Adult Hyperhidrosis Treatment (Primary Focal Hyperhidrosis)
Fast MD-only care for excessive sweating by secure online video visit, $49 flat-fee, no insurance required.
Hyperhidrosis is a condition where the body produces more sweat than it needs for temperature control. It can affect the underarms, hands, feet, face, or other areas and can be socially and professionally disabling. Our board-certified MDs use guideline-based evaluation to distinguish primary focal hyperhidrosis from secondary causes, review your history, and create an evidence-based treatment plan when appropriate for telehealth.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Online MD-Only Hyperhidrosis Care
- Adult 18+ evaluation for primary focal hyperhidrosis
- History-based screening for secondary causes and red flags
- Topical and selected oral options when appropriate
- Clear criteria for when in-person dermatology or primary care is needed
Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Certain medications for hyperhidrosis may require in-person baseline labs or long-term monitoring; our MDs will advise when office-based care is safer.
What Is Adult Hyperhidrosis (Excessive Sweating)?
Hyperhidrosis is a disorder of sweating where the body produces sweat in excess of what is needed for normal temperature regulation. Primary focal hyperhidrosis typically starts in childhood or adolescence and affects specific areas such as the underarms, palms, soles, face, or scalp, often on both sides and during waking hours.
Secondary hyperhidrosis is caused by another condition or medication, such as thyroid disease, infections, diabetes, menopause, or certain drugs. Part of your TeleDirectMD visit is reviewing your overall health, medications, and symptom pattern to determine whether telehealth-based treatment is appropriate or whether in-person evaluation and lab work are needed to rule out underlying causes.
Symptoms and Red Flags in Adult Hyperhidrosis
Many adults with long-standing, localized excessive sweating and no other symptoms can be evaluated safely by telehealth. Sudden onset, systemic symptoms, or signs of infection or endocrine disease may require in-person testing and follow-up instead of or in addition to an online visit.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent or in-person care |
|---|---|---|---|
| Years of excessive sweating of underarms, hands, or feet, starting in youth | Primary focal hyperhidrosis | Yes, often well-suited for telehealth evaluation and treatment | Not a red flag if stable and no other systemic symptoms |
| Sweating that stops during sleep and is worse with stress or heat | Typical pattern for primary focal hyperhidrosis | Yes, appropriate for telehealth if no concerning features | Red flag only if new severe symptoms or other illness is present |
| Sudden onset of generalized sweating over weeks to months | Possible secondary cause such as endocrine, infection, or medication effect | Telehealth can triage and recommend appropriate in-person workup | Persistent night sweats, weight loss, or fevers require in-person evaluation |
| Night sweats that soak clothing or bedding | Possible infection, malignancy, endocrine disorder, or other systemic illness | No as sole site of care | Requires in-person evaluation and labs; telehealth may only provide initial guidance |
| Palpitations, tremor, heat intolerance, and weight loss with sweating | Possible hyperthyroidism or other endocrine cause | Telehealth may identify concern and direct next steps | Needs in-person assessment, labs, and ongoing management |
| Chest pain, shortness of breath, or dizziness with acute sweating | Possible cardiac ischemia, arrhythmia, or other acute illness | No | Emergency evaluation (call 911 or go to nearest ER) |
| Local redness, warmth, and pain in an area of sweating | Possible skin infection or abscess | Sometimes appropriate for telehealth triage and initial treatment | Rapidly spreading redness, fever, or systemic symptoms need urgent in-person care |
| New neurologic symptoms with sweating (weakness, numbness, vision changes) | Possible neurologic or autonomic disorder | No as sole management | Requires prompt in-person neurologic and medical evaluation |
| Use of medications known to cause sweating (some antidepressants, opioids, etc.) | Drug-induced hyperhidrosis | Telehealth can review and suggest coordination with prescribing clinician | Red flag if combined with confusion, fever, or other toxicity signs |
Differential Diagnosis: Hyperhidrosis vs Other Adult Conditions
During your TeleDirectMD visit, the MD will clarify whether your sweating pattern is most consistent with primary focal hyperhidrosis or suggests a secondary cause that needs in-person testing. This helps determine which treatments are reasonable to start or adjust via telehealth.
Primary Focal Hyperhidrosis
- Excessive sweating in specific areas (palms, soles, underarms, face)
- Usually starts before age 25 and often runs in families
- Occurs when awake and with emotional or thermal triggers; minimal or no night sweating
- No other systemic symptoms such as weight loss, fevers, or palpitations
Other Conditions That Can Cause Sweating
- Endocrine disorders: Hyperthyroidism, diabetes, menopause, or pheochromocytoma.
- Infections or malignancy: Tuberculosis, occult infection, or certain cancers with night sweats and fevers.
