Excessive Sweating (Hyperhidrosis): Causes, Treatment, and When to See a Dermatologist
If you find yourself sweating excessively — through your clothing, dripping from your palms during a handshake, or avoiding social situations because of it — you may be dealing with a condition called hyperhidrosis. It is more common than many people realise, and it can have a significant impact on daily life, confidence, and comfort.
The good news is that effective treatments exist. At Panorama Dermatology Clinic in Cape Town, I see patients with hyperhidrosis regularly, and most respond well to treatment once we find the right approach.
What Is Hyperhidrosis?
Hyperhidrosis is a medical condition characterised by sweating that goes well beyond what the body needs to regulate temperature. It can affect specific areas — most commonly the underarms, palms, soles of the feet, and face — or it can be more generalised.
There are two main types:
Primary focal hyperhidrosis is the most common form. It typically starts in childhood or adolescence, often runs in families, and affects specific body areas symmetrically. It is not caused by an underlying medical condition — it is simply the result of overactive sweat glands.
Secondary generalised hyperhidrosis develops later in life and is usually linked to an underlying cause such as a thyroid disorder, menopause, certain medications, or other medical conditions. When sweating is new, generalised, or associated with other symptoms, it is important to investigate the underlying cause.
This distinction matters because the treatment approach differs depending on the type.
How Does Hyperhidrosis Affect Daily Life?
Many patients tell me they have been living with excessive sweating for years before seeking help. Some feel embarrassed to shake hands. Others change clothing multiple times a day or avoid certain fabrics and colours. The impact on work, social interactions, and self-confidence can be substantial.
If this sounds familiar, it is worth knowing that hyperhidrosis is a recognised medical condition — not simply a matter of being "a sweaty person." Effective treatment can make a meaningful difference.
Treatment Options for Excessive Sweating
At Panorama Dermatology Clinic, I take a stepwise approach to managing hyperhidrosis, starting with less invasive options and progressing as needed.
Topical Treatments
Prescription-strength antiperspirants containing aluminium chloride are usually the first step. These are applied to the affected areas and work by temporarily blocking sweat gland ducts. They are most effective for mild to moderate underarm sweating.
For some patients, topical glycopyrrolate (an anticholinergic agent) can be helpful, particularly for facial sweating.
Iontophoresis
Iontophoresis is a non-invasive treatment particularly well suited to sweating of the palms and soles. It involves passing a very mild electrical current through water-soaked skin, which temporarily reduces sweat gland activity. Treatments are performed regularly at first and then maintained at longer intervals. Many patients find iontophoresis effective and convenient, especially once they are comfortable performing sessions at home.
I have written in more detail about this treatment in a separate article on iontophoresis for excessive sweating.
Botox (Botulinum Toxin) Injections
Botox is one of the most effective treatments for focal hyperhidrosis, particularly underarm sweating. It works by blocking the nerve signals that stimulate sweat glands. The procedure involves a series of small injections into the affected area and typically takes 15 to 20 minutes.
Results usually become noticeable within a few days, with full effect by two weeks. The improvement typically lasts between four and nine months, after which the treatment can be repeated.
Botox for hyperhidrosis is well supported by clinical evidence and has been used for this indication for many years. When performed by a specialist dermatologist, the procedure is safe, well tolerated, and highly effective. Many of my patients describe it as life-changing.
Oral Medications
In cases where sweating is more widespread or where topical treatments and Botox are not suitable, oral anticholinergic medications such as glycopyrrolate or oxybutynin may be considered. These medications reduce sweating throughout the body but can have side effects including dry mouth and, in some patients, cognitive effects — so they need to be used carefully and monitored.
When to Consider Further Investigation
If excessive sweating has started suddenly, occurs mainly at night, or is accompanied by other symptoms such as weight loss, fever, or fatigue, it is important to rule out secondary causes. A thorough clinical assessment and, where appropriate, blood tests can help identify any underlying condition that may need treatment.
Why See a Specialist Dermatologist for Hyperhidrosis?
Hyperhidrosis sits at the intersection of medical and cosmetic dermatology, and getting the diagnosis and treatment right requires specialist knowledge. A dermatologist can:
Confirm the diagnosis and distinguish primary from secondary hyperhidrosis
Recommend the most appropriate treatment based on the location and severity of sweating
Perform Botox injections with the precision and dosing experience that comes from specialist training
Monitor treatment response and adjust the plan over time
At Panorama Dermatology Clinic, I personally manage every consultation, diagnosis, and treatment plan. There are no rotating doctors — you see the same specialist every time, which allows me to tailor your treatment and track your progress closely.
Serving Patients Across Cape Town's Northern Suburbs
Our clinic is located at 46 Hennie Winterbach Street in Panorama, with easy access from the N1 and Voortrekker Road. We regularly welcome patients from Durbanville, Bellville, Brackenfell, Kraaifontein, Parow, Goodwood, and the greater Tygerberg area.
If excessive sweating is affecting your quality of life, you do not need to simply put up with it. Effective treatments are available, and most patients see a significant improvement.
Book Your Consultation
If you are struggling with excessive sweating, I would be happy to assess your condition and discuss the treatment options that are most likely to help. Call us on 021 911 5470 or send a WhatsApp to 079 321 1973 to book an appointment at Panorama Dermatology Clinic.