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Hyperhidrosis

Medically reviewed. Last Edited on 2026-02-20

Hyperhidrosis means that the body sweats more than is actually necessary. The sweat glands operate in ‘continuous mode,’ even when it is not hot and there is no physical exertion. The armpits, hands, or feet are particularly often affected, sometimes also the face or other body areas.

The cause is not a ‘nervousness problem’ or lack of hygiene, but rather a malfunction of the nerves that regulate sweating. These nerves send too many signals to the sweat glands, even though the body does not require cooling. This predisposition often has a genetic background, meaning it is hereditary.

Hyperhidrosis is a physical condition that affects many people and can be effectively treated today. No one should feel ashamed of it.

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Overview

What is hyperhidrosis?

Hyperhidrosis means “excessive sweating” (literally translated from Greek: hyper = too much, hidros = water, thus too much sweat). The sweat glands are excessively activated and produce much more than necessary without a physical reason such as heat or exercise. This can happen spontaneously or sometimes even at night.

Sweating is inherently vital, as it cools the body and protects against overheating. In hyperhidrosis, however, this mechanism runs out of control. The autonomic nervous system, which normally controls sweating automatically, sends signals to the sweat glands that are too strong or too frequent.

What are the types of hyperhidrosis?

There are two main forms of hyperhidrosis:

  • Primary Hyperhidrosis: Occurs without an identifiable underlying condition. It often begins in childhood or puberty, usually affects specific body areas, and typically stops during sleep. The exact cause is not yet fully understood, but genetic factors likely play a role.
  • Secondary Hyperhidrosis: Is triggered by another illness or medication. Unlike the primary form, it often affects the entire body and can also occur at night.

How common is hyperhidrosis?

Hyperhidrosis is actually far more common than most people assume. Estimates suggest that approximately 1 to 5 percent of the population is affected, which corresponds to several million people in Germany alone. Many still do not seek medical help because they are unaware that hyperhidrosis is a recognized and highly treatable condition.

Symptoms

What are the symptoms of hyperhidrosis?

The main symptom of hyperhidrosis is sweating that exceeds normal levels. It can be so severe that sweat visibly penetrates through clothing or drips from the hands. Typical of the primary form is that sweating occurs at rest or with mild emotional tension, such as when shaking hands, typing, or speaking.

Typical signs include:

  • Your clothing is soaked with sweat within a short time.
  • Beads of sweat form without physical exertion.
  • Your hands are so wet that objects slip from your grasp.
  • You need to change your clothing several times a day.
  • Sweating often occurs very suddenly, known as sweating attacks.

Those affected often also suffer from accompanying symptoms. The skin can soften due to constant moisture, which promotes fungal infections or inflammation. An unpleasant odor can also develop. This places a significant burden on many people in their social lives.

Where does hyperhidrosis occur?

With primary hyperhidrosis, sweating usually occurs only in specific areas of the body. These are referred to as focal areas, meaning clearly defined zones. The most common are:

  • Face and scalp (Craniofacial hyperhidrosis [Blog post])
  • Groin and genital area (Inguinogenital hyperhidrosis [Blog post])

Often, several of these areas are affected simultaneously. Secondary hyperhidrosis, on the other hand, frequently occurs throughout the entire body.

Causes

What are the causes of hyperhidrosis?

In primary hyperhidrosis, the exact cause is not yet fully understood, but there is a genetic predisposition. What is known: The autonomic nervous system controls the sweat glands, and in hyperhidrosis, this nerve control is overactive and sends too many signals without an external stimulus alone explaining it. Stressful situations, heat, or excitement can trigger and intensify sweating, but they are not the actual cause.

Secondary hyperhidrosis is different. Here, another condition is behind the excessive sweating. Possible triggers include:

  • Hyperthyroidism (overactive thyroid)
  • Diabetes mellitus
  • Menopause
  • Infectious diseases or chronic inflammation
  • Neurological disorders (e.g., Parkinson’s disease)
  • Obesity

Medications that can trigger sweating

Some medications can cause excessive sweating as a side effect. This is more common than many think and is often not recognized as such. These medications include:

  • Certain antidepressants (especially SSRIs and SNRIs)
  • Fever-reducing medications such as acetylsalicylic acid or ibuprofen
  • Certain blood pressure medications
  • Morphine and other opioid pain medications

If you are unsure whether a medication is triggering your sweating, you can schedule an appointment with one of our specialists at any time.” [Schedule an appointment]

Is hyperhidrosis hereditary?

There is clear evidence that primary hyperhidrosis runs in families. Studies show that over two-thirds of those affected have at least one family member with the same symptoms. In cooperation between the DHHZ and the Research Institute for Psychobiology at the University of Trier, genetic loci have been identified. Hyperhidrosis is hereditary.

