Hyperhidrosis occurs when the nerves that stimulate the sweat glands become overactive. There are two main types:

Primary focal hyperhidrosis is the most common form and usually begins during childhood or adolescence. It is not caused by another medical condition and often runs in families. Primary hyperhidrosis most commonly affects the:

• Underarms (axillary hyperhidrosis)

• Palms of the hands

• Soles of the feet

• Face and scalp

Symptoms usually occur on both sides of the body and often stop during sleep.

Secondary hyperhidrosis results from an underlying medical condition or medication. Possible causes include:

• Thyroid disorders

• Diabetes

• Menopause

• Infections

• Certain neurological conditions

• Some prescription medications

If secondary hyperhidrosis is suspected, further investigations may be recommended.

People with hyperhidrosis may experience:

• Excessive underarm sweating

• Constantly damp hands

• Sweaty feet

• Facial or scalp sweating

• Sweat soaking through clothing

• Difficulty gripping objects or writing

• Embarrassment or reduced confidence

• Avoidance of handshakes or social situations

• Skin irritation or recurrent fungal infections

For many people, hyperhidrosis has a significant impact on work, education, relationships and emotional wellbeing.

Diagnosis is usually made during a consultation with a Specialist Dermatologist based on your symptoms, medical history and examination.

Your dermatologist will determine whether you have primary or secondary hyperhidrosis and recommend appropriate treatment.

Additional investigations may occasionally be required if an underlying medical condition is suspected.

Treatment depends on the areas affected and the severity of symptoms.

Options may include:

• Prescription-strength antiperspirants

• Lifestyle advice to reduce sweating triggers

• Prescription topical medications

• Oral medications to reduce sweating

• Iontophoresis for excessive sweating of the hands and feet

• Botulinum toxin (Botox®) injections for excessive underarm sweating

• Referral for surgical treatment in selected severe cases

Treatment is individualised to achieve the best balance between effectiveness, convenience and long-term symptom control.

Botulinum toxin injections are one of the most effective treatments for axillary (underarm) hyperhidrosis.

Tiny amounts of botulinum toxin are injected just beneath the skin, where they temporarily block the nerve signals that activate the sweat glands. This significantly reduces sweating while preserving normal body temperature regulation.

Most patients notice improvement within one to two weeks, with results typically lasting four to nine months before repeat treatment is required.

For eligible patients with severe primary axillary hyperhidrosis, Medicare provides a rebate for botulinum toxin treatment when specific clinical criteria are met. This significantly reduces the out-of-pocket cost, and treatment can generally be repeated every four months if required.

Your dermatologist will discuss whether you meet the Medicare eligibility requirements.

Iontophoresis is particularly useful for excessive sweating affecting the hands and feet.

During treatment, a gentle electrical current is passed through shallow trays of water while the hands or feet are immersed. Although the exact mechanism is not fully understood, this temporarily reduces sweat gland activity.

A series of treatments is usually required initially, followed by maintenance sessions to maintain the benefit.

For patients with more widespread or severe sweating, oral medications that reduce sweat gland activity may be recommended.

These medications can be very effective for selected patients but are not suitable for everyone and may cause side effects such as dry mouth, constipation or blurred vision. Your dermatologist will discuss the potential benefits and risks during your consultation.

Surgery is rarely required and is generally reserved for severe hyperhidrosis that has not responded to other treatments.

The most common procedure is endoscopic thoracic sympathectomy (ETS), which interrupts the nerves responsible for excessive sweating. While highly effective for selected patients, surgery carries important risks, including compensatory sweating elsewhere on the body, and is therefore considered only after less invasive treatments have been explored.

Living with hyperhidrosis

Simple measures that may help include:

• Wearing loose, breathable clothing

• Choosing moisture-wicking fabrics

• Using absorbent shoe inserts or socks

• Applying prescription-strength antiperspirants as directed

• Carrying a spare change of clothing when needed

• Avoiding known triggers where possible

Although these measures can help, many patients achieve much greater improvement with medical treatment.

Our Specialist Dermatologists have extensive experience diagnosing and treating excessive sweating using the latest evidence-based therapies.

We offer:

• Comprehensive assessment

• Individualised treatment plans

• Prescription medications

• Botulinum toxin (Botox®) injections for underarm sweating

• Iontophoresis for hand and foot hyperhidrosis

• Assessment for Medicare rebate eligibility

• Long-term management for chronic hyperhidrosis

Our aim is to reduce excessive sweating, improve confidence and help you return to daily activities without the constant worry of visible perspiration.