Compensatory hyperhidrosis is a common event that occurs after ETS or endoscopic thoracic symapathectomy. This is a form of rebound sweating that can occur on parts of the body that were not affected from sweating like sweaty palms. This form of excessive sweating can occur on the trunk, underarms, limbs, face, and scalp. Once compensatory hyperhidrosis occurs, it often persists. Effective treatments are possible. The Specialist at Sweat Free Clinic use a combination of creams, tablets and in some cases sweat stopping treatments injections to help reduce the inconvenience of compensatory sweating.

  • This form of excessive sweating commonly occurs after endoscopic thoracic surgery
  • Compensatory excessive hyperhidrosis is also called reflex or rebound sweating
  • The most common presenatation is that rebound sweating occurs after ETS surgery for excessive sweating of the hands or underarms
  • High concentrations can also result in skin irritation
  • A combination of treatments including antiperspirants, tablets, and compounded creams can manage the majority of cases of compensatory sweating
  • Treatment for compensatory sweating often needs to be lifelong


Special compounded creams can be tailor made for patients with excessive sweating.

Hyperhidrosis or excessive sweating of the armpits can be effectively treated with Sweatfree injections.

Several tablets are available to inhibit the transmission of chemical messengers that produce sweat.


Compensatory hyperhidrosis is also called reflex or rebound sweating and most commonly occur after ETS surgery. ETS surgery or endoscopic thoracic sympathectomy is a type of surgery for excessive sweating of the hands, underarm sweating or facial sweating. Compensatory sweating occurs in areas that were not affected by sweating before a procedure or event. Once sweating develops, it usually persists.

Compensatory hyperhidrosis is commonly seen after Endoscopic Thoracic Sympatectomy. Most patients undergo ETS for excessive sweating of the hands, or less commonly excessive underarm sweating, or facial sweating. Rebound or reflex sweating occurs several weeks or months after ETS surgery.

Rare causes of compensatory hyperhidrosis include nerve trauma, brain disorders, myelopathy and thoracic disorders.

The most common areas involved in excessive rebound sweating is the back, underarms and trunk, rarely compensatory hyperhidrosis can affect the neck and face. In extreme cases it can become generalised, and patients can sweat everywhere.

The exact cause of rebound sweating is poorly understood, however a theory is that the perception of a part of your brain called the hypothalamus, senses that your body temperature is too high. This stimulates nerves which in turn activates sweat glands in certain areas to sweat, which in turn reduces body heat.

In short - NO! Compensatory hyperhidrosis can not be predicted. The pattern of excess sweating has no link to gender, age or location. Most cases of compensatory sweating occur on the lower back, and trunk, however rebound underarm sweating can occasionally occur. Patients should give careful consideration before undergoing Endoscopic Thoracic Sympactectomy and should try medical treatment before contemplating this procedure.

Other possible options prior to consideration of ETS include:

Creams for excessive sweating

Tablets for excessive sweating

Iontophoresis treatment

sweat stopping treatments injections for sweating

Natural remedies for sweating

Compensatory excessive sweating can be hard to treat! Treatments will depend on several factors including the location of sweating, the total area of excessive sweating, and previous treatment success and failures.

Patients should try a topical antiperspirant as first line treatment. Never occlude the antiperspirant, and where possible, apply to dry skin, always wipe the excess sweat on the area targeted before putting on an antiperspirant. We advise DRICLOR as the first step.

Failing antiperspirant use, our specialists can compound a variety of special anti-sweating creams to use on the area. Sometimes we combine many treatments to help reduce focal areas of excess sweat. Prescription tablets to control sweating maybe helpful in some patients.

If compensatory sweating occurs in a small area, the use of sweat stopping treatments injections can be helpful. Tiny injections are placed in the areas of excessive sweating. Sweat stopping treatments injections can be successful in upto 80% of cases of compensatory hyperhidrosis and typically lasts up to 3-4 months. The limiting factor of sweat stopping treatments is the area involved, due to costing. Sweat stopping treatments, in the context of treating excessive sweating can be claimable via Medicare only if severe sweating occurs in the axillae or underarms.

Sweat Free is a dedicated Specialist run clinic for the management of all forms of sweat disorders, including excessive sweating of the hands, feet, underarms, sweaty palms and difficult cases like compensatory sweating.

This clinic is a multi-specialist clinic, run by Dermatologists, Neurologists, Vascular Surgeons, as well as Dieticians and Specialist Nurse Practitioners. Expertise combined with the latest in technology and research, provides patients with the highest level of sweat management.

Nigel Harris

Specialist Hyperhidrosis RN

Sweat Free Clinics

Compensatory rebound sweating is commonly seen at the Sweat Free Clinic. Most patients present secondary to ETS or endoscopic thoracic sympathectomy. The common story is that they have surgery for excessive and severe sweating of the hands, then a few weeks or months later, present with areas of excessive sweating elsewhere, most commonly on the back or trunk. Most patients do not regret having surgery in the first place, as excessive sweating on the hands is both more challenging to treat and has a higher impact on lifestyle than compensatory sweating elsewhere. The second most common presentation is that patients had ETS for facial sweating and blushing. Very rarely do patients have ETS for underarm sweating, now that effective treatments such as sweat stopping treatments are available under the PBS.

Compensatory excess sweating can be challenging to treat, however most patients respond with a combination of antiperspirants, prescription compounded creams, and tablets. Focal areas can also be injected with sweat stopping treatments, especially if it involves small areas on the back/trunk, as well as the forehead and scalp area.