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Primary Care: Including Pediatricians, Internists, Family Medicine, Nurse Practitioners & Physician Assistants
Hyperhidrosis treatment often starts in your primary care office (or, in the case of a child or teen, in the pediatrician's office). It is with a primary care provider, perhaps during a regular checkup, that you may first decide to discuss excessive, disruptive sweating.
A primary care provider may begin treating your hyperhidrosis with an antiperspirant. If this treatment doesn't provide enough relief or if skin irritation occurs, your primary care provider may recommend iontophoresis, an oral anticholinergic, or refer you to a specialist (often in dermatology). As of 2018, primary care offices have another treatment option to discuss with you, as well: a topical (applied on top of the skin) prescription wipe called Qbrexza.
Dermatology specialists (including physicians, nurse practitioners, and physician assistants) are specially trained to care for skin issues. As skin experts, dermatology practitioners are often informed about hyperhidrosis, its diagnosis, and its treatment. Dermatology specialists' expertise in treating excessive sweating is due, in part, to extensive American Academy of Dermatology and International Hyperhidrosis Society educational programs.
Dermatology specialists may be able to recommend stronger antiperspirants as well as antiperspirants that are less irritating to the skin, or they may prescribe additional skin products to help alleviate the irritation that sometimes occurs with the stronger antiperspirants. (Tip: To reduce the chance of irritation and get the most benefit, read our section on antiperspirant success). Dermatology specialists may also provide other treatments, such as iontophoresis, Botox (onabotulinumtoxinA injections), and local procedures for underarm excessive sweating, such as laser treatment or miraDry. As with primary care providers, they may also recommend oral or topical anticholinergics. They can also be adept at combining treatment options to meet individual patients' needs, especially when sweating from multiple body locations is a concern.
Neurologists specialize in treating conditions of the brain and nervous system. The human body’s sweat glands are controlled by the brain and nervous system such that the underlying mechanism of the condition falls within the realm of conditions that a neurologist may treat. Some neurologists, in fact, specialize in studying neurophysiology, management, and treatment of hyperhidrosis.
Neurologists can give onabotulinumtoxinA injections (Botox) and have been known to use onabotulinumtoxinA to treat a variety of conditions including spasticity and movement disorders. Neurologists may also work with oral medications (anticholinergics) and other treatments, as appropriate. In most cases, a neurologist is not consulted until "first-line" treatments, like antiperspirants, have been tried and have failed to provide relief.
Surgeons perform a wide variety of operations, ranging from removing an appendix to transplanting organs. Surgeons may also treat hyperhidrosis with local procedures or with a more invasive procedure called endoscopic thoracic sympathectomy (ETS). Endoscopic thoracic sympathectomy (ETS) should be discussed thoroughly before a decision is made to proceed. Multiple opinions are recommended as this surgery carries serious risks of compensatory sweating. Due to compensatory sweating risks, as well as other risks, ETS is recommended only as a last resort - a treatment not tried until other possible treatments have failed and it's only recommended for palmar hyperhidrosis (excessive palm sweating).
Working with your health plan
Many people in the U.S. receive healthcare coverage through a health maintenance organization (HMO), a preferred provider program, or another type of health plan. As a member of an insurance program, you may be required to visit a primary care provider first, before seeking treatment from a specialist, such as a dermatologist.
If your primary care provider determines that a specialist is best suited for treating your excessive sweating, he or she will provide you with a referral (if you have a particular provider in mind after searching our Clinician Finder, provide his/her contact information to your primary care provider and respectfully ask him/her for advice or input as to if this person might be an appropriate referral.)
In order to receive coverage for your visits to a specialist and for any treatments he or she may prescribe, it is important to receive this referral and to follow your health plan’s process. Every health plan is different. For more information, call your health plan’s customer service or toll-free number and visit our Insurance Tools section.