For this interview we turned to Dr Dimitris Rigopoulos, the founder and Co-Editor-in-Chief of the scientific journal Skin Appendage Disorders. Whether you actually suffer from hyperhidrosis, suspect you might be affected by this disorder or, as a healthcare professional, face the challenge of diagnosing and treating hyperhidrosis – here are the insights of an expert! Please also note that November is Hyperhidrosis Awareness Month.


First of all, what is hyperhidrosis?

Hyperhidrosis is the condition where we have uncontrollable overproduction of sweat, in amounts beyond what is important to maintain constant body temperature. This is due to an overstimulation of certain receptors on the eccrine sweat glands, which are simple, coiled, tubular glands present throughout the body. Hyperhidrosis affects almost 3% of the population and is more common in people between the ages of 20 to 60 years. Both sexes and all races are affected equally.

“Hyperhidrosis affects almost 3% of the population.”

What are the causes for hyperhidrosis, and is it a hereditary condition?

Hyperhidrosis is subdivided into primary and secondary hyperhidrosis.

  • Primary hyperhidrosis is bilaterally symmetrical, focal excessive production of sweat and it involves the armpits, palms, soles, groin, head and face. It’s about younger patients, patients suffering for more than 6 months, those with a family history and those with bilateral involvement. Patients suffering from this condition experience a negative influence on their quality of life and on their well-being, comparable to many common inflammatory dermatologic diseases. The cause of primary hyperhidrosis remains obscure. It is possible that genetic factors may play a role in the development of the disorder, despite that it is not considered a hereditary disease.
  • Secondary hyperhidrosis can be focal or even generalized, its symptoms start later in life, and it is caused by an underlying disease, mainly neurological (e.g. Parkinson’s disease), or use of medication, such as dopamine antagonists, antipsychotic drugs, etc.
“The cause of primary hyperhidrosis remains obscure.”

What are the treatment options?

It is a promising time to deal with primary hyperhidrosis, as we have a great number of surgical and non-surgical treatment modalities.

Non-surgical treatment includes topically (externally) applied and systematically (internally) delivered drugs.

Topically applied drugs:

  • Aluminum chloride hexahydrate 20% for 3–4 nights and then nightly as needed is an easy, popular and over-the-counter topical treatment.
  • Glycopyrronium 0.5–2% solution is also an option.
  • Botulinum toxins are used in the form of topical injections, with excellent efficacy rates.
  • Tap water iontophoresis, which uses electric current, is applied mainly for controlling palmo-plantar hyperhidrosis (excessive sweating from the palms and soles), every 48–72 hours (long-term treatment).
  • Microwave energy thermolysis is also approved by the Food and Drug Administration (FDA) for the treatment of primary hyperhidrosis.
  • A novel device using high-intensity microfocused ultrasonography produces thermal coagulation points within the skin and is now investigated for the treatment of the disorder.
  • Laser therapy with different devices is also an option for such patients.

Systematically administrated drugs are mainly used in patients not responding to topical drugs, injections and different devices.

Oxybutynin (anticholinergic medication) 5–10 mg/day can be used with good results.

Surgical treatments include sympathectomy (removal of the ganglia responsible for sweating), which can be also performed endoscopically.

In secondary hyperhidrosis, it is obvious that treatment of the underlying disease and discontinuation of the possible responsible drug is the treatment of choice.

“We have a great number of surgical and non-surgical treatment modalities.”

What new insights and developments can people expect with regards to the treatment?

Good education of patients is mandatory. Topical application of new drugs that can be effective, or new formulations of older drugs (botulinum toxin in the form of a gel), are future options for better controlling this rather frustrating condition.


Dr Rigopoulos, many thanks for your time and your insights.

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