Medically reviewed by Dr Tapan Patel
Last reviewed: 22nd February 2026
What is excessive sweating?
Excessive sweating, medically known as hyperhidrosis, means that patients may be producing more sweat than the body needs to regulate temperature. Sweating may soak through clothes, in some cases it can be difficult to hold a pen or phone, damage footwear, or even cause people to avoid handshakes and social situations.
Population estimates vary because many people do not seek medical help. A 2016 US prevalence study published in Archives of Dermatological Research estimated that 4.8% of the population had hyperhidrosis, which is close to one person in 20.
What is the difference between primary and secondary hyperhidrosis?
Primary focal hyperhidrosis causes excessive sweating without an identifiable underlying disease. It usually affects specific areas on both sides of the body, often starts during childhood or adolescence, and commonly affects the underarms, hands, feet or face.
Secondary hyperhidrosis is caused by a medical condition, medicine or hormonal change. It is more likely to begin suddenly, affect large areas of the body, or continue during sleep.
What causes excessive sweating?
Primary hyperhidrosis is associated with overactivity in the sympathetic nervous system, which controls many automatic body functions. The nerves release acetylcholine, a chemical signal that activates eccrine sweat glands even when extra cooling is not required.
Secondary hyperhidrosis can be associated with menopause, an overactive thyroid, diabetes, low blood sugar, infection, neurological disease and some cancers. Medicines that may increase sweating include certain antidepressants, pain medicines and hormonal treatments.
Anxiety, heat, exercise, caffeine, alcohol and spicy food can also trigger or worsen sweating, but a trigger is not l always necessarily the underlying cause. Don't stop prescribed medicines if you have been prescribed without speaking to the clinician who prescribed it.
Which parts of the body can hyperhidrosis affect?
Hyperhidrosis most commonly affects the underarms, palms and soles. It can also affect the face, scalp, groin, chest, back or most of the body.
The location influences treatment choice. Iontophoresis is often used for hands and feet, while microwave sweat-gland treatment (miradry) is designed for underarms.
Excessive Sweating treatment journey
How do clinicians diagnose hyperhidrosis?
Hyperhidrosis is usually diagnosed from the pattern, duration and effect of the sweating, together with a medical history and physical examination. Blood or urine tests may be needed if the sweating is generalised, began suddenly, occurs at night or could have an underlying medical cause.
Clinicians often suspect primary focal hyperhidrosis when focal sweating has continued for at least six months without another apparent cause and has at least two of these characteristics:
- It affects both sides of the body in a similar pattern.
- It occurs at least once a week.
- It interferes with work, social activity or daily tasks.
- It began before the age of 25.
- Another family member has similar symptoms.
- It stops during sleep.
These criteria guide assessment rather than replacing an individual diagnosis. The International Hyperhidrosis Society and the American Academy of Dermatology describe similar diagnostic patterns.
How is the severity of excessive sweating measured?
The Hyperhidrosis Disease Severity Scale, or HDSS, records how much sweating disrupts daily life. It uses four grades:
- Sweating is never noticeable and never interferes with daily activities.
- Sweating is tolerable but sometimes interferes with daily activities.
- Sweating is barely tolerable and frequently interferes with daily activities.
- Sweating is intolerable and always interferes with daily activities.
A score of 3 or 4 usually describes severe hyperhidrosis. A clinician may also ask how often clothes need changing, whether hand sweating affects grip, and which activities the patient avoids.
When should I see a doctor about sweating?
Speak to a GP or qualified clinician if sweating has continued for six months, happens at least weekly, disrupts daily life, occurs at night or began after starting medicine. Sudden generalised sweating, weight loss, fever, palpitations, tremor or other new symptoms also need medical assessment.
Seek urgent medical help if sudden heavy sweating occurs with chest pain, breathing difficulty, faintness or severe illness. The NHS guidance on excessive sweating advises medical review when sweating may have an underlying cause.
Why choose PHI Clinic?
