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Health condition · Clinically reviewed

Excessive sweating, antiperspirants, botulinum toxin, iontophoresis - and surgery when it fits.

More than a nuisance - hyperhidrosis affects work, relationships and confidence. A stepped medical plan beats guesswork.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including topicals, botulinum toxin, iontophoresis, MiraDry and thoracic surgery.

Key facts

Hyperhidrosis at a glance.

The essentials, in plain English - what it is, the two main types, and the ladder of treatments used in the UK today.

  • What it is

    Sweating beyond the level needed to regulate body temperature - focal or generalised, and often severely affecting daily life.

  • Primary focal

    Idiopathic, often starting in the teens - palms, soles, underarms, face, scalp, groin - driven by sympathetic overactivity.

  • Secondary generalised

    Caused by something else - thyroid disease, phaeochromocytoma, infection, lymphoma, medications, menopause, diabetes, anxiety.

  • How it is measured

    Hyperhidrosis Disease Severity Scale (HDSS), starch-iodine test and gravimetric weighing of sweat production.

  • First-line therapy

    20% aluminium chloride hexahydrate at night (Driclor, Perspirex) - washed off in the morning.

  • Specialist options

    Botulinum toxin, iontophoresis, oral anticholinergics, MiraDry, laser, and thoracic sympathectomy for severe cases.

Why this guide matters

More than sweat - a ladder of proven treatments.

Hyperhidrosis is common, treatable and often life-changing when addressed properly. Three points shape everything on this page.

  • Rule out secondary causes first

    Generalised or new-onset sweating with systemic features needs investigation - thyroid, endocrine, infection, lymphoma or medication.

  • Antiperspirants are step one

    A properly used 20% aluminium chloride regimen controls sweating for many people - and is the standard first-line before escalation.

  • Effective specialist options exist

    Botulinum toxin, iontophoresis, MiraDry and thoracic sympathectomy work well when topicals are not enough - do not settle.

How the diagnosis is made

From first history to a clear plan.

The steps a UK GP, dermatologist or hyperhidrosis clinic will normally follow, in order - so you know what to expect.

  1. 01

    Assessing

    History and pattern

    Age of onset, sites affected, symmetry, night sweats, triggers and family history - to separate primary focal from secondary generalised hyperhidrosis.

  2. 02

    Assessing

    HDSS severity score

    The Hyperhidrosis Disease Severity Scale (1 to 4) grades how much sweating interferes with daily activities and guides treatment intensity.

  3. 03

    Assessing

    Screen for secondary causes

    Weight loss, fevers, palpitations, tremor, medication history and menopausal symptoms all point away from primary hyperhidrosis.

  4. 04

    Confirming

    Starch-iodine and gravimetric

    Starch-iodine test maps sweating areas visually. Gravimetric weighing of absorbent pads quantifies sweat production before and after treatment.

  5. 05

    Confirming

    Bloods where indicated

    Thyroid function, full blood count, glucose, inflammatory markers and specialist hormonal tests when a secondary cause is suspected.

  6. 06

    Referring

    Dermatology referral

    Moderate-to-severe primary hyperhidrosis or failure of topical therapy is worth a specialist opinion - dermatology or a private hyperhidrosis clinic.

  7. 07

    Referring

    MDT for advanced options

    Botulinum toxin, MiraDry and thoracic sympathectomy need dermatology, thoracic surgery and specialist clinic input working together.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What hyperhidrosis actually looks like.

Focal patterns of primary hyperhidrosis, the generalised patterns of secondary disease - and the features that mean it is time to look deeper.

  • Palmar sweating

    Constantly damp hands - dripping in social or work situations, damaging paperwork, phones and keyboards.

  • Plantar sweating

    Wet feet, macerated skin, foot odour, damaged footwear and increased risk of fungal infection.

  • Axillary sweating

    Visible sweat patches through clothing, staining and having to change tops repeatedly through the day.

  • Craniofacial sweating

    Dripping from the forehead, scalp and face - often triggered by stress, heat or eating.

  • Groin and truncal sweating

    Focal groin or truncal sweating - less common but very distressing and often overlooked.

  • Compensatory or cyclical sweating

    New sweating patterns after sympathectomy, or cyclical sweating tied to menstrual cycle or menopause.

  • Night sweats

    Drenching night sweats point away from primary focal hyperhidrosis towards infection, lymphoma, endocrine or menopausal causes.

  • Red flag - generalised or systemic

    Whole-body sweating with fever, weight loss or lymphadenopathy needs urgent investigation, not cosmetic treatment.

Treatment

How hyperhidrosis is treated in the UK.

Antiperspirants first, then oral options, botulinum toxin and iontophoresis - with MiraDry and thoracic sympathectomy reserved for selected cases.

  • 20% aluminium chloride

    Driclor or Perspirex applied at night to dry skin and washed off in the morning - first-line for axillary, palmar and plantar hyperhidrosis.

  • Oral anticholinergics

    Oxybutynin, glycopyrronium bromide or propantheline. Effective but limited by dry mouth, dry eyes, urinary retention and constipation.

  • Botulinum toxin injections

    Botox, Dysport or Xeomin injected subcutaneously - highly effective for axillary, palmar and craniofacial sweating for 6 to 12 months.

