Face and scalp sweating

Craniofacial sweating is common — it affects roughly one in fifteen people to some degree. The pattern that responds to treatment looks like this.

• Forehead, scalp, upper lip or the whole face
• It runs — it drips rather than glistens
• It happens out of proportion to the temperature or the effort
• Heat, stress, embarrassment and spicy food set it off
• It stops while you are asleep
• You choose seating, lighting and social situations around it

This is the Hyperhidrosis Disease Severity Scale — the same four-line scale used in the research and, for underarm treatment, in deciding whether you qualify for a rebate. Pick the line that fits.

The same overactive sympathetic signal, in the most socially exposed site on the body. Facial and scalp sweating frequently accompanies flushing, and the two can be difficult to separate — treating one does not necessarily treat the other.

It is often the last form people seek help for, which is a pity, because it is the one that shapes behaviour most. Across all forms of hyperhidrosis, 85% of people wait three or more years before mentioning it to anyone, and half wait more than ten.

1. Start topical

   Aluminium chloride hexahydrate at 10 to 15%, at night. Skin irritation is the limiting factor on the face, so it is applied carefully and not to broken skin.

2. Then a compounded anticholinergic

   A compounded wipe or lotion at 0.5 to 2%. For the scalp specifically, a lotion carries better than a cream. Many people do well enough here and go no further.

3. Mapping

   Before injecting, the sweating area is mapped, because forehead, temple, scalp and upper lip each behave differently and the dose is not uniform across them.

4. The injection

   Placed very superficially — in the skin rather than the muscle. This is the whole technical point: sweat glands sit above the muscles, and the depth and dilution are what keep the effect out of the frontalis.

5. 3 to 6 months

   Shorter than the underarm, because the area is mobile and the doses used are deliberately conservative.

Injections are highly effective here. The realistic expectation is that sweating becomes unnoticeable rather than absent, for three to six months at a time.

Topicals should not be dismissed — a meaningful number of people with mild to moderate facial sweating are well controlled on a compounded anticholinergic alone, at a fraction of the cost and with no risk to the brow.

What will not change: flushing. If your face goes red as well as wet, the redness is a vascular problem and needs a vascular laser, not an anti-sweat injection. They are separate treatments for separate mechanisms, and I will tell you which one you actually have.

No Medicare rebate applies to facial or scalp sweating. Item 18362 is written for the underarm only.

Expect $1,900 to $3,590 depending on how much area is treated — a forehead alone sits at the lower end, a full scalp at the upper.

The topical anticholinergic is compounded and costs considerably less. It is worth trying first for that reason alone.

No downtime in the ordinary sense. Small injection marks settle within the hour and you can return to work.

The risk that matters is temporary weakness of the muscles underneath — a heavier brow, a slightly asymmetric forehead, or reduced movement when you raise your eyebrows. It is uncommon with correct placement and it is temporary when it happens, but it is the reason this site is not a routine injection.