PHI Clinic is London’s best destination for safe, effective treatment. Clinic founder Dr Tapan Patel holds The Aesthetics Award 2023 for Outstanding Achievement in Medical Aesthetics, and ensures his team is always up to date with the latest, most effective techniques. PHI Clinic is renowned for its elegant, natural-looking results, and exceptional levels of client satisfaction.
How is excessive sweating treated?
Excessive sweating is usually treated in stages, beginning with self-care and strong antiperspirants before prescription, device-based or surgical treatment is considered. The appropriate stage depends on the cause, body area, severity, previous treatment and medical history.
The Primary Care Dermatology Society and NHS describe the following general pathway:
- Identify and treat any underlying condition or medicine-related cause.
- Use practical measures and a strong antiperspirant.
- Consider iontophoresis for hands, feet or selected underarm cases.
- Consider prescription medicine or botulinum toxin type A after clinical assessment.
- Consider microwave treatment or a local sweat-gland procedure for persistent underarm sweating.
- Reserve nerve surgery for severe cases that have not responded to less invasive treatment.
Which excessive sweating treatments are available at PHI Clinic?
PHI Clinic provides miraDry and Botox to treat excessive sweating under the arms with both treatments providing a viable options for our patients, injections providing a more temporary solution but less invasive. All procedures are performed by our team of highly trained practitioners. Injectable treatments are always doctor and nurse-led procedures.
PHI Clinic does not provide iontophoresis, oral anticholinergic prescribing, sweat-gland surgery and endoscopic thoracic sympathectomy. Patients who need an unavailable treatment will be directed to an appropriate GP, dermatologist or surgeon.
Prescription-only treatment can be considered only after an individual consultation and medical assessment. A consultation should establish whether the sweating is primary or secondary, identify contraindications and compare suitable treatments rather than assuming one procedure is right for every patient.
Which treatment is best for excessive sweating?
There is no single treatment that is best for every type of hyperhidrosis. Antiperspirants are usually tried first, iontophoresis is particularly useful for hands and feet, and botulinum toxin type A is an established temporary treatment for severe primary underarm sweating.
Microwave thermolysis is designed for longer-term reduction of underarm sweat glands. Oral medicines can help sweating in several areas but produce more whole-body side effects, while surgery is usually reserved for severe cases that have not responded to other treatments.
These timeframes describe treatment classes, not a guarantee for an individual patient. The dose, treatment area, health history and biological response all affect the result.
Which treatment is usually considered for each body area?
Treatment choice changes according to where the sweating occurs and how much it interferes with daily life.
Underarm sweating
Strong antiperspirants are usually tried first. Botulinum toxin type A, microwave thermolysis, oral medicine or a local sweat-gland procedure may be considered when topical treatment has not worked.
Sweaty hands
Iontophoresis is a common next step after antiperspirants. Botulinum toxin may reduce hand sweating, but this use can be off-label and temporary grip weakness is a recognised risk.
Sweaty feet
Antiperspirants and iontophoresis are commonly considered. Botulinum toxin injections can be painful in the soles and may be used off-label only after a detailed assessment.
Face and scalp sweating
Facial and scalp sweating requires careful diagnosis because treatment close to facial muscles and eyes has additional risks. Topical treatment, medicine or specialist injection treatment may be considered, depending on the exact area and cause.
Generalised sweating
Sweating across much of the body requires assessment for a medical or medicine-related cause. Whole-body symptoms should not be treated as a cosmetic concern until secondary hyperhidrosis has been considered.
Can hyperhidrosis be cured permanently?
Primary hyperhidrosis has no guaranteed permanent cure, but treatment can reduce the frequency and severity of sweating. Antiperspirants, iontophoresis, medicines and botulinum toxin require continued or repeat treatment.
Microwave thermolysis and local surgery are intended to produce lasting reduction in the treated underarm sweat glands. Thoracic sympathectomy produces a long-term change in nerve signalling but carries a substantial risk of compensatory sweating.
Secondary hyperhidrosis may improve when its underlying cause is treated or when a responsible medicine is safely changed by the prescribing clinician.
Will treating one area make me sweat somewhere else?
