Hyperhidrosis is excessive sweating beyond the body’s physiological need. It often manifests in specific areas like underarms, palms, face, or feet, even at rest or in cool temperatures. This condition can significantly affect daily life, causing social discomfort or embarrassment. Knowing which medical professional to consult is the first step toward effective management.
Your First Stop: Primary Care
Your initial point of contact for excessive sweating is typically a primary care physician (PCP). PCPs assess sweating patterns, medical history, affected areas, frequency, and potential triggers. This evaluation determines if your sweating is primary hyperhidrosis (no identifiable cause) or secondary (due to another medical condition or medication).
To rule out secondary causes, your PCP might order blood or urine tests for conditions like thyroid problems or diabetes. They also review current medications, as some drugs cause excessive sweating. Following assessment, your doctor may suggest initial treatment options, including prescription-strength antiperspirants containing aluminum chloride. If these first-line treatments don’t provide relief, or an underlying condition is suspected, your PCP will provide a referral to a specialist.
Consulting a Specialist
When initial treatments are ineffective or sweating is severe, a specialist consultation is appropriate. The most common specialist for primary hyperhidrosis is a dermatologist. Dermatologists offer advanced treatments like iontophoresis (using low electrical current to block sweat glands, particularly for hands and feet) and botulinum toxin injections (which temporarily reduce sweat production by blocking nerve signals to sweat glands, often effective for underarms). Oral medications that reduce overall sweat gland activity may also be prescribed.
If neurological conditions contribute to hyperhidrosis, a neurologist may be consulted. Conditions like Parkinson’s disease or certain nerve disorders can cause excessive sweating; a neurologist assesses nervous system involvement. Neurologists can also administer botulinum toxin injections.
For severe cases unresponsive to other treatments, a thoracic surgeon might be considered for surgical intervention. The most common surgical procedure is endoscopic thoracic sympathectomy (ETS), which involves cutting or clamping specific nerves in the chest that control sweating. This procedure is a last resort due to its invasive nature and potential side effects like compensatory sweating.
An endocrinologist may be involved if your PCP suspects a hormonal imbalance or endocrine disorder. Conditions like hyperthyroidism or certain types of diabetes can cause generalized excessive sweating. The endocrinologist diagnoses and manages these underlying hormonal issues, which can alleviate hyperhidrosis.
Maximizing Your Appointment
Thorough preparation can maximize your medical appointment. Document sweating patterns: when and where it occurs, triggers (stress, heat), and its impact on daily activities. This detailed symptom history provides valuable insights.
Compile a list of all current medications (including OTC and supplements), allergies, and relevant family medical history, as primary hyperhidrosis can run in families. Prepare questions about potential diagnoses, treatment options, side effects, and prognosis.