Can Prescription Hyperhidrosis Treatments Help Mitigate Symptoms?

Hyperhidrosis (HH) is more than a quality-of-life issue—it can significantly exacerbate dermatologic diseases including atopic dermatitis (AD),¹ acne,² psoriasis,³ rosacea,⁴ seborrheic dermatitis,⁵ cholinergic urticaria (CU),⁶ and hidradenitis suppurativa (HS).⁷ In patients with HH and one or more of these conditions, controlling excessive sweating may be an important adjunct to disease management.

Sweat glands are widely distributed throughout the body. Apocrine sweat glands, concentrated in the groin and axillae, produce oily sweat in response to emotional stimuli via norepinephrine.⁸

Eccrine glands serve a primarily thermoregulatory function and receive sympathetic innervation via cholinergic fibers.⁸ Cholinergic stimulation of muscarinic receptors, particularly M3, induces sweating. In primary hyperhidrosis (PH), it is postulated that sweat glands become overstimulated by acetylcholine binding to M3 receptors leading to excessive and often debilitating sweating.⁹

Prolonged, excessive sweating due to either primary HH (PH) or secondary HH (SH) may create friction in skin folds, triggering localized irritation, erythema, and worsening AD pruritus and barrier dysfunction.^10-12 Moreover, sweat allows sebum and bacteria to clog pores, exacerbating acne flares.¹³  Warm, humid environments, ideal for bacterial and fungal growth,¹⁰ foster Cutibacterium acnes colonization in acne-prone skin, fungal infections like tinea pedis, and Staph infections in AD.¹⁴ Excessive sweat is particularly problematic for patients with cholinergic urticaria (CU) and HS.

CU occurs when an increase in body temperature causes sweating and release of histamine, resulting in hives.⁶ The underlying cause of CU is unknown, but it is relatively common, occurring in an estimated 1 of 3 persons with hives and about 7% of those with chronic hives.¹⁵  HH, exercise, hot humid environments, and stress are triggers and hives appear in sweaty areas such as the arms, face, and axilla.⁶  CU is primarily managed with antihistamines; in those with CU and HH, a combination of HH treatments and antihistamines may be beneficial.^6,16,17 Anticholinergic drugs may manage excessive sweat to lessen CU symptoms, but these medications are not a primary treatment for CU without HH.

HS is a chronic, inflammatory condition that primarily involves the hair follicle unit, which includes eccrine and sebaceous glands.^7,18 The upper portion of the follicular unit becomes blocked, causing follicular rupture. This expels bacteria, dead keratinocytes, and hair fragments causing inflammation and painful HS lesions and abscesses.^7,18  Lesions typically appear in high-friction areas rich in sweat glands including the axilla and groin regions.^7,18,19

Studies suggest that managing hyperhidrosis—particularly in early HS stages—may reduce HS lesion severity, maceration, and lesion progression.²⁰ Patients diagnosed with both HS and PH may particularly benefit from topical or systemic HH therapies, including botulinum toxin,^20,21 antiperspirants,²² and anticholinergics,²³ highlighting the need for broader clinical integration of sweat management in HS care.

Excessive sweating is more than a nuisance—it can be a significant driver of morbidity in patients with chronic dermatologic conditions. As the understanding of hyperhidrosis evolves, so too should its role in the comprehensive management of diseases such as HS, AD, acne, and CU. While evidence is emerging, clinicians are often faced with the need to act before guidelines catch up. This calls for clinical creativity—leveraging available prescription HH treatments, repurposing therapies off-label when appropriate, and personalizing care based on each patient's unique sweat patterns, comorbidities, and quality-of-life concerns. For patients caught in the cycle of sweat-induced flares and inflammation, targeted sweat control may not only alleviate symptoms but also change the trajectory of their disease. Dermatologists and Advanced Practice Practitioners alike should begin to think beyond standard protocols and recognize sweat management as a potentially powerful tool in their therapeutic arsenal.

The author reports no relevant financial disclosures.

