Hyperhidrosis
Specialist assessment and treatment for excessive sweating
At Midland Skin we offer Hyperhidrosis consultations with a Dermatologist for patients in Birmingham, Solihull, Coventry, Wolverhampton, Worcester and the Midlands.
Quick Facts about hyperhidrosis
Best for
Persistent excessive sweating
Appointment
Initial dermatology assessment
Treatment
Topical, tablets or injections
Symptoms
Sweating beyond normal need
Provider
Consultant dermatologist
Price
See below
What is hyperhidrosis?
Hyperhidrosis is excessive sweating that is inappropriate for the situation in which it occurs. The problem may occur all over the body or be localised to certain areas such as the underarms, palms, soles, face, scalp, groin and under the breasts.
Sweating of this kind is not simply a nuisance. It can be embarrassing, affect confidence, and interfere with work, study and social life. Many people spend years disguising the problem with dark clothing or avoiding situations where it may show. Effective treatment can make a substantial difference.
How severe is your sweating?
Dermatologists grade hyperhidrosis using a simple four-point scale. It is a useful way to describe the problem at your appointment:
- Sweating is never noticeable and never interferes with daily activities
- Sweating is tolerable but sometimes interferes with daily activities
- Sweating is barely tolerable and frequently interferes with daily activities
- Sweating is intolerable and always interferes with daily activities
A score of 3 or 4 indicates severe hyperhidrosis, and treatment options beyond over-the-counter products are usually appropriate.
When should I see a dermatologist for hyperhidrosis?
Excessive sweating is a treatable medical condition, and a dermatology assessment establishes the cause and identifies which treatments are suitable for you.
A specialist assessment is particularly worthwhile when:
- Everyday life is affected – work, study, clothing choices, handshakes or social situations
- Over-the-counter products have not worked – including strong antiperspirants
- Sweating is persistent – present for months or years without an obvious explanation
- The underarms, face or scalp are affected – areas where prescription treatment is often effective
- The palms or soles are affected – where a different treatment approach is required
- An underlying cause may be involved – particularly where sweating is generalised or has started recently
- You want to know which treatments apply to you – rather than continuing to guess
Mason Simmons
Why the pattern of sweating matters
Most excessive sweating is primary hyperhidrosis. This typically begins in younger life, affects specific areas in a symmetrical pattern, and settles during sleep. It often runs in families.
Sweating can also be secondary to another medical condition or to a medication. Features that point in this direction include sweating that is generalised rather than localised, sweating that began recently, sweating that continues at night, or sweating accompanied by symptoms such as flushing, tremor or weight loss.
The distinction matters because it changes what treatment is appropriate. Where the pattern suggests an underlying cause, blood tests can be arranged in clinic as part of your assessment.
Treatment pathway
Initial dermatology assessment
You meet with a consultant dermatologist who assesses the pattern and severity of your sweating and reviews your symptoms, previous treatments, medical history and relevant medications.
Care plan
A treatment plan is discussed with you. This may include topical treatment, tablet treatment or injections, depending on which areas are affected and what you have already tried. Tests are arranged where the pattern of sweating suggests an underlying cause.
Review consultation
A review consultation is required to assess your response to treatment and decide whether treatment should be continued, changed or stopped. Your dermatologist will also discuss longer-term management where appropriate.
How is hyperhidrosis treated at Midland Skin?
Treatment depends on which areas are affected, how severe the sweating is and what you have already tried. Your dermatologist will discuss the options that apply to you at your assessment.
Topical treatment
Prescription-strength aluminium chloride preparations are sometimes used as a starting point, depending on severity and previous treatment.
Prescription glycopyrronium cream is a further option for underarm sweating. It is applied to the skin and works by blocking the nerve signals that stimulate the sweat glands. It suits some people well and others less so, and it needs to be continued to maintain any benefit, so it is usually worth a trial period to see how well it works for you. Your dermatologist will discuss whether it is a sensible option in your case.
