Hyperhidrosis FAQs | Top Doctors

Mr Andrea Bille, leading cardiothroacic surgeon in central London, answers some of the most commonly-asked questions about hyperhidrosis in this informative article.

What is hyperhidrosis, and how does it differ from normal sweating?

Hyperhidrosis is excessive sweating that occurs in specific areas like the hands, feet, underarms, or face, often without heat or physical activity. Unlike normal sweating, it happens even when the body doesn’t need to cool down and can interfere with daily life.

What are the most common areas of the body affected by hyperhidrosis?

The most common areas of the body are hands, feet, underarms, or face.

Is it usually caused by genetics, medical conditions, or lifestyle factors?

Primary hyperhidrosis: The exact cause is unknown, but it's believed to involve overactive sweat glands due to a problem with the nervous system. It often runs in families.

Secondary hyperhidrosis: This type is caused by an underlying condition such as:

Thyroid problems
Diabetes
Infections
Menopause
Certain medications

A stressful lifestyle may contribute to make symptoms worse

What are the most effective treatments available today for hyperhidrosis?

Hyperhidrosis can be effectively treated with options like prescription-strength antiperspirants, Botox® injections to block sweat signals, oral medications that reduce overall sweating, iontophoresis using mild electrical currents, microwave therapy to destroy sweat glands, and, in severe cases or when little response to other treatment, surgical procedures such as endoscopic thoracic sympathectomy (ETS).

Are there any cutting-edge or newer treatments you’re particularly excited about?

Cutting-edge treatments for hyperhidrosis include the newly approved topical Sofpironium bromide (Sofdra), the quick in-clinic Brella thermolysis patch, and emerging therapies like anticholinergic gels, microneedle radiofrequency, and targeted oral drugs, offering less invasive, longer-lasting, and more personalised relief than traditional options.

What surgical options exist, and when are they appropriate?

ETS is a surgical option for severe hand or face sweating that involves cutting nerves to stop sweating, and when performed with robotic surgery, it offers greater precision, smaller incisions, and faster recovery compared to traditional methods. Surgery is generally reserved for severe cases when other treatments don’t work or aren’t tolerated, due to possible complications and side effects.

How successful are treatments generally, and what should patients realistically expect?

Medical treatments for hyperhidrosis, like prescription antiperspirants, Botox®, and oral medications, are effective for many patients, often reducing sweating by 50 to 80 per cent, but they may require ongoing use and can have side effects.

ETS tends to offer more permanent relief, with success rates around 90 per cent, but carry risks such as compensatory sweating and are usually reserved for severe cases. Patients should realistically expect improvement rather than a complete cure and discuss the benefits and risks of each option with their doctor.

If you're considering expert hyperhidrosis treatment, arrange a consultation with Mr Bille via his Top Doctors profile.