Diagnosis and tests

How does a doctor diagnose hyperhidrosis?

The diagnosis of hyperhidrosis is primarily clinical, meaning it is based on a discussion with the patient and a physical examination. Your doctor will ask how long the sweating has been occurring, where exactly, whether it happens at night, and if any triggers are known. Additionally, it will be checked whether an underlying condition could be the cause.

Standardized questionnaires, such as the Hyperhidrosis Disease Severity Scale (HDSS), help to assess the severity and find the right treatment.

If the symptoms are causing you significant distress, an initial evaluation with your primary care physician may be advisable. For a specialised diagnosis and treatment, you can also book an appointment with us directly. [Schedule an initial consultation]

What tests are available to diagnose hyperhidrosis?

In addition to the discussion, there are several diagnostic tests that can help with the diagnosis:

  • Iodine-starch test (Minor’s test): An iodine solution and starch powder are applied to the skin. Areas with excessive sweat turn black, making the affected zone visible.
  • Gravimetry: The amount of sweat is measured directly by collecting it on filter paper, which is then weighed. This provides an objective measurement of how much sweat is actually produced.
  • Sudometry: This examination visualizes the stimulus-response regulation of sweating. The dynamics of sweating differ in hyperhidrosis from “normal sweating” and are measurable. Sensors are attached to the skin, sweating is then provoked, and the sweating response to the stimulus is measured dynamically.
  • Apparatus-based and blood tests: If secondary hyperhidrosis is suspected, further investigations may be necessary. For example, thyroid values, blood sugar, hormone levels, and other parameters are checked. Alternatively, imaging procedures such as CT or MRI may be required for further clarification.

Not all tests are always necessary. Which examination is appropriate depends on your individual situation. You can also take our free [Online Quick Check] in advance to better assess whether a medical evaluation is recommended. We offer a brief complimentary video call here, and after 12 minutes you will have clarity on how to proceed.

Treatment

How is hyperhidrosis treated?

There are many effective treatment options for hyperhidrosis. They are usually applied in stages, ranging from simple home measures to medical interventions. The appropriate treatment depends on the severity of the symptoms and the affected body areas.

Hyperhidrosis Treatment at Home

As a first step, special antiperspirants containing the active ingredient aluminum chloride are recommended. This temporarily blocks the sweat gland ducts, thereby reducing sweat production. These products are available without a prescription and are applied to dry skin in the evening. They can be effective for mild hyperhidrosis.

  • Wear breathable clothing made of natural fibers so that sweat evaporates more quickly
  • Functional clothing, made of materials such as polyester, transports sweat away from the skin more quickly to the next layer of clothing, ensuring a drier skin feel.
  • Regular changing of socks and insoles for foot hyperhidrosis [Blog post: Sweaty feet – what really helps?]

Hyperhidrosis Medication

For many sufferers, antiperspirants are only the first step. If they are insufficient, pharmacological options are available. These medications inhibit the nerve signals to the sweat glands, thereby reducing sweat production. They are available in two forms:

  • As tablets: These act on the entire body and can regulate overall sweating as needed. They are very well tolerated and have reasonably minor side effects, such as dry mouth.
  • Topically effective cream: A relatively new and little-known cream, originating from Germany, has been developed with significant support from DHHZ. Specifically developed for axillary hyperhidrosis, the medication Axhidrox® is applied directly to the affected area, travels through the skin to the glandular nerves, and inhibits the sweating signal. What makes it special: It offers direct action and fewer side effects, as only a small amount of the active ingredient is distributed throughout the body. More information about Axhidrox® can be found here: [Axhidrox]

Drug treatment can also be monitored as an online treatment at the DHHZ. You can find more about medications for hyperhidrosis here: [Medications for hyperhidrosis treatment]

Further hyperhidrosis therapies

Beyond a certain degree of severity, specialized therapies are used that specifically target the sweat glands.

  • Tap-water iontophoresis: Hands or feet are immersed in trays of tap water through which a weak direct current flows. The procedure has been proven to reduce sweat production and has hardly any side effects. At the beginning, daily applications are necessary, which is why we prescribe such systems for home use. Once the effect has set in, maintenance sessions are sufficient. Devices are also available for home use. More information: [Tap-water iontophoresis]
  • Botulinum Toxin Injections: Botulinum toxin, often colloquially referred to as Botox®, is injected directly into the affected skin areas. It blocks nerve signals to the sweat glands and is particularly effective for underarm, hand, and foot sweating, but can also be used in all other body regions. The effect typically lasts 4 to 9 months and must be repeated thereafter. Details: [Botulinum toxin for hyperhidrosis]
  • Thermotherapy (miraDry®): The miraDry microwave therapy ablates the sweat glands without external injury. Since sweat glands do not regenerate, the effect is permanent. MiraDry was developed for the treatment of underarm sweating and is also used at the DHHZ for sweating on the torso, buttocks, and intimate areas. Further information: [miraDry]

Hyperhidrosis Surgery

For severe hyperhidrosis that does not respond to other therapies, surgical intervention may be considered.

