Primary Care Physicians Including Pediatricians, Internists & Family Physicians
Hyperhidrosis treatment often starts in your primary care physician’s (PCP) office. It is with your PCP, perhaps during a regular checkup, that you may first decide to discuss the condition.
A PCP may begin treating your hyperhidrosis with an antiperspirant. If this treatment doesn't provide enough relief, if skin irritation occurs, or if the PCP feels that another doctor can provide more successful treatment, he or she will refer you to a specialist, most commonly it will be a dermatologist.
Dermatologists are specially trained to diagnose and treat skin problems. As skin experts, dermatologists are often the most informed about hyperhidrosis, its diagnosis, and its treatment. Dermatologists' expertise in treating excessive sweating is due, in part, to extensive American Academy of Dermatology and International Hyperhidrosis Society educational programs.
Dermatologists may be able to provide stronger antiperspirants as well as antiperspirants that are less irritating to the skin, or, they may prescribe additional skin products to help alleviate irritation that sometime occurs with the stronger antiperspirants (to reduce the chance of irritation, and get the most benefit, be sure to read our section on Tips for Antiperspirant success). Dermatologists may also provide other treatments, such as iontophoresis, Botox (onabotulinumtoxinA injections), and surgery for underarm excessive sweating, such as liposuction.
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 the 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. 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.
A number of different types of operations may be used to treat hyperhidrosis, including local surgical procedures, and endoscopic thoracic sympathectomy (ETS). Endoscopic thoracic sympathectomy (ETS), in particular, is an invasive procedure that carries serious risks. Due to these risks, ETS for excessive sweating is a last resort - a treatment not tried until other possible treatments have failed, and only for palmar hyperhidrosis (excessive palm sweating).
Working with your health plan
Many people in the US receive health insurance through a health maintenance organization, or HMO. As a member of an HMO, you may be required to visit your primary care physician first, before seeking treatment from a specialist, such as a dermatologist.
If your PCP determines that a specialist is best suited for treating your excessive sweating, he or she will provide you with a referral to a particular specialist.
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.