Some patients come to my practice carrying a bag full of specialist deodorants. Some have already seen three dermatologists. They all say the same thing: "I have tried everything." Hyperhidrosis — pathological excessive sweating — affects roughly one to three percent of the population. And for those affected, it is far more than a cosmetic issue.
What is hyperhidrosis?
Hyperhidrosis is excessive sweating that goes far beyond normal temperature regulation. Those affected sweat:
- Even in cool temperatures
- Without physical exertion
- Disproportionately in stressful situations
- So heavily that it interferes with daily life
Primary hyperhidrosis (with no identifiable underlying cause) usually occurs locally: underarms, hands, feet, or forehead. It often begins during puberty and accompanies those affected throughout their lives.
How much of a burden is hyperhidrosis?
The impact extends well beyond the physical sweating itself:
- Professional life: Fear of handshakes, visible sweat patches in meetings
- Social life: Avoiding hugs, withdrawing from social situations
- Emotional wellbeing: Shame, insecurity, anxiety about the next "episode"
- Practical concerns: Limited clothing choices, changing clothes multiple times a day
Many sufferers endure years of distress before learning that effective treatment options exist.
What treatment options are available?
Level 1: Antiperspirants
Specialist deodorants containing aluminium chloride can help with mild hyperhidrosis. They temporarily block the sweat glands. The downside: they can irritate the skin and are often insufficient for severe cases.
Level 2: Medical treatment
The same active ingredient used for wrinkle treatments can also stop excessive sweating. The hyperhidrosis treatment is one of the most effective medical applications in my practice. It blocks the nerve impulses to the sweat glands, causing them to produce significantly less sweat.
Advantages:
- Highly effective (80 to 90 percent reduction)
- Fast onset (within three to seven days)
- Long-lasting (four to nine months)
- No downtime
Level 3: Further options
In very severe cases, iontophoresis (electrical current therapy) or — as a last resort — surgical procedures are available. However, these are rarely necessary.
How does the treatment work?
- Diagnosis: We identify the affected areas and assess the intensity
- Iodine-starch test: Makes the sweat zones visible
- Numbing: Numbing cream for sensitive areas (hands, feet)
- Injection: Many small injections in a grid pattern across the affected area
- Follow-up: After two weeks, we assess the result
The treatment takes approximately 30 to 45 minutes depending on the area. Most patients describe it as very manageable — a light pricking sensation.
Which areas can be treated?
- Underarms: The most common treatment area, with excellent results
- Hands: Possible, but slightly more involved due to the many nerves
- Feet: Similar to hands
- Forehead: Particularly for severe forehead sweating
What does the treatment cost?
- Underarms: from 449 euros
- Hands: from 549 euros
- Forehead: from 349 euros
Important: For documented severe hyperhidrosis, some insurance providers may cover part of the costs or offer subsidies. Ask me about this — I can help with the application process.
Is it dangerous to sweat less?
A legitimate question that I hear often. The answer: no.
The body has more than enough other sweat glands to maintain temperature regulation. The treated areas represent only a very small fraction of the total body surface. You will not overheat.
How long does the effect last?
- Underarms: six to nine months, sometimes longer
- Hands and feet: four to six months
- Forehead: four to six months
Many patients report that the effect lasts a little longer with each successive treatment. After several years of regular treatment, some only need a top-up once a year.
Frequently asked questions
Will sweating increase in other areas?
Compensatory sweating is rare, and when it occurs, it is mild. Most patients notice no change in other parts of the body.
Can I exercise right after?
We recommend a 24-hour break from intense exercise and sauna. Normal activities can be resumed immediately.
Is the treatment permanent?
No, the effect gradually wears off after several months. For a lasting result, regular top-ups are needed.
My advice
If excessive sweating restricts your daily life — if you choose your clothes by colour because sweat patches must not show, if you avoid handshakes — then get help. Hyperhidrosis is not a vanity problem. It is a recognised medical diagnosis.
What convinced me most about this treatment is the impact it has on patients' everyday lives. I had a patient who wore a grey t-shirt for the first time in years after her first session. That might sound small. For her, it was enormous. You can find all the details on our hyperhidrosis treatment page.