  • Iontophoresis

    A galvanic device (Idromed, Hidrex) delivers low-level current through water baths for palms and soles. Specialist-guided course, then home use.

  • MiraDry microwave therapy

    Microwave thermolysis of axillary sweat glands - a permanent option for underarm sweating delivered in a specialist clinic.

  • Laser or ultrasound

    Laser and ultrasound-based axillary sweat gland ablation - specialist procedures offered in selected clinics.

  • Endoscopic thoracic sympathectomy

    Definitive surgical option for severe palmar or facial hyperhidrosis. Very effective but carries a real risk of compensatory sweating.

  • Treat the underlying cause

    For secondary hyperhidrosis, the priority is treating the endocrine, infective, menopausal or medication-related driver.

Procedures we cover

Related treatment guides on this site.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and patient organisations - current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Hyperhidrosis: management.

  • British Association of Dermatologists (BAD). Hyperhidrosis patient information leaflet.

  • International Hyperhidrosis Society. Clinical guidelines and HDSS.

  • MHRA. Prescribing information for oxybutynin, glycopyrronium and botulinum toxin.

  • Hyperhidrosis UK Support Group. Patient resources and specialist clinic directory.

Red flags

When sweating needs urgent attention.

Most hyperhidrosis is manageable in primary or specialist dermatology care. These are the situations that need a broader look.

  • Generalised sweating with systemic symptoms

    Weight loss, fevers, drenching night sweats or lymphadenopathy point to infection, lymphoma or endocrine disease - not primary hyperhidrosis.

  • Suspected phaeochromocytoma

    Episodic sweating with palpitations, headaches and severe hypertension warrants urgent endocrine investigation.

  • Hyperthyroidism

    Heat intolerance, weight loss, tremor and tachycardia alongside sweating - check thyroid function early.

  • Diabetes and hypoglycaemia

    Sudden sweating with tremor, hunger and confusion in a person with diabetes - treat as hypoglycaemia and review the regimen.

  • Menopause and perimenopause

    Hot flushes and night sweats warrant a menopause discussion, not axillary botulinum toxin alone.

  • Medication and substance related

    SSRIs, opioids and cholinesterase inhibitors can drive sweating. Alcohol excess and drug withdrawal are common triggers.

  • Compensatory sweating after surgery

    New sweating on the trunk or back after thoracic sympathectomy - a well-recognised and sometimes disabling complication.

  • Skin breakdown and infection

    Macerated skin, fungal infection and cellulitis in constantly wet areas need targeted treatment alongside sweat control.

  • Psychological impact

    Social withdrawal, work avoidance and low mood are common. A compassionate mental-health conversation belongs in every consultation.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - a proper antiperspirant routine, willingness to escalate, patient-group support and looking after your mental health.

A quiet reminder

Do not accept sweating as untreatable.

The UK ladder is genuinely effective. If topicals fail, ask about the next step rather than living with it.

  1. 01 Routine

    Start with the basics

    Breathable clothing, absorbent liners, antiperspirant wipes and a proper 20% aluminium chloride regimen at night - given six to eight weeks to settle.

  2. 02 Escalate

    Do not stop at antiperspirant

    If topicals are not enough, ask about iontophoresis, botulinum toxin, MiraDry and oral options. Effective treatments exist.

  3. 03 Support

    You are not alone

    Hyperhidrosis UK and the International Hyperhidrosis Society offer patient guidance, forums and clinic directories.

  4. 04 Mental

    Mind the psychological load

    Anxiety, social avoidance and low mood are common. Treating the sweating and the mental-health impact together works best.

Frequently asked

Everything we get asked about hyperhidrosis.

Quick answers on antiperspirants, botulinum toxin, iontophoresis, MiraDry and surgery.

  • What is hyperhidrosis?

    Hyperhidrosis is sweating beyond what the body needs for temperature regulation. Primary focal hyperhidrosis is idiopathic and affects specific sites like palms, soles and underarms. Secondary hyperhidrosis is generalised and driven by an underlying condition or medication.

  • How is severity measured?

    The Hyperhidrosis Disease Severity Scale (HDSS) is a simple 1 to 4 score based on how much sweating interferes with daily life. Starch-iodine testing maps the areas involved and gravimetric weighing quantifies sweat production before and after treatment.

  • What is the first-line treatment?

    A 20% aluminium chloride hexahydrate antiperspirant such as Driclor or Perspirex, applied to dry skin at night and washed off in the morning. It is safe, inexpensive and effective for many people if used correctly and consistently.

  • When are botulinum toxin injections used?

    Botulinum toxin injections (Botox, Dysport or Xeomin) are typically offered when topicals are not enough. They are highly effective for axillary, palmar and craniofacial hyperhidrosis and usually last 6 to 12 months per treatment cycle.

  • Is surgery an option?

    Endoscopic thoracic sympathectomy is a definitive option for severe palmar or facial hyperhidrosis when other treatments have failed. It works well but carries a real risk of compensatory sweating elsewhere on the body, so it is a last-resort decision made with a thoracic surgeon.

  • Could my sweating be a sign of something else?

    Yes. Generalised sweating with weight loss, fever, drenching night sweats or palpitations can point to thyroid disease, phaeochromocytoma, infection, lymphoma or a medication side effect. Those features deserve investigation before assuming primary hyperhidrosis.

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