Heavy sweating: What causes it and what really helps

Woman stands in the hallway on a hot day trying to relieve her high body temperature with her fan so that she doesn’t sweat so hard.

Clammy hands when shaking hands, a shirt soaked through just minutes into a meeting – heavy sweating is more than just uncomfortable, it can become a daily burden. But what actually affects our sweating? When does it become an illness? And more importantly: What can be done?

Irena Ristic – CSS editor
| 3 Min. Reading Time

Heavy sweating (hyperhidrosis) – key facts

Sweating is the body's vital cooling system. Millions of sweat glands regulate body temperature, preventing overheating in hot weather or during physical activity.

Excessive sweating that occurs regardless of temperature or activity may point to hyperhidrosis. Around 2-4% of the Swiss population are affected – especially on the hands, feet, underarms and scalp.

There are three levels of severity, from occasionally damp hands and feet to visibly dripping sweat. Dermatologists make the diagnosis based on symptoms and the patient’s personal circumstances.

  • Primary hyperhidrosis usually starts before the age of 25 and results from an overactive nervous system, without an underlying illness.
  • Secondary hyperhidrosis develops as a symptom of another condition (e.g. thyroid disease) or as a side effect of medication.

Hormonal changes (such as the menopause), stress and certain foods – including alcohol, spicy seasoning or histamine-rich products – can all intensify sweating.

  • Topical treatments: Aluminium-based antiperspirants are used to block the sweat glands.
  • Glycopyrronium bromide cream: This blocks local nerve signals to the glands (available in Switzerland since 2022).
  • Iontophoresis: Mild electric current baths are especially effective for hands and feet.
  • Botox injections: These block sweat gland signals for 6–12 months.
  • Surgery & laser: Intended to permanently destroy or remove sweat glands, but with the risk of compensatory sweating elsewhere.

Hyperhidrosis: when sweating becomes a problem

Sweating is essential. Our millions of sweat glands work around the clock to prevent us from overheating during hot weather, exercise or saunas. But when this system goes into overdrive without a clear reason, doctors call it hyperhidrosis – excessive sweating regardless of temperature or activity.

Recognising hyperhidrosis – severity levels

From a harmless overreaction to a disorder requiring treatment, dermatologists categorise hyperhidrosis into three grades:

  • Grade 1: hands and feet are repeatedly clammy.
  • Grade 2: visible sweat beads and noticeable stains on clothing.
  • Grade 3: sweat is visibly dripping from hands and feet.

How is it assessed?

Diagnosis begins with a detailed discussion of the patient’s symptoms, personal triggers and everyday life. Tests often include the iodine-starch test or gravimetric measurement. This is where a precisely weighed filter paper is applied to the skin and weighed again after a few minutes, with the difference showing the sweat volume in milligrams per minute.

In Switzerland, 2-4% of the population live with hyperhidrosis, especially on the hands, feet, underarms and scalp.

Primary or secondary hyperhidrosis? Getting the diagnosis right is vital

Primary hyperhidrosis is an independent condition that often starts before the age of 25. It’s caused by overstimulation of the sweat glands by the sympathetic nervous system – the same one responsible for the "fight-or-flight" response. In those affected, this system switches on without reason.

Typical primary hyperhidrosis signs: Sweating is localised, symmetrical and often runs in families – for example affecting both hands, both feet, underarms and the face.

Secondary hyperhidrosis can indicate a disease

Secondary hyperhidrosis, by contrast, is a symptom – that means it appears as the result of another disease or as the side-effect of medication. Possible causes include:

  • metabolic disorders such as an overactive thyroid (hyperthyroidism), diabetes or Parkinson’s disease
  • tumour diseases or chronic alcohol abuse
  • medication, e.g. dopamine agonists (for Parkinson’s), selective serotonin reuptake inhibitors (SSRIs) from the antidepressants’ product group, or insulin

Why is hyperhidrosis more than a minor issue?

Axillary hyperhidrosis, or heavy underarm sweating, is the most common form. Studies show it can affect quality of life as much as some chronic illnesses. Beyond the physical symptoms, many with the condition suffer from social anxiety and withdraw from everyday activities. This is why researchers in Australia warn that hyperhidrosis is still too often overlooked and undertreated. Only 38% of those affected ever seek medical help – women almost twice as often (48%) as men (29%).

Other causes: hormones and menopause

Heavy sweating isn’t always caused by illness. Hormonal changes can also play a role. During the menopause, many women experience hot flushes and night sweats. Hormone imbalances, such as low progesterone or cortisol, can also affect the body’s temperature. In the same way, thyroid disorders are among the most common triggers of excessive sweating.

Reduce stress to reduce sweating

Stress is another trigger. A tense conversation, time pressure or a packed schedule can be enough to bring on sweating. The reason is cortisol, the body’s key stress hormone. When its levels are elevated, it stimulates the autonomic nervous system. The system overreacts and a vicious cycle follows: Stress increases sweating and sweating increases stress. Regular relaxation exercises, meditation or breathing exercises can help ease sweat production and reduce stress in daily life.

Diet and sweating

Certain foods and drinks can also be triggers: Alcohol, spicy food, fatty meals, garlic or histamine-rich products such as red wine, mature cheese or smoked foods can trigger sweating in some people, especially those with histamine intolerance. Even small changes to eating habits can make a noticeable difference. A balanced acid-alkaline intake also supports metabolism, with an alkaline-rich diet often proving helpful.

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Acid-alkaline balance

A balance of acid and alkaline levels leads to normal metabolism.

Alkaline diet

Treatment: What really helps against heavy sweating

Alongside breathable clothing and home remedies such as sage tea or apple cider vinegar, which may ease milder cases, there are effective medical therapies. For primary hyperhidrosis, doctors usually take a step-by-step approach.

  • Topical treatments: Aluminium-based antiperspirants seal off the sweat glands.
  • Glycopyrronium bromide cream: Has been approved in Switzerland since 2022 for underarm sweating. Has an anticholinergic effect – meaning: The agent glycopyrronium bromide blocks nerve impulses to the sweat glands locally.
  • Tap-water iontophoresis: This is particularly effective for hands and feet. The body parts affected are immersed in a water bath with a mild electrical current.
  • Botulinum toxin injections (Botox): These block sweat gland signals for 6-12 months. Especially effective for underarms, hands and feet.
  • Laser treatments & surgical procedures: Used to permanently destroy or remove the sweat glands (suction curettage) or sever the relevant nerves (sympathectomy). However, surgery carries the risk of compensatory sweating elsewhere on the body.

Regaining peace of mind

Heavy sweating isn’t something you just have to live with. By understanding the causes and taking the right action, many people soon feel a significant improvement – and can enjoy a life relieved of constant worry. Whether with home remedies, medical treatment or a combination of both, there are more options than most people realise. The most important step is to talk about it and book that first appointment with a dermatologist.

Sources

Irena Ristic – CSS editor
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