1. Kaneko S, Murota H, Murata S, Katayama I, Morita E. Usefulness of sweat management for patients with adult atopic dermatitis, regardless of sweat allergy: a pilot study. Biomed Res Int. 2017;2017:8746745. doi:10.1155/2017/8746745
2. Kutlu Ö, Karadağ AS, Wollina U. Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment. An Bras Dermatol. 2023;98(1):75-83. doi:10.1016/j.abd.2022.01.006
3. Micali G, Verzì AE, Giuffrida G, Panebianco E, Musumeci ML, Lacarrubba F. Inverse psoriasis: from diagnosis to current treatment options. Clin Cosmet Investig Dermatol. 2019;12:953-959. doi:10.2147/CCID.S189000
4. National Rosacea Society. What’s sweating got to do with it? Rosacea.org. Published June 2014. Accessed October 21, 2025. https://www.rosacea.org/blog/2014/june/whats-sweating-got-to-do-with-it
5. Cheong WK, Yeung CK, Torsekar RG, et al. Treatment of seborrhoeic dermatitis in Asia: a consensus guide. Skin Appendage Disord. 2016;1(4):187-196. doi:10.1159/000444682
6. Fukunaga A, Oda Y, Imamura S, Mizuno M, Fukumoto T, Washio K. Cholinergic urticaria: subtype classification and clinical approach. Am J Clin Dermatol. 2023;24(1):41-54. doi:10.1007/s40257-022-00728-6
7. Shams RB, Sayed CJ. Patient-reported exacerbating factors for hidradenitis suppurativa: a cross-sectional study. J Am Acad Dermatol. 2024;91(2):333-336.
8. Hodge BD, Sanvictores T, Brodell RT. Anatomy, skin sweat glands. In: StatPearls. StatPearls Publishing; 2025. Accessed October 21, 2025. https://www.ncbi.nlm.nih.gov/books/NBK482278/
9. Coon EA, Low PA. Regulation of sweating. In: Primer on the Autonomic Nervous System. 4th ed. Elsevier; 2022:253-256. doi:10.1016/B978-0-323-85492-4.00079-X
10. Parashar K, Adlam T, Potts G. The impact of hyperhidrosis on quality of life: a review of the literature. Am J Clin Dermatol. 2023;24(2):187-198. doi:10.1007/s40257-022-00743-7
11. Sissons B. What’s the link between sweat and eczema? Med News Today. Published February 2025. Accessed October 21, 2025. https://www.medicalnewstoday.com/articles/sweat-eczema
12. Murota H, Yamaga K, Ono E, Murayama N, Yokozeki H, Katayama I. Why does sweat lead to the development of itch in atopic dermatitis? Exp Dermatol. 2019;28(12):1416-1421. doi:10.1111/exd.13981
13. West M. Does sweat cause acne or make it worse? Med News Today. Published February 2024. Accessed October 21, 2025. https://www.medicalnewstoday.com/articles/does-sweat-cause-acne
14. Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol. 2009;61(2):242-246. doi:10.1016/j.jaad.2009.02.038
15. Cleveland Clinic. Cholinergic urticaria. Published December 2023. Accessed October 21, 2025. https://my.clevelandclinic.org/health/diseases/cholinergic-urticaria
16. Altrichter S, Wosny K, Maurer M. Successful treatment of cholinergic urticaria with methantheliniumbromide. J Dermatol. 2015;42(4):422-424. doi:10.1111/1346-8138.12765
17. Tsunemi Y, Ihn H, Saeki H, Tamaki K. Cholinergic urticaria successfully treated with scopolamine butylbromide. Int J Dermatol. 2003;42(10):850. doi:10.1046/j.1365-4362.2003.02010.x
18. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-115. doi:10.2147/CCID.S111019
19. Frings VG, Roth N, Gläsel M, et al. Hidradenitis suppurativa: absence of hyperhidrosis but presence of a proinflammatory signature in patients' sweat. Acta Derm Venereol. 2022;102:adv00793. doi:10.2340/actadv.v102.2731
20. Shih T, Lee K, Seivright JR, De DR, Shi VY, Hsiao JL. Hyperhidrosis treatments in hidradenitis suppurativa: a systematic review. Dermatol Ther. 2022;35(1):e15210. doi:10.1111/dth.15210
21. Geoghegan L, Rodrigues R, Harrison CJ, Rodrigues JN. The use of botulinum toxin in the management of hidradenitis suppurativa: a systematic review. Plast Reconstr Surg Glob Open. 2022;10(11):e4660. doi:10.1097/GOX.0000000000004660
22. Rosenberg A, Gottlieb C, Luba J, Abramovits W, Cockerell C, Rigel D, Smythe C. Gel antiperspirants for hidradenitis suppurativa: a pilot study. J Skin. 2025;9(4):2462-2470. https://skin.dermsquared.com/skin/article/view/3550
23. Atluri S, Masson R, Tran K, Hsiao JL, Shi VY. Managing seasonal flares in hidradenitis suppurativa. J Am Acad Dermatol. 2024;90(1):e23-e24. doi:10.1016/j.jaad.2023.01.055