Hyperhidrosis: Causes and Treatment from Antiperspirants to Botox
Part of: Botox
Sweaty hands, underarms and feet can be primary or caused by a medicine or illness. How to tell them apart, which treatment suits each area, how long Botox lasts, and how to use an antiperspirant correctly.
Medical Dermatology · 1 min read · August 22, 2026
Written and medically reviewed by Dr. Yousef Abo Zarad · German board-certified dermatologist · Last reviewed: September 2026
Key takeaways
- Primary hyperhidrosis starts in childhood or the teens, affects one or two areas, and stops during sleep.
- Sweating all over the body or during sleep may be secondary to a medicine or illness and needs assessment.
- A strong antiperspirant is the starting point for most people, applied at night to dry skin.
- Botox reduces sweating within 7 to 10 days and lasts 3 to 10 months in the underarms and hands.
- Iontophoresis is an effective option for the hands and feet.
Primary or secondary?
| Primary | Secondary | |
|---|---|---|
| Onset | Childhood or the teens | Often in adulthood |
| Where | One or two areas: underarms, palms, soles, scalp or face | Most of the body |
| During sleep | Stops | May happen |
| Cause | No underlying illness | A medicine or another medical condition |
| Treatment | Treat the sweating directly | Treat the cause or change the medicine |
How does it affect daily life?
- Trouble gripping things, writing, using a computer and shaking hands.
- Body odor from sweat mixing with bacteria and yeast.
- Soggy, wrinkled skin, chafing and frequent skin infections.
- Embarrassment, anxiety and sometimes depression.
How to use an antiperspirant correctly
- Apply it to completely dry skin before bed.
- Let it dry completely.
- Results usually show within a few weeks.
- Once sweating improves, once or twice a week is often enough.
Research has not found that the aluminum in antiperspirants causes Alzheimer's disease or breast cancer.
Which treatment suits each area?
| Treatment | Area | Notes |
|---|---|---|
| Strong antiperspirant | All areas | The usual starting point |
| Glycopyrronium cloths or sofpironium gel | Underarms | Once daily; approved from age 9 |
| Botox | Underarms, hands, feet, face | Works within 7 to 10 days |
| Iontophoresis | Hands and feet | 20- to 30-minute sessions; improvement after 5 to 10 treatments |
| Microwave treatment to destroy sweat glands | Underarms | Immediate results in 1 or 2 visits, but expensive |
| Anti-sweating pills | Whole body | Dry mouth is the most common side effect, also constipation and drowsiness |
| Propranolol | Anxiety- or event-related sweating | 30 to 60 minutes before the event; not for regular use |
| Surgery (sympathectomy) | Palms and underarms | Can cause compensatory sweating on the belly, legs or back |
How long does Botox last?
| Area | Duration |
|---|---|
| Underarms or hands | 3 to 10 months |
| Feet | 3 to 6 months |
| Face | About 4½ months |
Iontophoresis for the hands and feet
A device passes a mild electrical current through water into the skin. Sessions last 20 to 30 minutes, daily or every 2 to 5 days until sweating improves, which usually takes 5 to 10 treatments. After that, most patients keep their results with a session once a week or every other week.
Common questions
- Is hyperhidrosis a medical condition? Yes, it's a real medical condition that can be treated, not just extra sweat.
- Does it get better with age? Primary hyperhidrosis tends to ease with age.
- When should I worry? If sweating starts suddenly later in life, affects the whole body, or happens during sleep, see a doctor to look for a cause.