Compensatory sweating is most strongly associated with endoscopic thoracic sympathectomy. It can affect the back, chest, abdomen, legs or other areas and can be more troublesome than the original symptoms.
Increased sweating elsewhere has been reported after some local treatments, but it is not the expected main effect of antiperspirants, iontophoresis or botulinum toxin. Oral anticholinergic medicines act throughout the body and can reduce overall heat tolerance instead.
Is hyperhidrosis the same as body odour?
Hyperhidrosis and body odour are different conditions. Eccrine sweat is mostly water and salt and is usually odourless when it reaches the skin.
Odour develops when skin bacteria break down components of sweat, particularly in areas with apocrine glands such as the underarms. Reducing sweat may help, but persistent odour can need separate assessment for bromhidrosis, infection or another skin condition.
What is the difference between deodorant and antiperspirant?
Antiperspirant reduces sweat by temporarily blocking sweat ducts. Deodorant is intended to reduce or mask odour and does not usually reduce the amount of sweat produced.
A product labelled as both an antiperspirant and deodorant addresses both concerns. People with hyperhidrosis may need a stronger aluminium salt preparation than a standard cosmetic product.
What should I expect at an excessive sweating consultation?
An excessive sweating consultation should establish where the sweating occurs, when it began, whether it happens during sleep and how it affects everyday activities. The clinician should also review medicines, medical conditions, previous treatments and family history.
The skin and sweating pattern may be examined, and further medical testing or GP referral may be recommended if secondary hyperhidrosis is possible. Treatment should proceed only when the diagnosis, likely benefit, risks, alternatives and repeat-treatment requirements are clear.
At PHI Clinic, the consultation includes assessment, prescriber involvement, consent process and whether diagnostic testing or GP referral is available.
Who may not be suitable for procedural treatment?
Suitability depends on the selected treatment, the body area and the patient’s health. Active skin infection, an allergy to a treatment component, pregnancy, breastfeeding, neuromuscular disease, implanted electrical devices and medicines that affect nerve or muscle function can alter which options are safe.
These are not universal exclusions for every treatment. An individual consultation and assessment are required before any injectable, energy-based or invasive procedure.
How much does excessive sweating treatment cost in London?
The cost depends on the body area, severity, treatment type and whether repeat or maintenance sessions are required. A quote should state whether it covers the consultation, treatment of one or both sides, follow-up and any repeat procedure.
PHI Clinic’s consultation fee is £125 and treatment prices are displayed above.
Is excessive sweating treatment available through the NHS?
A GP can assess excessive sweating, review possible underlying causes and recommend or prescribe stronger antiperspirants. Referral for iontophoresis, medicine, botulinum toxin treatment or surgery depends on local NHS criteria and service availability.
The NHS may require evidence that conservative treatments have been tried first. Private treatment does not replace medical investigation when sweating begins suddenly, occurs at night or is accompanied by other symptoms.
What results should I realistically expect?
A successful result means sweating interferes less with clothing, work, exercise, social contact or daily tasks. Complete and permanent dryness is not a realistic promise for most treatments.
Results vary by diagnosis, body area and treatment. Temporary options require maintenance or repeat appointments, while longer-lasting procedures carry different recovery periods and risks.
Which clinical sources support this page?
The treatment pathway, diagnostic information and risk discussion on this page draw on the following medical and professional sources:
Primary Care Dermatology Society: Hyperhidrosis
American Academy of Dermatology: Hyperhidrosis
International Hyperhidrosis Society
Mayo Clinic: Hyperhidrosis diagnosis and treatment
NICE: Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb
How do strong antiperspirants treat hyperhidrosis?
Strong antiperspirants containing aluminium salts temporarily block sweat ducts and reduce the amount of sweat reaching the skin. Aluminium chloride hexahydrate is commonly recommended as an early treatment for focal hyperhidrosis.
It is usually applied to completely dry skin at night and washed off in the morning, following the product or prescriber’s directions. Once sweating is controlled, applications may be reduced to a maintenance schedule.