The most common method for therapy-resistant hand sweating is Endoscopic Thoracic Sympathectomy, or ETS for short, or ETSC, as performed at our DHHZ, where we carry out the sympathetic blockade with clips. In this procedure, titanium clips are clamped onto the sweat nerve, interrupting the nerve impulses that control sweating in the hands, armpits, or head.

Sweaty feet can also be surgically treated with a sympathetic blockade. This operation is called ELSC, Endoscopic Lumbar Sympathetic Clip Blockade, and results in sustainably dry feet.

A sympathetic blockade is permanently effective but involves surgery with risks and side effects. The most significant side effect is certainly compensatory sweating, which always occurs after ETSC and much less severely after ELSC. We have special information on this: [compensatory sweating].
For this reason, surgery is only considered when all other therapies have not yielded sufficient success. And we can estimate compensatory sweating through special examinations.
More information: [Surgery / ETS]

Are there any side effects of the treatment?

The side effects that may occur depend heavily on the treatment chosen and vary greatly from person to person. This is why a therapy tailored to you personally is so important. [Schedule Appointment]

Antiperspirants are generally well tolerated, but may occasionally cause irritation in sensitive skin. Anticholinergics in tablet form work systemically and are therefore more frequently associated with side effects such as dry mouth, and less commonly with vision problems or constipation. Botulinum toxin injections are usually well tolerated, although temporary pressure pain at the injection site or slight muscle weakness are possible.

Surgery, like any procedure, carries risks and side effects, and therefore the level of distress and the chance of success must be carefully weighed.

Thorough examinations, a clear diagnosis, comprehensive information about all available treatment options, and an experienced team to support you will bring you the best treatment outcome.

How long does the treatment take?

How long a treatment lasts cannot be stated generally, as it depends heavily on the chosen method. Antiperspirants and iontophoresis are not one-time measures; they only work as long as they are used regularly. Botulinum toxin lasts several months and must then be repeated. Surgical procedures are generally permanent.

Hyperhidrosis is often a chronic condition. However, this does not mean that you have to suffer permanently. It may be that treatment needs to be continued long-term.

Frequently asked questions

What can I expect in the long term?

Hyperhidrosis can be treated effectively in many cases. If the therapy suits you, sweating can be significantly reduced, and for some people, it approaches a normal level again. This often makes everyday life noticeably easier and can significantly improve the quality of life.

In primary hyperhidrosis, it can also happen that the symptoms subside on their own over time, for example, after puberty or in older adulthood. However, this cannot be predicted with certainty. Many affected individuals have the condition for years, some even permanently.

When should I see a doctor?

You should consult a doctor if:

  • sweating restricts your daily life, work, or social life
  • you suddenly start sweating heavily, which you haven’t experienced before
  • sweating occurs at night and wakes you up
  • fever, unintentional weight loss, or other symptoms occur
  • you have tried initial self-measures that have not helped

Night sweats and generalized sweating all over the body are warning signs that should be medically evaluated – they can indicate an underlying condition.

Which doctor should I see for hyperhidrosis?

Often, the family doctor is the first point of contact. They can assess whether another cause is behind the sweating and whether further examinations are useful. If necessary, you will also receive a referral.

For hyperhidrosis itself, dermatologists are often responsible. They can classify the symptoms and discuss with you which treatment options are generally available.

If you would like a specialized evaluation and clear treatment plan from the start, you can also contact the German Hyperhidrosis Center directly. We will carefully review your situation and discuss together which next steps make sense. You can schedule an initial appointment here. [Appointment]

Will health insurance cover the treatment?

Whether health insurance covers costs depends on the individual case. . Some treatments, such as iontophoresis or botulinum toxin, may be covered by statutory health insurance if a medical certificate proves their necessity. Other therapies, such as miraDry, are usually billed privately.

Since health insurance companies can make different decisions in individual cases, it is worthwhile to clarify the cost issue specifically before starting treatment. Seek advice from the practice and additionally inquire directly with your health insurance company. This way, you will know early on what documents are needed and what you can expect.

Experts you can trust

Medically reviewed by PD Dr. Schick. Last updated on 2026-02-15

Created by the DHHZ editorial team. Medically reviewed by specialists. Based on evidence-based information and current clinical standards.

  • Lin Z., Lin M. Which patients are more likely to experience compensatory hyperhidrosis after endoscopic thoracic sympathectomy: a meta-analysis and systematic review (https://peerj.com/articles/19097/). Retrieved on February 15, 2026.
Sweat drops on skin

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