Excessive sweating (hyperhidrosis) and facial flushing treatment

Hyperhidrosis / sweaty hands

Hyperhidrosis is a condition of excessive sweating in certain parts of the body. Axillary hyperhidrosis refers to severe sweating under the arms. Excessive sweating without any underlying medical condition is called primary hyperhidrosis. If the cause of excessive sweating is due to a medical condition, this is referred to as secondary hyperhidrosis. Hyperhidrosis is caused by overactive sweat glands where the increased release of acetylcholine, a chemical from the central nervous system that directs the sweat glands to produce sweat, causes excessive perspiration. Hyperhidrosis may significantly affect the social and psychological well-being of an individual. It may cause physical discomfort, social embarrassment, affect occupational and daily activities, and sometimes cause social isolation.

Several treatment options are available for the treatment of hyperhidrosis:

  • Antiperspirants/deodorants: Aluminum chloride hexahydrate-containing agents block the sweat pores, and deodorants help control the body odour. These agents may cause irritation and itching of the skin.
  • Medications: Agents that inhibit the release of acetylcholine, such as glycopyrrolate (Robinul, Robinul-Forte). These agents may cause dry-mouth, dizziness and other side effects.
  • Iontophoresis: A small electric current temporarily blocks the sweat glands. This is often used for treating excessive sweating of the palms and soles of the feet. A drawback with iontophoresis is that the results are temporary, require multiple sessions every week, and it cannot be used for underarm sweating.
  • Surgery: Surgery may be performed to remove the sweat glands or to interrupt the impulses from the central nervous system in a procedure called Endoscopic Thoracic Sympathectomy (ETS). The ETS procedure is considered a last resort as it can cause a side effect of compensatory sweating that can be even worse than the original problem.

Facial flushing

Facial flushing refers to sudden blushing of the face in response to a strong emotion such as anger, embarrassment or excitement. It may also cause a feeling of warmth around the face. Although it is a normal response, it can be triggered by the following factors as well:

  • Medications: These include vasodilators, tamoxifen, raloxifene, calcium channel blockers, calcitonin, glyceryl trinitrate and isosorbide dinitrate. A number of medications used for the treatment of prostate cancer also cause flushing.
  • Medical conditions: Certain medical conditions that are sometimes associated with facial flushing include rosacea, carcinoid syndrome, erythrophobia, menopause and mastocytosis.
  • Other common triggers: These may include alcohol consumption, hot or spicy food, hot drinks, fever above 101ºC, vigorous exercise, food additives such as monosodium glutamate and sudden changes in temperature.


Facial flushing usually reduces on treatment with a cold compress or by intake of cool fluids. However, frequent and severe facial flushing may negatively impact the personal and professional life of the patient. A consultation with a doctor is required to diagnose the underlying cause of facial flushing and get an appropriate treatment.

Treatment for facial flushing depends on the underlying cause and may include change of causative medications, treatment of the underlying medical condition or avoidance of common triggers. Psychotherapy may be recommended if facial flushing is secondary to social phobia. Medications such as beta-blockers or clonidine may also be used to manage facial flushing. Administration of Botox injections provides a temporary treatment for facial flushing, the effect of which lasts for about six months.

Surgery for severe flushing

Severe facial flushing, accompanied by excessive sweating (hyperhidrosis) and not responding to conservative treatment, is called Idiopathic Craniofacial Erythema. It is caused by overactivity of the autonomic nervous system, and endoscopic thoracic sympathectomy surgery may be recommended in these cases.

Endoscopic thoracic sympathectomy is a minimally invasive surgery that is performed through a very small incision under the armpit. The surgery is performed under general anaesthesia and involves ablation of the sympathetic nerves in the thoracic ganglia that control the extra blood supply to the blood vessels of the face and secretions from the sweat glands on the hands and face. Both sides can be treated at the same time.

Endoscopic thoracic sympathectomy provides a permanent cure for Idiopathic Craniofacial Erythema and has a high success rate. It is relatively safe but may be rarely associated with a small risk of injury to the chest and droopy eyelid or Horner’s syndrome.