Skin irritation, itching and stinging are common drawbacks. Application to broken or recently shaved skin can increase irritation, and a clinician or pharmacist can advise on changing frequency or treating irritation.
Frequently asked questions about excessive sweating treatment
Primary hyperhidrosis is not usually dangerous, but it can cause sore skin, recurrent infections and marked disruption to daily life. Generalised sweating, night sweats or a sudden change can indicate another medical condition and should be assessed.
Primary hyperhidrosis can activate sweat glands without heat or exercise. Stress and anxiety can also stimulate the sympathetic nervous system, so sweating may occur in a cool room or during a quiet activity.
Underarm hyperhidrosis can produce sweat faster than clothing can absorb or evaporate it. A clinician can distinguish persistent focal hyperhidrosis from sweating caused by heat, medicine, hormones or another medical condition.
Anxiety can trigger or worsen sweating through the sympathetic nervous system. Persistent sweating that also occurs when someone feels calm may still be primary or secondary hyperhidrosis and warrants assessment.
Botulinum toxin type A can produce a substantial reduction in underarm sweating, but complete dryness is not guaranteed. The effect is temporary and commonly lasts four to 12 months.
Underarm injections are usually described as brief pinpricks, with tenderness or bruising possible afterwards. Hand and foot injections are more sensitive, so pain-control options should be discussed before treatment.
Treatment uses multiple small injections spaced across the sweating area. The exact number depends on the prescribed product, dose, mapped area and clinician’s technique, so it can be confirmed only after assessment. Anticholinergic medicines may be unsuitable for people with conditions such as narrow-angle glaucoma, urinary retention, some bowel disorders or myasthenia gravis. A prescriber must review the patient’s health and other medicines.
Most people can return to non-strenuous daily activities on the same day, although the area may feel tender. Patients must follow the treating clinician’s instructions on exercise, heat exposure, rubbing the area and skin products.
Repeat timing depends on the chosen treatment. Botulinum toxin commonly lasts four to 12 months, while iontophoresis may need maintenance every few days or weeks and antiperspirant must continue on a regular schedule.
Some medicines and procedures are avoided during pregnancy or breastfeeding because safety data are limited. A prescriber must assess the proposed treatment, and postponing elective treatment may be advised.
Hyperhidrosis often begins during childhood or adolescence, but treatment choice depends on age, severity, product licensing and clinical need. Younger patients should first be assessed by a GP, dermatologist or clinician experienced in treating hyperhidrosis in that age group.
Exercise guidance depends on the treatment. Oral anticholinergic medicines can impair cooling, while injectable, energy-based and surgical procedures have different recovery instructions.
Local underarm treatment can be appropriate after assessment, but no procedure is risk free. The risks vary from temporary irritation with antiperspirants to swelling and altered sensation after microwave treatment, or scarring and infection after surgery.
An individual assessment is the safest way to distinguish primary from secondary hyperhidrosis and compare treatments for the affected body area. The consultation should cover expected duration, repeat sessions, recovery, contraindications and material risks.
Suitability depends on the selected treatment, the body area and the patient’s health. Active skin infection, an allergy to a treatment component, pregnancy, breastfeeding, neuromuscular disease, implanted electrical devices and medicines that affect nerve or muscle function can alter which options are safe.
These are not universal exclusions for every treatment. An individual consultation and assessment are required before any injectable, energy-based or invasive procedure.
A successful result means sweating interferes less with clothing, work, exercise, social contact or daily tasks. Complete and permanent dryness is not a realistic promise for most treatments.
Results vary by diagnosis, body area and treatment. Temporary options require maintenance or repeat appointments, while longer-lasting procedures carry different recovery periods and risks.
Location
PHI Clinic
102 Harley Street,
London,
W1G 7JB,
United Kingdom
Tel: 02070345999
Opening Hours
Monday & Tuesday - 9:30am to 6:00pm
Wednesday & Thursday - 9:30am to 8:00pm
Friday - 9:30am to 5:00pm
Saturday - 11:30am to 12:30pm
Sunday - Closed
Opening times can change, if your appointment is outside of these times please contact the clinic for confirmation.
