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Sweating (Hyperhidrosis & Sweat Gland Problems)

Sweating is how your body cools itself, but some people sweat far more than their body needs, and sudden or unexplained sweating can be a warning sign. Most excessive sweating has no dangerous cause and can be treated, yet sweating with chest pain, confusion, or night sweats with fever or weight loss needs prompt medical care.

Call 911 right away if sweating comes with chest pain, pressure or tightness, especially with shortness of breath, nausea, light-headedness, or pain spreading to an arm, the back, the jaw or the neck. NHLBI lists “sweating a lot for no reason” among the symptoms of a heart attack and says not to drive yourself or let someone else drive you (NHLBI, NHS).

Treat sudden heavy sweating with confusion as an emergency. Possible causes include dangerously low blood sugar, which can lead to passing out or a seizure and needs treatment right away (NIDDK); a serious infection (sepsis), where the NHS lists confusion or slurred speech, uncontrollable shivering and a high or low temperature, and says to get medical help immediately (NHS); or heatstroke, where the NHS lists a very high temperature, fast breathing, a fast heartbeat, confusion and hot skin that is not sweating, and calls it a medical emergency (NHS). In the United States, call 911.

Call your doctor promptly (do not wait it out) for: night sweats that soak your night clothes and bedding if you also have a very high temperature, a cough or diarrhea, or are losing weight for no reason. The NHS lists these as reasons to see a doctor rather than emergencies (NHS). Fever for no known reason, drenching night sweats and unexplained weight loss are also listed among the symptoms of Hodgkin lymphoma (MedlinePlus), one of several possible causes your doctor will want to rule out. Also get care quickly for skin that is painful, hot and swollen, because cellulitis needs antibiotics and can become serious if not treated quickly (NHS). MBHA also suggests having any rash in a sweaty area that oozes, smells bad or is spreading looked at.

Nothing on this page is a reason to delay emergency care. Never try an herb, supplement, acupuncture visit or massage first when you have these warning signs.

Normal sweating, and when it is too much

Sweat is a clear, salty liquid made by glands in your skin, and sweating is how your body cools itself. You sweat mainly under your arms and on your feet and palms, and a lot of sweating is normal when it is hot or when you exercise, are anxious or have a fever (MedlinePlus). The NHS describes excessive sweating, or hyperhidrosis, as sweating when your body does not need to cool down; it can affect the whole body or just certain areas, and sometimes gets better with age (NHS). Estimates of how common it is vary: one review puts primary (idiopathic) hyperhidrosis at 2 to 5% of people (Schreiner et al., 2026), and another cites 4.8% of the U.S. population (Hosp and Hamm, 2017).

When sweat mixes with bacteria on the skin it can cause an odor, which bathing and antiperspirants or deodorants can help control (MedlinePlus). See our body odor guide.

On the other side, sweating too little (anhidrosis) can be life-threatening because the body can overheat; causes include dehydration, burns and some skin and nerve disorders (MedlinePlus).

Primary or secondary: two very different situations

Some specific examples from the sources:

Sometimes no cause is found for night sweats (NHS). This is why the botulinum toxin label tells doctors to evaluate for causes of secondary hyperhidrosis, such as hyperthyroidism, rather than only treat the symptom (FDA label).

When to see a doctor (not an emergency)

The NHS suggests seeing a doctor if you are sweating excessively and things you can do yourself are not helping, it has lasted at least 6 months, it stops you doing daily activities, it happens at least once a week, it happens at night, you have a family history of excessive sweating, or you take medicine for another condition. The doctor may arrange tests if another condition may be the cause (NHS). If there is no obvious cause and nothing helps, you may be referred to a dermatologist (NHS).

How it affects daily life

Hyperhidrosis can cause emotional, psychological, social and occupational problems (Brackenrich and Medeus, 2022). A 2026 review of 18 studies (47,053 people) found that about 18% of people with primary hyperhidrosis had depression as measured on validated scales, though the studies varied widely and the comparison with the general population should be read cautiously (Wang et al., 2026). If sweating is keeping you from work, school, relationships or sleep, or you feel low, that is a good enough reason to see a doctor. See our depression guide and anxiety guide. In children, primary hyperhidrosis often begins in childhood or the teen years (Remington et al., 2021).

