Sweaty Face and Head
Do beads of sweat pour over your forehead while you're sitting at your desk? Has streaming facial sweat gotten in the way of your success at work? Or has it prevented you from thriving socially? If you answered yes to any of these questions, you may suffer from craniofacial hyperhidrosis, or excessive sweating of the face, head, or scalp.
Facial sweating is a common problem and can be even more stressful and embarrassing than other types of excessive sweating. Even people who sweat heavily from other body areas may find that it's their facial sweating that bothers them the most. That's because our faces are how we present ourselves to the rest of the world, and we cannot hide the effects of excessive sweating on the face.
The first step for anyone with any type of excessive sweating is to see a healthcare professional for a full medical check-up including an assessment to make sure that excessive sweating is not due to another medical condition or a side effect of a medication. When extreme sweating is due to a different medical condition or a medication, it's called secondary hyperhidrosis. Secondary hyperhidrosis can signify a more serious health problem and so should always be considered first.
If your medical provider determines that your extreme sweating is independent of other medical conditions or medications, then it's called primary hyperhidrosis and the hyperhidrosis treatment plan will be similar to that used for other body areas of excessive sweating. For example, products used on the skin in the area of sweating (topical solutions) may be tried first. These may include common over-the-counter antiperspirants containing aluminum chloride and prescription-strength antiperspirants containing aluminum chloride hexahydrate. Of course, as with other areas of the body, strong antiperspirant products can be irritating to the skin of the face, head, or scalp. Understand how antiperspirants work so you can use them effectively and avoid irritation. Always follow your clinician's instructions and, if trying a new topical product, try it on a small area of the skin first to see how you react.
If topical antiperspirant solutions don't work or are too irritating, onabotulinumtoxinA (commonly known by the brand name Botox) injections may be recommended. Botox injections work well on the head and face, but the injection technique requires skill so patients should seek an experienced practitioner. A potential side effect of Botox injections in the face as a treatment for sweating is asymmetry, particularly of the forehead. This can happen if some of the Botox diffuses into the facial muscles. Such asymmetry, however, is temporary and can, if necessary, be balanced out by additional Botox injections. Working with an experienced dermatologist can minimize these risks.
In a British Journal of Dermatology study (2000), researchers found Botox (botulinum toxin A) to be an effective and safe treatment for hyperhidrosis on the face, with the amount of sweat being significantly reduced 4 weeks after treatment. The effect lasted at least 5 months in nine of the 10 patients treated. All patients said the treatment as very effective. Similarly, in another 2000 study (J Neurol.), the effect of botulinum toxin A was studied on 12 patients with head/face hyperhidrosis. After 1-7 days the craniofacial sweating in the area injected had completely ceased in 11 patients and was mildly reduced in the remaining one. The treatment's effects lasted, depending on the person, from 9 months to 27 months.
More recently there's another topical option for head and face sweating called topical glycopyrrolate (for head/face sweating it would be an off-label use). A 2015 review of published scientific studies found that based on available evidence: topical glycopyrrolate, oral oxybutynin (an oral systemic medication) and intradermal botulinum toxin A (Botox injections) may be all recommended as first-line therapies for head/face sweating due to their effectiveness and safety. And in 2022 researchers found in comparing topical 2% glycopyrrolate and botulinum toxin A injection for facial hyperhidrosis that both treatments showed complete response in 75% of cases but with a longer duration of effects in the botulinum toxin group (up to 6 months). Side effects were minor and temporary. The researchers concluded that topical glycopyrrolate 2% showed comparable results to botulinum toxin A for facial excessive sweating treatment with faster onset but shorter duration of action.
Systemic medications (prescription medicines taken by mouth called anticholinergics) may also be used to treat facial sweating, particularly one called clonidine. Side effects, including dry mouth, blurry vision, and constipation can occur but can often be managed by carrying a water bottle to sip from, using doctor-recommended oral rinses, using eye drops, adjusting diet for constipation, or asking your medical provider to adjust medication doses. Oral medications such as one called propanolol can be useful for those people who want to temporarily treat their facial sweating in order to prevent discomfort or embarrassment at an important event, such as a critical presentation at work, a job interview, wedding, graduation, or dramatic performance. Read our full discussion about this hyperhidrosis treatment option here. The International Hyperhidrosis Society held an "Ask Me Anything" webinar event all about oral medications to treat hyperhidrosis - it's expert-led and incredibly informative, we hope you'll "Watch here."
You may have heard about new treatments for hyperhidrosis in research. And you may be a bit discouraged when you see that few studies (so far) are for craniofacial sweating. Please take heart and remember that all research has to start somewhere. For hyperhidrosis treatments, the starting place has been underarms because they have been considered relatively 'uncomplicated'. Once treatment is proven safe and effective--and the researchers see that there is interest in applying the treatment to other focal areas--then the research moves to other focal areas like palms or face. What does that mean to you? It means you have to stay active in the hyperhidrosis community here and jump on any opportunity (such as clinicial trials) that the International Hyperhidrosis Society may notify you about. Make sure that you are signed up to receive our alerts. If no one answers the call, no progress will be made.
If you're living with excessive and embarrassing head, scalp, or facial sweating, isn't it time to head off the problem? From antiperspirant products to Botox injections or oral medications, there are ways to treat head and facial sweating so you can always put your best face forward. Talk to your dermatologist or healthcare professional.