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Hyperhidrosis is characterized by abnormal, excessive sweating that can occur in the hands, armpits and feet. For some, the abundant sweating is localized to one area, such as the hands, while others may experience increased sweating in a combination of areas.

Hyperhidrosis is rare, affecting about 1 percent of the population. However, for those affected, the condition often interferes with their daily activities and can be rather embarrassing in social situations. Although the exact cause of this excessive sweating remains unknown, we do know that it is commonly controlled by the sympathetic nervous system, which normally responds strongly in situations of fear or stress. It is not understood why patients with hyperhidrosis appear to have constant increased activity of this system.

Our approach to hyperhidrosis

UCSF offers effective, long-lasting treatments for hyperhidrosis. These include Botox injections and a minimally invasive surgery called endoscopic thoracic sympathectomy (ETS), which blocks the excessive nerve activity leading to severe sweating. Our surgeons are experienced at performing ETS, and it's highly successful for most patients.

Signs & symptoms

Hyperhidrosis is characterized by abnormal, profuse sweating that can affect one or a combination of the following:

  • Hands, called palmar hyperhidrosis
  • Armpits, called axillary hyperhidrosis
  • Feet, called plantar hyperhidrosis

The excessive sweating often interferes with daily activities. For example, patients with palmar hyperhidrosis have wet, moist hands that sometimes interfere with grasping objects. Those with axillary hyperhidrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress. Plantar hyperhidrosis, excessive sweating of the feet, makes ones socks and shoes wet, which leads to increased foot odor.

Symptoms of hyperhidrosis often become noticeable during childhood and adolescence. In many cases sweating can be quite severe, affecting everyday life and causing social embarrassment. It is thought that the excessive sweating may be brought on by stress, emotions or exercise. However, it also can occur spontaneously.


Hyperhidrosis is diagnosed by physical examination. In addition, your doctor will ask how long you have been experiencing excessive sweating, what areas are affected, how often it happens and other questions to get a sense of the extent of your condition.


Many patients with hyperhidrosis try topical medications or herbal remedies to ease their condition, but these have only temporary or no benefit. Fortunately, effective treatments are available.

Medical Botox

UCSF dermatologists use botulinum toxin (Botox) injections to treat hyperhidrosis. The injections temporarily block a chemical in the body that stimulates the sweat glands, and will reduce sweating for about four to six months.

The treatment is relatively painless, and most patients do not need anesthesia. Doctors can apply anesthetic cream or ice to the skin before the injections, if desired. Patients typically resume their regular activities immediately after the treatment.

ETS surgery

Surgical interruption of the sympathetic nerve chain offers proven, long-term results. These nerves primarily affect blood flow to the skin and the function of the sweat glands. Interrupting the sympathetic nerves in the chest results in dilation of the veins and arteries in the arm and hand as well as the complete blockage of sweating.

A minimally invasive procedure called endoscopic thoracic sympathectomy (ETS) was developed to treat hyperhidrosis. Using very small incisions, the sympathetic chain is cut or clamped to eliminate the excessive sympathetic nerve activity. The ETS procedure may be done on an outpatient basis with quicker recovery and less scarring than open surgery. The procedure is highly effective in eliminating excessive sweating of the hands in more than 98 percent of patients. In addition, the risk of complications is very low. ETS also can be used in some patients with axillary hyperhidrosis, or excessive sweating of the armpits.

UCSF surgeons have significant experience in treating hyperhidrosis using ETS. We can perform ETS on both sides of the body during a single operation if needed. The operation requires general anesthesia, and two 5 millimeter incisions on each side. Most patients leave the hospital in less than 24 hours and recover completely within two weeks.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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