a problem. Most people with medical Hyperhidrosis are just plain sweating too much.

How long does a Botox treatment last for excessive sweating?

Neuromodulators, depending on the severity of the sweating, can last 3-6 months, sometimes a little bit longer. It really depends on the severity, if you’re combining it with other treatments and are exercising.

Do you build up toxins if you don’t sweat?

Don’t worry, you will still get rid of toxins.

Are there permanent solutions for excessive sweating? Can you remove the sweat glands?

There is the surgery, but it’s quite risky. There are other solutions that may be more permanent like liposuction in the armpit and microwave technologies, but there are always pros and cons.

Does Botox treatment get rid of BO?

No it doesn’t. The bacteria on the skin causes BO. Sweating, however, can make BO worse.

Can I exercise after Botox injections?

Yes! The post-op after getting the injections takes 5 minutes. It barely hurts and you can go exercise afterwards. Results from the injections may take a few days to kick in.

What is the best type of Botox for sweating?

I happen to like dysport the best. Its diffusion capacity covers the area best and I find that it lasts longer. They all work, but I like Dysport the best.

Would you recommend Botox for a 16 year old with an excessive sweating problem? Most treatments are 18+.

I’ve had 13 year olds that have had this done. Neuromodulators are used in infants and children for medical reasons, so there’s no reason that if a kid has a real problem, they can’t get this treatment.

What is Miradry?

Miradry is the microwave device that you use under the arm. It can hurt, there are people who have some neurological issues afterwards, I’ve had patients where it didn’t work at all. I’ve tried it many times and I don’t find it to be a huge success in terms of efficacy, safety, pain and downtime. I really prefer Neuromodulators because it’s quick, it’s easy, it’s cost effective, and for those who aren’t super, severe it’s the best option.