- Medication effects: Some antidepressants, opioids, or other drugs that increase sweating.
- Anxiety or panic: Episodic sweating with palpitations, shortness of breath, and intense fear.
When your history suggests a secondary cause or there are red-flag symptoms, our MDs will recommend in-person primary care or specialty evaluation, and may limit or defer prescription therapies until appropriate workup is completed.
When Is a Video Visit Appropriate for Adult Hyperhidrosis?
When a Video Visit Is Appropriate
- Adult 18+ with long-standing excessive sweating in focal areas (palms, soles, underarms, face)
- Symptoms began in childhood or adolescence and have been relatively stable
- No unexplained weight loss, fever, night sweats, chest pain, or palpitations
- No known uncontrolled endocrine or cardiac disease
- Seeking prescription-strength topical treatment or discussion of selected oral options
- Desires guidance on home measures, antiperspirant use, and clothing strategies
- Willing to pursue in-person follow-up if labs or specialist evaluation are recommended
Red Flags Requiring In-Person or ER Care
- New, rapidly progressive generalized sweating over weeks to months
- Night sweats severe enough to soak bedding, especially with weight loss or fevers
- Chest pain, shortness of breath, palpitations, or dizziness with sweating episodes
- Confusion, very high fever, or signs of acute systemic illness
- Known or suspected endocrine disorder without recent evaluation
- Neurologic symptoms such as new weakness, vision changes, or numbness
- Refusal of recommended in-person evaluation despite high-risk features
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD is not an emergency service and is best used for stable adults needing evaluation of chronic excessive sweating and discussion of treatment options.
Treatment Options for Adult Hyperhidrosis
Hyperhidrosis treatment focuses on reducing sweat production in affected areas while screening for secondary causes. Our MDs prioritize safe, stepwise options that can reasonably be managed via telehealth and coordinate in-person care when higher-risk therapies or procedures are being considered.
Supportive Measures and Lifestyle Strategies
- Use clinical-strength or prescription-strength antiperspirants as directed, often at night.
- Choose breathable, moisture-wicking clothing and socks; rotate shoes to allow drying.
- Use absorbent dressings or sweat shields for underarms when needed.
- Identify and reduce triggers such as spicy foods, hot environments, or caffeine when possible.
- Practice stress-reduction techniques if emotional triggers worsen sweating.
Prescription Options (When Appropriate)
- Topical aluminum chloride solutions for underarm or palm/sole hyperhidrosis.
- Topical anticholinergic agents (such as glycopyrronium cloths) for focal areas in selected adults.
- Oral anticholinergic medications in carefully selected, otherwise healthy adults when benefits outweigh risks.
- Referral to dermatology or other specialists for options such as iontophoresis, botulinum toxin injections, or procedural therapies.
TeleDirectMD does not perform procedures or prescribe controlled substances. Certain oral medications for hyperhidrosis can have important side effects, including dry mouth, urinary retention, or blurry vision, and may not be appropriate for all patients or for long-term telehealth-only management. Our MDs will discuss the safest options based on your health history.
Common Medications Used for Adult Hyperhidrosis
The specific regimen depends on the areas involved, severity, other medical conditions, and prior treatments. The examples below illustrate typical options that may be discussed during a TeleDirectMD visit for adults with primary focal hyperhidrosis.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Aluminum chloride hexahydrate 20% topical solution | Apply thin layer to dry skin at night, then wash off in morning | Several nights per week, then taper to lowest effective frequency | First-line option for axillary or palmar/plantar hyperhidrosis in many adults |
| Topical glycopyrronium cloth (dose per product) | Apply to affected area once daily as directed | Ongoing, with periodic reassessment of benefit and side effects | Localized underarm or facial hyperhidrosis when topical anticholinergic therapy is appropriate |
| Oxybutynin 2.5–5 mg tablet | 2.5–5 mg by mouth 1–2 times daily as tolerated | Weeks to months with regular monitoring | Selected adults with primary focal hyperhidrosis when topical therapy is insufficient and no contraindications exist |
| Glycopyrrolate tablet (dose per product) | Low starting dose by mouth once or twice daily | Weeks to months with periodic reassessment | Alternative oral anticholinergic in carefully selected adults under MD supervision |
These are example regimens only. Actual medications, strengths, and durations are determined by the MD after reviewing your history, other diagnoses, and current medications. Some therapies may be deferred to in-person dermatology or primary care due to monitoring needs or side-effect risks. TeleDirectMD does not prescribe controlled substances via telehealth.
Home Care, Expectations, and Return to Work
Hyperhidrosis is a chronic condition that usually waxes and wanes over time. While many adults do not achieve a complete cure, combining targeted treatments with practical strategies can significantly reduce daily impact and improve comfort and confidence.
