Treatment for excessive sweating in London

Why this page starts with your GP

Hyperhidrosis is a recognised medical condition with a defined treatment pathway. It is genuinely disabling for some people, affecting work, clothing and social life, and it is taken seriously by clinicians. It is not a cosmetic complaint and it should not be approached as one.

There are two reasons the GP comes first. The first is that excessive sweating can be secondary to another condition, to a medicine, or to a change such as the menopause, and treating the sweating without establishing why would be a mistake. The second is that effective treatment is available through the NHS, and paying privately for the first step of a pathway you could access anyway is not a good use of your money.

A cosmetic clinic that treats sweating without asking why you sweat has skipped the part that mattered.

The standard pathway

1. Assessment, including which sites are affected, when it started, whether it happens during sleep, and a review of medicines and general health.
2. Antiperspirant containing aluminium chloride, applied to dry skin at night as directed. This is more effective than most people expect when it is used correctly, and most people use it incorrectly.
3. Practical measures: fabric choice, absorbent underarm shields, avoiding known triggers.
4. Where first-line treatment fails, referral or further options including botulinum toxin, oral medication that reduces sweating, or iontophoresis for hands and feet.
5. Specialist referral for severe cases, where further options including surgery may be discussed.

Where botulinum toxin fits

Botulinum toxin blocks the nerve signal that triggers sweat glands, in the same way it blocks the signal to muscle. Injected into the affected skin it reduces sweating in that area for several months. It is a well-established option for underarm sweating where first-line treatment has failed.

Practical points:

• The area is mapped first, sometimes with a starch and iodine test that shows exactly where the sweating occurs.
• Many small injections are given across the area. The underarm is generally well tolerated.
• Onset is over several days to two weeks.
• The effect commonly lasts four to six months and sometimes longer, generally longer than for cosmetic muscle treatment.
• Treatment of the palms is more painful and requires nerve blocks, and carries a risk of temporary hand weakness. It is a more specialised undertaking.
• It is a prescription-only medicine and must be prescribed for you individually after a face-to-face assessment.

What to establish before paying privately

If you have been through the pathway and are considering private treatment, the questions are slightly different from those for a cosmetic procedure:

1. Has a secondary cause been excluded, and by whom?
2. Have you completed a proper trial of first-line treatment, applied correctly?
3. Is the practitioner a prescriber, and are they assessing you in person?
4. Do they map the area, and how?
5. What is their experience with this indication rather than with cosmetic treatment?
6. What happens if the effect is patchy, and is a top-up included?
7. Are they registered with the Care Quality Commission where the service they provide is a regulated activity?

That last point is worth understanding. In England the Care Quality Commission registers providers of regulated activities. Purely cosmetic injectable treatment usually falls outside that, but treating a medical condition may not. It is a reasonable question to ask.

Risks and what to expect

• Bruising and tenderness at the injection sites.
• Compensatory sweating elsewhere, which some people report.
• Patchy effect where mapping was imprecise, usually correctable.
• Temporary weakness of the small muscles of the hand where palms are treated.
• The usual precautions for botulinum toxin, including pregnancy, breastfeeding and neuromuscular conditions.

Aftercare is straightforward. Avoid strenuous exercise, saunas and steam for around twenty four hours, and avoid applying antiperspirant to the treated area for the first day.

Living with it while you work through the options

Practical measures make a genuine difference and are frequently overlooked in favour of procedures.

• Natural fibres and looser cuts; some technical fabrics manage moisture better than cotton.
• Absorbent underarm shields, which are inexpensive and effective.
• Identifying triggers, which for many people include caffeine, alcohol, spicy food and anxiety.
• Treating anxiety where it is part of the cycle, because sweating and anxiety reinforce each other.
• Support organisations, which exist for this condition and are worth finding.

None of this is a substitute for treatment where the condition is severe. It is what makes the interval between appointments tolerable.