Related sweat-gland and skin problems

  • Skin infections: wet or sweaty feet raise the chance of athlete’s foot, a fungal infection that can usually be treated with pharmacy creams, sprays or powders but can keep coming back (NHS). See our athlete’s foot guide and cellulitis guide.
  • Hidradenitis suppurativa (HS) is a different problem. It is a painful, long-term skin condition with boil-like lumps, abscesses and scarring that occurs near hair follicles where there are sweat glands, usually in the groin, bottom, breasts and armpits. The NHS says it is not infectious and is not linked to poor hygiene, and that smoking and obesity are strongly associated with it (NHS). It is not the same as hyperhidrosis, but the two can both affect the underarms, so a doctor or dermatologist should tell them apart.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Find any underlying cause, then step up: stronger antiperspirants, prescription anticholinergic cloths or gel, iontophoresis, botulinum toxin injections, anticholinergic tablets, a microwave device for the armpits, and as a last resort surgery. Cost estimate being researched. Evidence is limited overall. Reviews found moderate-quality evidence for botulinum toxin in the armpits and weaker evidence for iontophoresis on the palms. Surgery for the hands can cause sweating elsewhere (compensatory sweating).
Chiropractic No established role in treating excessive sweating. Chiropractic care is aimed at spinal and joint problems, not sweat glands. About $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first visit, per The Pricer. Medicare covers only spinal adjustments for a subluxation. We found little research on chiropractic for hyperhidrosis. Do not let it delay checking for a cause.
Acupuncture Fine needles at acupuncture points. Most studied for menopausal hot flashes and night sweats rather than hyperhidrosis itself. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. A 2026 review found evidence for hyperhidrosis limited to small, often uncontrolled studies. For menopausal hot flashes, benefits were short-term, and NCCIH says acupuncture was not shown to beat sham acupuncture.
Herbal medicine No herb is proven for hyperhidrosis. Sage and black cohosh are sold for menopausal symptoms, with small or uncertain evidence. Cost estimate being researched. We found little research on herbs for hyperhidrosis. NCCIH says only small studies suggest sage might reduce menopausal hot flashes. Herbs can interact with medicines.
Massage therapy Hands-on work for stress and muscle tension. It has no known effect on the sweat glands. One national chain: about $125 to $160 for a 60-minute massage for non-members and about $65 to $90 for members, per The Pricer. Prices vary by location. We found little research on massage for hyperhidrosis. It may help with stress, which can be a sweating trigger, but evidence is limited. Avoid massage over a hot, red, painful skin infection.
MBHA Wellness Coach Everyday habits: breathable clothing and socks, shoe rotation, spotting triggers such as alcohol and spicy food, sleep-room set-up, heat safety, and keeping up with medical follow-up. Cost estimate being researched. Supports — never replaces — a check for underlying causes. The NHS lists these everyday steps as things you can do to help.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on whether the sweating is primary or secondary. If another condition or a medicine is behind it, treating that condition or changing the medicine is the main step, and the NHS says any treatment you need will depend on the cause (NHS, NHS). For primary hyperhidrosis, doctors usually step up from simple measures to stronger ones. The evidence base is modest: a UK systematic review of 50 studies found most were small, at high risk of bias and poorly reported, and concluded that few firm conclusions can be drawn (Wade et al., 2018). A 2026 review likewise found only a few high-quality studies (Schreiner et al., 2026).

Step 1: everyday measures and antiperspirants

  • Everyday steps. The NHS suggests loose-fitting clothes, moisture-absorbing socks changed at least twice a day if possible, leather shoes worn on different days, and avoiding tight or synthetic clothing, enclosed boots or sports shoes, alcohol and spicy food, which can make sweating worse (NHS).
  • Pharmacy products. A pharmacist can suggest stronger antiperspirants instead of deodorant, sweat shields to protect clothing, foot powders and gentler soap substitutes (NHS). Aluminum-based compounds are the active ingredient in antiperspirants; they form a temporary plug in the sweat duct that stops the flow of sweat to the skin’s surface (NCI). Products that are both deodorants and antiperspirants count as both cosmetics and drugs under U.S. law (FDA).
  • Aluminum chloride class. In reviews, topical aluminum chloride is a first-line treatment for mild to moderate sweating, alongside oral anticholinergics (Brackenrich and Medeus, 2022, Schreiner et al., 2026). Reviews list local reactions such as itch, pain and skin irritation among the side effects of first-line treatments (Schreiner et al., 2026). We do not list strengths or schedules; your provider will set these.
  • Safety question. The National Cancer Institute says no scientific evidence links antiperspirant use to breast cancer, though because studies have conflicted it says more research would be needed to be sure (NCI). One drug-safety review notes that concerns about aluminum salts and breast cancer or Alzheimer disease remain unresolved (Hosp and Hamm, 2017).

