Cosmetic medicine
Primary focal hyperhidrosis or secondary causes—neuromodulators, topicals, iontophoresis.
Primary hyperhidrosis causes excessive sweating without underlying illness, often in palms, soles, underarms, or face. Secondary causes include hyperthyroidism, infections, medications, and malignancy—history guides testing. The AAD hyperhidrosis overview outlines treatment ladders.
Neuromodulator injections block nerve signals to sweat glands in focal areas.
Genetic predisposition, emotional stress, and heat exposure trigger flares. Secondary causes must be excluded if new onset or generalized.
Clinical-strength antiperspirants, onabotulinumtoxinA injections, iontophoresis for palms/soles, microwave devices for axillae, and oral anticholinergics in refractory cases. Insurance may cover treatments when medical criteria are met.
Neuromodulators for underarms often last 6–12 months; sweating gradually returns as nerve endings regenerate.
Coverage varies by province and plan—documentation of severity and failed topicals may be required. Cosmetic sweating is not covered.
Temporary weakness in nearby muscles or compensatory sweating elsewhere can occur—technique matters.
If sweating is generalized, new, or associated with weight loss or fever, we investigate medical causes—primary focal hyperhidrosis often needs no labs.