How much sweat is too much sweat?

How Much Sweat is Too Much Sweat?

Hyperhidrosis is a medical condition defined as sweating beyond what is necessary to cool the body. It commonly affects the hands, feet, groin, face and underarm. It causes people to sweat excessively even at rest and in cool temperature. In severe cases, Hyperhidrosis can be debilitating condition that affects 3% of the population.


It can be triggered by exercise, stress, and/or embarrassment, but most commonly it is completely without obvious triggers. The excessive sweating often interferes with daily activities, moist hands that sometimes interfere with grasping objects, sweating profusely from their underarms causing them to stain their clothes shortly after they dress.  And, excessive sweating of the feet, makes ones socks and shoes wet, which leads to increased foot odor.

What are the Symptoms?

Symptoms often become noticeable during childhood and adolescence. In many cases sweating can be quite severe, affecting everyday life and causing social embarrassment. It is thought that the excessive sweating may be brought on by stress, emotions or exercise. However, it also can occur spontaneously.

Hyperhidrosis and the Sympathetic Nervous System

The cause of Hyperhidrosis is not well understood.

But what we do know is the the sympathetic nervous system (shown left) is responsible for the fight-or-flight response under stress and important in the control of sweating.

This system may for some reason be overactive in patients who suffer from hyperhidrosis.




Hyperhidrosis can have a serious impact on self-confidence, personal relationships and even career success. But today’s treatments offer hope. Innovative surgical and non-surgical approaches allow you to specifically treat the affected area. It is important for people with hyperhidrosis to have a complete medical evaluation and blood work done to rule out an underlying medical condition which can mimic hyperhidrosis.

Questions include:

  1. Does it occur your face, palms, or armpits, or, all over the body?
  2. What is the time pattern? Does it occur at night? Did it begin suddenly?
  3. What about triggers? For example, does the sweating occur when you are reminded of something that upset you (such as traumatic event)?
  4. What other symptoms do you have?
  • Weight loss
  • Pounding heartbeat
  • Cold or clammy hands
  • Fever Loss of appetite

Some conditions that can present with excessive sweating, such as: medications, diabetes, thyroid disease, neuropathy, heart disease, menopause, spinal cord injury, infections and other problems. During your medical visit you will be asked to fill out self-assessment quiz (HDSS-Hyperhidrosis Disease Severity Scale). There are 6 questions which you score on a severity scale.

Common Treatments

Topical antiperspirant treatments: the “first line” of treatment for severe underarm sweating, over-the-counter antiperspirants work by blocking sweat ducts, thereby reducing the amount of perspiration that reaches the skin. The most widely used ingredients in antiperspirants are metallic salts, including aluminum chloride hexahydrate. Deodorants help control body odor, which is caused by a reaction between bacteria and sweat. The deodorants work by making the skin more acidic, and hence less attractive to bacteria. They are often used in combination with antiperspirants to help control sweating in addition to odor. Prescription Antiperspirants/Deodorants Your doctor may prescribe a stronger antiperspirant for your severe underarm sweating, available from your pharmacist. Like over-the-counter antiperspirants, these also work by blocking sweat ducts, thereby reducing the amount of perspiration that reaches the skin applying aluminum chloride hexahydrate, typically useful only in HDSS 1 or 2 only. Can be quite irritating to the skin.

Medications: At this time there are no medication FDA approved for control of sweating, although some anticholinergic medications ( used for frequent urination) can be tried. However, they typically have side effects, constipation, dry mouth and dizziness that limit there usage.

Alternative Therapy Herbal Remedies: Sage tea or sage tablets, chamomile, valerian root, and St. John’s wort, as well as biofeedback, acupuncture, hypnosis, and relaxation techniques, are sometimes suggested as treatments for severe underarm sweating.

Iontophoresis: applying low-intensity electric current for treatment of the hands or feet – can be time consuming with treatments taking 30 min per area and initially are done 3-4 times per week.

Surgery: Surgical approaches have been used to treat severe underarm sweating, but they are usually reserved for the most extreme cases that do not respond to other treatments. One of the most common types of surgery used today for this condition is called endoscopic thoracic sympathectomy(ETS). This is a surgical procedure performed by a specially trained thoracic surgeon who destroys the sympathetic tracks at the levels appropriate to the patient’s problem area. Other types of surgery sometimes used for severe underarm sweating include liposuction and removal of the sweat glands under the armpits.

The BOTOX® Alternative

Used to treat HyperhidrosisBOTOX® treatment is approved by the FDA to treat the symptoms of severe underarm sweating when medicines used on the skin (topical) do not work well enough.

BOTOX® neurotoxin is injected into the affected areas to help control this condition by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating stops. Since the treatment is virtually painless, the underarms, face and head, can be treated without anesthesia. Hands and feet need some anesthesia. Side effects are minimal

Treatment using Botox for HyperidrosisThe 95% effectiveness of BOTOX®–treated patients responded at week 1 with an average sweat reduction of 83%, and by week 16 82% of people still had an average sweat reduction of 69%. Treatment typically 4 to 7 months when treated with 50 U per axilla. The procedure involves identifying the area of sweating production using iodine and starch treatment. Then the area is treated with multiple injections of BOTOX® using a tiny needle. Most people need 50u of BOTOX® for each armpit, which is 25 injects for each armpit.

The cost for actual BOTOX® treatment for hyperhydridosis is $8 a unit of BOTOX®. Some insurance companies will pay for the consultation and treatment. If your insurance company does cover the procedure we will need to document your diagnosis and response to treatments which can take several months for approval.

Information provided on this website and in the Doctor’s Blog is for informational and educational purposes only. It is not intended as and does not substitute for medical advice. Please consult your health care professional for evaluation of your individual case.

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