Step 2: prescription anticholinergic cloths and gels

Hyperhidrosis involves overstimulation of cholinergic receptors on sweat glands (Brackenrich and Medeus, 2022), and anticholinergic medicines work against that signal; the sofpironium label describes it as a competitive inhibitor of acetylcholine receptors on tissues including sweat glands (FDA label). Two prescription products are FDA-approved for primary axillary (underarm) hyperhidrosis in adults and children 9 and older: a glycopyrronium cloth, approved in June 2018 (FDA review), and a sofpironium gel, approved in 2024 (FDA label). A 2026 meta-analysis of 8 randomized trials (1,921 people) found topical anticholinergics outperformed placebo, with side effects such as dry mouth, dilated pupils and constipation; it noted limited, short trials (Kim et al., 2026).

Safety points from the FDA documents: they are contraindicated in conditions that anticholinergic effects can worsen, such as glaucoma, myasthenia gravis or Sjögren’s syndrome; new or worsening urinary retention can occur; blurred vision can occur; accidental eye exposure from touching the eyes or children reaching discarded cloths has caused dilated pupils; the gel is flammable; and, importantly, in hot weather heat illness can occur because of decreased sweating, so users should watch for a general lack of sweating in hot environments (FDA review, FDA label).

Step 3: iontophoresis (a weak current in water)

The NHS describes iontophoresis as treating the areas with a weak electric current passed through water or a wet pad (NHS). A UK review found weak but consistent evidence for iontophoresis for the palms (Wade et al., 2017); one review of palm treatment found a study reporting 81% improvement in symptoms (Chudry, 2022). A dermatology review calls it safe, with minimal side effects, and notes it can be done at home or in the office and combined with other treatments (Pariser and Ballard, 2014). In a 70-person trial of palm and sole sweating, tap water iontophoresis outperformed an aluminum chloride solution over four weeks, with fewer side effects; it was a single-centre study (Rahim et al., 2022). MBHA suggests asking your provider whether iontophoresis is safe if you have a pacemaker, metal implant or are pregnant; we did not find a source we could open that covers this. See our pacemakers, pumps and ventilators guide and metal implants guide.

Step 4: botulinum toxin injections

Botulinum toxin is given as injections into the skin of the affected area. The FDA label covers it for severe primary axillary hyperhidrosis that is inadequately managed with topical agents; safety and effectiveness for hyperhidrosis in other body areas have not been established, weakness of hand muscles can occur with palm treatment, and its use under 18 for hyperhidrosis has not been established. The label carries a boxed warning that toxin effects can spread from the injection area, and in sweating trials the most common reactions were injection-site pain and bleeding, sweating in other areas, infection, flu-like symptoms and headache. Injections are repeated when the effect wears off (FDA label (2021 revision)). Evidence: moderate-quality evidence of a large effect for armpit sweating (Wade et al., 2017); one randomized trial for the palms reported improvement in 90% of people (Chudry, 2022). The NHS notes it may not be available on the NHS (NHS); we did not find a source for U.S. insurance coverage or cost.

Step 5: anticholinergic tablets

The NHS lists tablets that reduce sweating among options a dermatologist may recommend (NHS). In a review of palm hyperhidrosis, two studies of oral oxybutynin, an anticholinergic, found over 80% of people improved, with dry mouth the most common side effect (Chudry, 2022). Other effects can include widened pupils, urinary retention and headache (Schreiner et al., 2026), and reviews say tablets are often limited by side effects and that starting low and increasing slowly helps avoid severe ones (Togel et al., 2002, Hosp and Hamm, 2017). Because the FDA labels for the topical products warn about heat illness from reduced sweating, MBHA suggests asking your prescriber about heat precautions for tablets too.

Step 6: microwave device and other in-office options

For the armpits, a microwave device aimed at the sweat glands has been cleared by the FDA, first in 2011 as an “instrument for treatment of hyperhidrosis” (FDA 510(k) database); the 2018 clearance covers primary axillary hyperhidrosis, and it may also reduce underarm odor (FDA 510(k) summary). In a within-person randomized trial, sweat reduction was significant with both botulinum toxin and microwave treatment, greater with botulinum toxin at 6 months but equal at one year; microwave also reduced hair, and 76% preferred it (Grove et al., 2024). The UK review rated evidence for newer energy-based sweat-gland treatments such as laser and microwave as low or very low quality (Wade et al., 2017). The NHS also lists surgery such as removing sweat glands (NHS), and reviews describe curettage (scraping) for the armpits (Schreiner et al., 2026).