- Use prescription and over-the-counter antiperspirants exactly as directed.
- Allow time for medications and routine changes to work; some options take several weeks to show full benefit.
- Plan ahead with extra clothing, wipes, or sweat shields for high-stress or high-heat situations.
- Track your triggers and response to treatments so your MD can make data-informed adjustments.
- Seek in-person follow-up if sweating worsens suddenly or new systemic symptoms develop.
Most adults with hyperhidrosis can work, exercise, and socialize safely. TeleDirectMD can typically provide documentation of evaluation and treatment planning rather than recommending time away from work, unless there are job-specific safety concerns or suspected underlying conditions that require in-person clearance.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care and chronic condition support for adults using secure video visits to evaluate issues such as primary focal hyperhidrosis and excessive sweating. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, clarify what can be safely managed via telehealth, and explain when in-person primary care, endocrinology, or dermatology evaluation is more appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.
Adult Hyperhidrosis Treatment FAQs
Hyperhidrosis is a condition where the body produces much more sweat than it needs for temperature control. Sweating may occur even in cool environments or with minimal activity and can interfere with work, social situations, or daily tasks. Normal sweating is usually predictable with heat, exercise, or stress and does not cause ongoing functional problems or embarrassment.
Yes. For many adults 18+ with long-standing, localized excessive sweating and no red-flag symptoms, TeleDirectMD MDs can evaluate your pattern by video, screen for secondary causes with a detailed history, and prescribe appropriate topical or selected oral treatments. If your history suggests an underlying medical condition, we may recommend in-person testing before or alongside treatment.
Primary focal hyperhidrosis often starts in childhood or adolescence, affects specific areas on both sides of the body, and does not cause symptoms during sleep. Secondary causes are more likely when sweating begins later in life, is generalized, occurs at night, or is accompanied by weight loss, fevers, palpitations, or other systemic symptoms. Your MD will ask targeted questions to decide whether you need in-person evaluation and labs.
Depending on your case, we may recommend prescription-strength antiperspirants such as aluminum chloride solution, topical anticholinergic medications for focal areas, and in selected otherwise healthy adults, oral anticholinergic medications. We also review practical clothing, skin-care, and trigger strategies and may refer you to dermatology or other specialists for procedures like iontophoresis or botulinum toxin injections when appropriate.
Topical treatments can sometimes cause skin irritation or dryness. Oral anticholinergic medications can cause dry mouth, constipation, blurry vision, or difficulty urinating and are not safe for everyone, especially those with certain eye, bladder, or heart conditions. Your MD will review your medical history and other medications before prescribing and will explain warning signs that need prompt follow-up or in-person care.
For many adults, primary focal hyperhidrosis is a long-term condition that tends to improve or worsen at different times rather than disappearing completely. The goal of treatment is to reduce sweating to a level that allows you to function comfortably at work and in social settings. In some cases, procedural or surgical options offered by specialists can provide longer-lasting relief when conservative measures are not enough.
Many adults with classic primary focal hyperhidrosis do not need extensive testing. However, if your sweating is new, generalized, occurs at night, or is associated with symptoms such as weight loss, palpitations, or fevers, your MD may recommend in-person evaluation with blood tests or other studies to rule out endocrine, infectious, or other causes before starting or escalating treatment.
Some adults with mild hyperhidrosis can manage symptoms with clinical-strength antiperspirants, breathable clothing, and trigger reduction. Many others benefit from a combination of lifestyle measures and prescription treatments. Your plan may change over time, and medications can sometimes be tapered or adjusted as you learn which strategies work best for you and as your life circumstances change.
In-person dermatology or specialty care is recommended if you have severe, disabling symptoms that do not respond to first-line treatments, if there is concern for a secondary medical cause, or if you are considering procedures such as iontophoresis, botulinum toxin injections, or surgical options. TeleDirectMD can help clarify whether those next steps are appropriate and provide you with a summary to share with local clinicians.
Yes. While primary focal hyperhidrosis is often benign, new or worsening generalized sweating, especially with night sweats, weight loss, fevers, chest pain, or palpitations, can signal an endocrine, infectious, cardiac, or oncologic problem. In those situations, we will recommend prompt in-person evaluation and may not be able to manage your condition fully by telehealth alone until underlying causes are addressed.
TeleDirectMD offers MD-only, guideline-based evaluation of excessive sweating through secure video visits with a simple $49 flat-fee model and no insurance required in 25+ states. We focus on identifying who is appropriate for telehealth management, choosing safe treatments, screening for red flags, and giving clear guidance on when in-person primary care, endocrinology, or dermatology is the safer next step.