Hyperhidrosis is a medical condition defined by excessive sweating. It is generally categorized into two main types: focal and generalized hyperhidrosis. Focal hyperhidrosis, the most common form, typically involves specific body areas like the palms, soles, underarms, or face, and often has no known cause. Generalized hyperhidrosis affects larger areas of the body and is often a secondary symptom caused by an underlying medical condition or medication. Understanding which medical professional to consult is the first step toward finding effective management for this condition.
The Starting Point: Primary Care Providers
A general practitioner or primary care provider (PCP) is the usual first point of contact and performs an initial screening to distinguish between the two types of hyperhidrosis. This evaluation involves a detailed medical history to determine the pattern of sweating, such as whether it occurs only in specific areas or is body-wide, and if it happens during sleep.
Identifying secondary generalized hyperhidrosis is particularly important, as this type requires treating the root cause. The doctor may order blood tests to rule out conditions like thyroid disorders, diabetes, or certain infections that can trigger excessive sweating. Initial treatment typically begins with conservative options, such as recommending over-the-counter or low-strength prescription antiperspirants containing aluminum chloride. If symptoms are not controlled by these initial measures, or if the diagnosis is uncertain, the PCP refers the patient to a specialist.
The Primary Specialist: Dermatologists
Dermatologists are the primary medical specialists for managing hyperhidrosis, particularly the focal type, since the condition involves the sweat glands. They confirm the diagnosis of primary focal hyperhidrosis and offer targeted, non-surgical treatments that are more potent than those available through primary care. This is where patients often find significant, lasting relief after initial treatments have failed.
One of the first specialized treatments a dermatologist may prescribe is a stronger formulation of topical aluminum chloride, which works by physically blocking the sweat ducts. For palmar and plantar hyperhidrosis, iontophoresis is a common and effective second-line therapy. This procedure involves immersing the affected area in shallow water while applying a low-voltage electrical current, temporarily inactivating the sweat glands. Treatments are typically conducted several times per week initially until dryness is achieved, after which maintenance sessions are spaced out.
Dermatologists also administer botulinum toxin injections (Botox), which is a highly effective treatment for axillary (underarm) hyperhidrosis. The toxin works by temporarily blocking the nerve signals that stimulate the sweat glands, with results lasting approximately four to ten months. While this treatment can be used for hands and feet, it is more commonly used for the underarms and requires careful technique. For patients with generalized symptoms or those who do not respond to topical treatments, the dermatologist may prescribe oral anticholinergic medications, which reduce sweating by inhibiting nerve impulses.
Advanced Treatment Specialists
If first- and second-line treatments (prescription antiperspirants, iontophoresis, and botulinum toxin injections) fail, a patient may be referred to an advanced specialist. This step is reserved for individuals with severe, debilitating hyperhidrosis resistant to less-invasive methods. The two main specialists at this stage are thoracic surgeons and neurologists.
Thoracic surgeons become involved when Endoscopic Thoracic Sympathectomy (ETS) is considered. ETS is a minimally invasive surgical option that involves interrupting a segment of the sympathetic nerve chain in the chest that controls the overactive sweat glands. This procedure is most commonly performed for severe palmar or craniofacial hyperhidrosis, but it is considered a last resort due to the potential for compensatory sweating (excessive sweating in new areas).
Neurologists, who specialize in nervous system disorders, may play a role in complex or systemic cases of hyperhidrosis. Because the sympathetic nervous system controls sweating, neurologists are sometimes consulted when an underlying neurological cause is suspected or when systemic treatments are required. They may assist in diagnosing hyperhidrosis secondary to a neurological condition, or administer botulinum toxin injections, particularly for insurance coverage purposes.