Last resort: sympathectomy and compensatory sweating

Endoscopic thoracic sympathectomy is surgery on the sympathetic nerve ganglia in the chest, used mainly for palm sweating (Schreiner et al., 2026). One review calls it an end-of-line treatment (Wade et al., 2017). Another review found over 95% symptom improvement in two studies, but said it carries significant adverse effects such as compensatory sweating and surgical complications (Chudry, 2022). Compensatory sweating means new, often heavy sweating elsewhere on the body. In a study of 138 people, 78.9% reported it after surgery, nearly a quarter of those severely, and symptoms got worse over five years (Wu et al., 2025). A 20-year follow-up of 106 people (only 24 answered) found most still had dry palms, with sweat shifted to the abdomen and back, and satisfaction stayed high (Ureña et al., 2025). A 2026 meta-analysis of 11 studies (3,090 people) found operating while sparing the T2 nerve level was linked to less compensatory sweating (Delgado et al., 2026). MBHA suggests asking any surgeon how often compensatory sweating happens in their patients before deciding.

Treating menopause-related sweating

For hot flushes and night sweats from menopause, the NHS lists hormone replacement therapy, and non-hormonal options such as cognitive behavioural therapy, clonidine or an antidepressant (NHS). Talk with your doctor about the right choice for you.

Children and teens

A review of treatments for children covers topical, oral, procedural and adjunctive therapies, and highlights the need for more research (Remington et al., 2021). The two topical anticholinergics are approved from age 9 (FDA review, FDA label); botulinum toxin’s safety for hyperhidrosis under 18 has not been established (FDA label).

Cost

Cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care focuses on the spine and joints. Sweat glands are controlled by nerves, and primary hyperhidrosis is thought to involve overactive sympathetic nerves (Maazi et al., 2025), but we found little research testing whether spinal adjustments change excessive sweating. MBHA does not claim chiropractic treats hyperhidrosis.

Safety. NCCIH reports that mild side effects such as soreness and stiffness are common after spinal manipulation and usually go away within 24 hours; serious problems, including strokes involving neck arteries, are very rare (NCCIH). If your sweating arrived suddenly or comes with other warning signs, get it checked first.

Cost. About $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first visit (The Pricer). Medicare Part B covers only spinal adjustments to correct a subluxation, with 20% coinsurance after the deductible (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture for sweating has been studied mostly in menopause rather than in hyperhidrosis.

  • Hyperhidrosis. A 2026 review of acupuncture for hyperhidrosis and flushing found that evidence for primary, emotional and paraneoplastic (cancer-related) sweating is limited to small, often uncontrolled studies with significant methodological shortcomings (Lu et al., 2026). A small Chinese report compared acupuncture with Western medicine in 56 people with spontaneous heavy sweating and reported better results with acupuncture; the abstract does not say how people were assigned or whether anyone was blinded (Wang and Zhao, 2008).
  • Menopausal hot flashes. The same review found multiple trials and meta-analyses supporting short-term improvements in frequency and severity, with effects generally fading by three months after treatment (Lu et al., 2026). NCCIH describes a 2018 analysis in which acupuncture reduced hot flashes and night sweats better than no acupuncture, but was not shown to be better than sham acupuncture (NCCIH).

Safety. Relatively few complications are reported, but nonsterile needles and improper delivery can cause serious problems such as infections or punctured organs; the FDA requires acupuncture needles to be sterile and single-use (NCCIH).

Cost. About $90 to $185 per follow-up visit paying cash, and community clinics near $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb has been shown to treat primary hyperhidrosis. We found little research on herbs for hyperhidrosis itself. Herbs are mostly discussed for menopausal symptoms, and the NHS says that herbal remedies sold for menopause, such as red clover and black cohosh, have very little evidence on how well they work or how safe they are (NHS).

  • Sage. NCCIH says sage is promoted as a supplement for menopause symptoms, among other purposes, but only small amounts of research exist, and the results of a few small studies suggest common sage might reduce the frequency of menopausal hot flashes (NCCIH). One 80-woman randomized trial of a sage extract tablet reported a bigger drop in a menopause symptom score than placebo over four weeks, along with a fall in hot flush severity (sage extract trial, 2021). We did not find studies of sage for hyperhidrosis outside menopause. NCCIH adds that some sages contain thujone, which can be toxic in large amounts or with long use, and that sage may be unsafe in pregnancy (NCCIH).
  • Black cohosh. A 2023 review found black cohosh products potentially beneficial for overall menopause symptoms, with improvements in hot flashes; rare cases of liver damage have been reported and it is uncertain whether black cohosh caused them (NCCIH).