For sweating of the face and scalp, we can arrange topical glycopyrrolate prepared at a specific concentration to suit the area being treated. This is not a standard pharmacy product and is not generally available outside specialist practice.
Botulinum toxin injections
Botulinum toxin injections reduce sweating by blocking the nerve signals that activate the sweat glands. Injections are given into the skin of the affected area by a consultant dermatologist.
- Underarms – the best established use, and often highly effective where antiperspirants have not worked
- Face and scalp – for facial and scalp sweating, including sweating that has become troublesome around the menopause
- Other areas – including the groin, under the breasts, amputation stumps, and compensatory sweating following previous surgery
We do not offer botulinum toxin injections for the palms or soles.
Injections are carried out at a separate appointment after your assessment, not on the day you are first seen.
Tablet treatment
Where sweating is generalised or affects several areas, tablet treatment may be considered. Suitability, benefits and side effects are discussed at your assessment, and treatment is monitored at review.
Sweating of the palms and soles
For hyperhidrosis affecting the hands and feet, iontophoresis is usually the most useful approach. This passes a weak electrical current through water to reduce sweating, and is carried out at home using a device you buy yourself. Your dermatologist will advise on whether it is appropriate for you and how to use it, alongside any topical or tablet treatment that may help.
Surgery
Surgical treatment is occasionally considered where other treatments have not helped. It is not carried out at Midland Skin, but we can arrange referral to an appropriate surgical specialist and discuss whether it is a reasonable option for you.
What to expect from botulinum toxin treatment
Sweating usually begins to reduce within a few days, with the full effect apparent by around two weeks.
The effect is temporary. Treatment of the underarms commonly lasts several months before it needs repeating, and the effect on the face and scalp tends to be shorter. Most people who continue with treatment return once or twice a year.
Injections reduce sweating rather than stopping it entirely, and the degree of benefit varies between individuals and between areas. Some people notice slightly increased sweating elsewhere. Your dermatologist will discuss what is realistic for the area being treated before any treatment is arranged.
Your dermatology appointments: FAQs
Who will assess me?
You meet with a consultant dermatologist, who assesses the pattern and severity of your sweating and reviews your symptoms, previous treatments, medical history and relevant medications.
Will I be treated at my first appointment?
No. Your first appointment is an assessment. Where botulinum toxin treatment is appropriate, it is arranged at a separate appointment so that the plan can be discussed properly beforehand.
What information is useful at my assessment?
It helps to know which areas are affected, when the sweating started, whether it continues at night, what treatments and antiperspirants you have already tried, and details of any regular medication.
Will I need any tests?
Tests are not routinely needed for localised sweating. Where the pattern suggests an underlying cause, blood tests can be arranged in clinic.
What do botulinum toxin injections involve?
The area is mapped and a series of small injections is given into the skin. The appointment is short, no anaesthetic or sedation is required, and you can return to normal activities the same day.
Why is a review consultation required?
A review consultation is required to assess your response to treatment and decide whether treatment should be continued, changed or stopped. Your dermatologist will also discuss longer-term management where appropriate.
Book in with us
Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
Fees for hyperhidrosis (excessive sweating)
Hyperhidrosis Show pricing
Book ConsultationInitial dermatology assessment
Up to 25 minutes
Botulinum toxin – Armpit sweating, small
Botulinum toxin – Armpit sweating, large
Botulinum toxin – Forehead and scalp sweating
Ian Williams
References used for this article
- Moniati F, Vassiliou M, Costa C, Chatzimatthaiou C, Chatzimatthaiou M. Efficacy and safety of treatments for primary palmar hyperhidrosis: a systematic review assessing patient-centric outcomes. Dermatol Res Pract. 2025. doi:10.1155/drp/8867838.
- National Institute for Health and Care Excellence. Glycopyrronium bromide cream for treating severe primary axillary hyperhidrosis. NICE technology appraisal guidance TA1175. 2026.
Further information can be found at the following websites:
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 22nd Sep 2026
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