Sweating at work.

Definition: hyperhidrosis is sweating beyond what temperature regulation needs – triggered by overactivity of the sympathetic nervous system, not by heat. About two to three percent of the population are affected, mostly in the armpits, hands, feet or forehead. It often begins in puberty and runs in families.

When it is a condition: when it limits daily life – changing clothes, avoiding handshakes, dreading presentations. Questionnaires such as the HDSS (Hyperhidrosis Disease Severity Scale) measure the burden. From grade 3 it is considered to need treatment. Secondary causes (thyroid, medicines, infections, menopause) should be excluded first – especially with generalised or night sweating.

Step 1 – antiperspirants: aluminium chloride solutions (10–20 %), in the evening on dry skin. Effective for mild forms, often irritating.
Step 2 – botulinum toxin: blocks the sweat-gland nerves in the treated area. Effect after about a week, reduction of sweating typically 80 to 90 percent, duration six to nine months. Armpits are standard; hands and feet are possible but more painful.

Step 3 – iontophoresis: tap-water current baths for hands and feet, several times a week, home device. Effective but demanding.
Step 4 – surgical procedures: sweat-gland suction or microwave therapy of the armpits; sympathectomy only in exceptional cases because of compensatory sweating.

What is realistic: no procedure makes you 'dry'. The goal is a level that no longer bothers you. With botulinum toxin most reach that – many describe the effect at work as greater than any wrinkle treatment.

Costs: at VIVA DERM a self-pay service under the GOÄ. With severe hyperhidrosis and step 1 exhausted, the treatment can be an insured service at statutory practices.