Safety. Supplements are not approved by the FDA before sale (NCCIH), and herbs and medicines can interact (NCCIH). Tell your doctor about every product, especially if you take anticholinergic, thyroid or diabetes medicines. Cost estimate being researched.

Approach 5 of 6

Massage therapy

We found little research on massage for hyperhidrosis, and massage has no known effect on the sweat glands. Where it may help is with stress: NCCIH reports some evidence that massage may ease anxiety in people with cancer, fibromyalgia or HIV, although most studies are small and of low quality (NCCIH). Stress and anxiety can bring on sweating (MedlinePlus), so a relaxing massage may be worthwhile for comfort, but we cannot say it will reduce sweating.

Safety. The risk of harm appears low, but there are rare reports of serious problems such as a blood clot, nerve injury or broken bone, some with vigorous deep-tissue work or in older adults (NCCIH). MBHA suggests avoiding massage over skin that is hot, red, painful or oozing (a possible infection).

Cost. Prices vary by location. At one national chain, franchise price lists show about $125 to $160 for a 60-minute massage for non-members and about $65 to $90 for members, whose memberships run about $70 to $90 a month (The Pricer). Tips are extra.

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Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build everyday habits that make sweating easier to live with, alongside — never instead of — a check for underlying causes.

  • Clothing and shoes. The NHS suggests loose-fitting clothes, moisture-absorbing socks changed at least twice a day if possible, and leather shoes worn on different days; it advises against tight or synthetic clothing such as nylon and enclosed boots or sports shoes (NHS). Wet or sweaty feet also raise the risk of athlete’s foot (NHS).
  • Know your triggers. The NHS lists alcohol and spicy food as things that might make sweating worse (NHS). A coach can help you keep a simple diary of when sweating is worst, including stress, foods, medicines and time of day, to bring to your doctor.
  • Bedroom and night sweats. It is normal to sweat at night if the room or bedding is making you too hot (NHS). MBHA suggests breathable bedding and a cooler room, and noting how often you wake soaked, which the NHS says is worth getting checked if regular (NHS).
  • Stress and anxiety. Anxiety is a common cause of sweating (NHS). A coach can support breathing, relaxation and sleep routines; for ongoing worry, see our anxiety guide.
  • Heat safety. Heat exhaustion causes heavy sweating with pale, clammy skin; the NHS advises moving to a cool place, drinking water and cooling the skin, and says heatstroke, with hot skin that is not sweating, is an emergency (NHS). If you use an anticholinergic medicine, the FDA labels warn to watch for a lack of sweating in hot weather (FDA review).
  • Follow-through. Many treatments work best when used regularly and reviewed. A coach can help you track what helps and prepare questions for your dermatologist.

Cost estimate being researched.

Another approach

Night sweats: a quick guide

Most people sweat during the night, but if you regularly wake up with soaking wet sheets, the NHS says to get it checked (NHS). It is normal to sweat if the room or bedding is too hot. Night sweats are different: your night clothes and bedding are soaked even though where you sleep is cool (NHS).

  • Most common reasons listed by the NHS: menopause symptoms, anxiety, medicines (some antidepressants, steroids and painkillers), low blood sugar, alcohol or drug use, and hyperhidrosis. Sometimes the cause is unknown (NHS).
  • See a doctor if they wake you or worry you, come with a very high temperature (or feeling hot, cold or shivery), a cough or diarrhea, or you are losing weight for no reason (NHS).
  • Bring a list of medicines. If a medicine is the cause, the doctor may prescribe a different one (NHS). Do not stop a medicine on your own.

Another approach

Sweating, heat and heat illness

Sweating is how your body cools itself (MedlinePlus), so problems with sweating can matter in hot weather.

  • Heat exhaustion: tiredness, dizziness, headache, nausea, heavy sweating with pale, clammy skin, cramps and thirst. Move to a cool place, remove extra clothing, drink water and cool the skin; the person should feel better within 30 minutes (NHS).
  • Heatstroke: a very high temperature, hot skin without sweating, fast breathing and heartbeat, confusion, seizure or loss of consciousness. It is a medical emergency; the NHS says not to drive yourself (NHS). In the United States, call 911.
  • If you sweat too little (anhidrosis), the body can overheat, which can be life-threatening (MedlinePlus). Anticholinergic medicines, including the prescription underarm products, can cause heat illness by decreasing sweating (FDA review, FDA label).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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