The Call-On-Doc Guide to Excessive Sweating

Per the American Academy of Dermatology, hyperhidrosis is not diagnosed based solely on how much someone sweats. Common signs include:

• Constant or unpredictable sweating: Sweating that occurs even without heat, exercise, or stress

• Daily life interference: Difficulty with tasks like writing, typing, gripping objects, or wearing certain clothing

• Frequent skin infections: Prolonged moisture increases the risk of fungal or bacterial infections (e.g., athlete’s foot)

• Soft or fragile skin: Chronic moisture can lead to skin breakdown, irritation, or peeling

If sweating interferes with normal activities or causes distress, evaluation is appropriate.

Hyperhidrosis is not typically life-threatening, but it can have a major impact on mental health and quality of life. Many people experience social anxiety, embarrassment, reduced self-confidence, and avoidance of daily or professional activities. Ongoing moisture can also contribute to skin irritation, odor, and infections. Modern treatment focuses on symptom control and quality-of-life improvement.

Hyperhidrosis affects all genders equally. Studies suggest it may be reported more frequently among Caucasian and Asian populations, though no definitive cause has been identified for primary hyperhidrosis. Age is a factor—primary hyperhidrosis often begins before age 30—while secondary hyperhidrosis can occur at any age.

Hyperhidrosis is caused by overstimulation of sweat glands via cholinergic (acetylcholine) pathways. According to StatPearls, it is classified as:

Primary Hyperhidrosis

• Localized (hands, feet, underarms, face)

• No identifiable underlying medical cause

• Due to overactive sweat glands

• Sweating occurs even at rest

Secondary Hyperhidrosis

• Caused by an underlying condition or medication

• Often generalized (whole body)

• Possible causes include endocrine disorders, infections, neurologic conditions, medications, or substance use

Identifying the type guides treatment.

Diagnosis is often clinical, based on history and exam. When testing is needed, Johns Hopkins Medicine notes two commonly used tools:

• Starch-iodine test: Identifies areas of excessive sweating by color change

• Vapometer (sudorometer): Measures sweat rate to assess severity and treatment response

Yes. If excessive sweating affects your daily life, medical evaluation is recommended. With CallOnDoc, you can complete an online consultation, receive a diagnosis when appropriate, and start treatment—all from home.

Management follows a step-based approach, tailored to severity and location:

Prescription Antiperspirants

• Aluminum chloride–based antiperspirants are first-line therapy

• Reduce sweat by temporarily blocking sweat ducts

Topical Anticholinergics

• Glycopyrronium or glycopyrrolate topical agents

• Reduce sweat gland stimulation with fewer systemic effects

Oral Anticholinergic Medications

• Glycopyrrolate or oxybutynin

• Reduce sweat production system-wide

• Used cautiously due to possible side effects (dry mouth, constipation, blurred vision)

Iontophoresis

• Uses low-level electrical current to reduce sweat gland activity

• Especially effective for hands and feet

• CallOnDoc partners with RA Fischer and can assist with insurance authorization

Other Advanced Options (Specialty Care)

• Botulinum toxin (Botox) injections

• Microwave thermolysis

• Surgical options (rare, severe cases)

Hyperhidrosis is typically chronic, but it is highly manageable. While there is no permanent cure, most patients achieve significant symptom relief with the right treatment plan and ongoing care.

If excessive sweating affects you or a loved one, medical evaluation and treatment can make a meaningful difference.