Whether you're running from meeting to meeting or sitting in a cubicle all day, sweat happens. In fact, nearly 3% of the U.S. population has been diagnosed with hyperhidrosis (excessive sweating). And of this group, most experience profuse sweating in their underarms, known as axillary hyperhidrosis.
What Is Axillary Hyperhidrosis?
Axillary hyperhidrosis occurs when people have a regular number of sweat glands in their underarms but a higher sympathetic response. These overactive sweat glands produce more sweat than is required for temperature control, resulting in obvious sweat marks that leave serious psychological, emotional and social effects.
Overactive sweat glands can occur in more places than underarms — such as hands, feet, head/face, groin and torso.
How Axillary Hyperhidrosis Develops
Within the hyperhidrosis umbrella are two overarching types: primary and secondary hyperhidrosis. Primary hyperhidrosis is excess sweat that occurs in one area and is often inherited, meaning a family member has likely suffered from the disorder. In these cases, oversweating can begin during childhood. Axillary hyperhidrosis falls under primary hyperhidrosis because people experience profuse sweating primarily in the underarm area.
Secondary hyperhidrosis can be characterized by generalized sweating — meaning it occurs all over the body and isn't limited to one specific area. Medications or behavior (like chronic alcoholism, food supplements, obesity, etc.,) activate the disorder, typically in adulthood.
Solutions to Axillary Hyperhidrosis
If you deal with axillary hyperhidrosis, you understand the struggle of shielding embarrassing underarm sweat marks on a daily basis. But it doesn’t have to be this way. Whether you suffer from the clinical definition or want to feel dry all day, consider these axillary hyperhidrosis treatments:
Both ‘antiperspirants’ and ‘deodorants’ are often used interchangeably. However, deodorants don’t contain any anti-sweat ingredients; they simply combat the smell associated with underarm sweat. Nearly all over-the-counter antiperspirants will also be deodorants, but by definition, it’s impossible for a deodorant to be an antiperspirant unless clearly labeled as both.
Antiperspirants are often considered the first line of defense. Most over-the-counter clinical-strength antiperspirants contain aluminum salts that slow sweat from leaving the sweat glands. Newer antiperspirants contain aluminum zirconium compounds, which claim to be better tolerated by the skin and less likely to cause irritation.
Prescription antiperspirants contain high levels of the active ingredient aluminum chloride, which is more effective at fighting wetness. Antiperspirants are most effective when applied at night and in the morning, but this treatment doesn’t work for everyone. The most common side effect is skin irritation.
2. The Thompson Tee
Armed (literally) with the patented Hydro-Shield technology, the Thompson Tee offers an inexpensive yet effective way to combat the obvious signs of axillary hyperhidrosis. For $24.99, this undershirt is guaranteed to lock in sweat so it doesn’t seep through to your outerwear and keep you dry throughout the day. Handcrafted in the U.S. and backed by an unconditional 30-day guarantee!
3. Oral medications
The most commonly used medications for excessive sweat are anticholinergics. However, anticholinergics have not been studied in clinical trials specifically for hyperhidrosis, so their use for hyperhidrosis is “off-label.” The FDA approval is based on studies involving other medical conditions.
Because anticholinergic drugs decrease sweating over the entire body, Dee Anna Glaser, MD, president and founding board member of the International Hyperhidrosis Society, cautions her patients saying, “When taking anticholinergics, the body may have more difficulty keeping itself cool with the sweat mechanism ‘turned off.’ Therefore, athletes, people who participate in sports, people who work outdoors and anyone who may potentially cause themselves injury by becoming overheated must use extra care when considering these treatments.”
Patients taking these medications must be aware of water intake, temperature, exertion, and any symptoms of overheating such as dizziness, pale skin, headache, nausea, and muscle cramping. Although oral anticholinergic drugs can stop the activation of the sweat glands, they aren't for everyone because of certain side effects such as blurred vision, heart palpitations, and urinary problems.
Another oral medication used in treating specific types of hyperhidrosis is beta blockers (propranolol) and benzodiazepines, which work by “blocking” the physical effects of anxiety. Acting on the central nervous system, these medications are best for patients who experience situational hyperhidrosis (weddings, job interviews, public speaking, etc). Various side effects limit their long-term use. Benzodiazepines can be habit-forming, and many patients cannot tolerate the sedative effects caused by both of these medications.
Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum, the same toxin that causes a life-threatening type of food poisoning called botulism. Botox injections work by blocking the secretion of the chemical that activates sweat glands. Injections run around $500 per armpit per treatment and can last anywhere from three to 12 months.
Per the manufacturer of Botox, “It is not known whether BOTOX® is safe or effective for severe sweating anywhere other than your armpits.”
Also, be sure to check with your doctor if are pregnant, plan to become pregnant, breastfeeding or plan to breastfeed (it is not known if BOTOX® can harm your unborn baby or pass into breast milk). As with any drug, it’s important to understand the risks. Click here for risk factors.
During iontophoresis, a medical device is used to pass a mild electrical current through water (usually utilizing shallow pans big enough for your hands or feet) and through the skin's surface.
Although people can have success with this method, it’s not typically recommended for axillary hyperhidrosis patients because the skin in the armpits can likely be irritated and the physical structure of the underarms makes iontophoresis difficult to accomplish.
There are no significant or serious side effects, and the results vary, but the benefits can be long term, provided you keep up with the maintenance schedule your doctor recommends (usually once per week).
This new ‘noninvasive’ treatment (excluding the 15+ shots of local anesthetic in each armpit) utilizes microwave technology to destroy sweat glands in the underarms and suppress sweating. Results vary, so multiple treatments are recommended. Treatments average around $3,000.
Common side effects include underarm swelling, redness, and tenderness lasting for several days. Numbness and tingling can occur in the upper arm or armpit and may last for about five weeks. Click here to read real-life stories of folks who unfortunately found themselves on the wrong side of the risk factors.
Laser treatments offer a way to target and destroy sweat glands but have not been proven in clinical trials. They are also an expensive option that few doctors offer. The cost of treatment is approximately $3,000. Side effects include bruising, numbness, and swelling.
8. Underarm surgery
After all other options have been exhausted, you physician may consider surgical treatment as an solution to hyperhidrosis. It's often hard to find a surgeon experienced in sweat-related surgeries, so be sure to do your homework and test their knowledge.
Patients who want underarm surgery often have to pay for it themselves. Local surgeries as a treatment for hyperhidrosis are not typically covered by health insurance. Underarm surgery techniques include:
- Excision (cutting out sweat glands – NO LONGER RECOMMENDED)
- Curettage (scrapping out sweat glands)
- Liposuction (removing sweat glands via suction)
- ETS (endoscopic thoracic sympathectomy: cut/destroy nerve paths of overactive sweat glands – NO LONGER RECOMMENDED).
While these treatments can be effective, they are the most invasive and expensive form of treatment, require the use of local anesthesia and can leave irreversible effects.
It's important to note that excision, the complete removal of underarm tissue containing sweat glands, is NO LONGER RECOMMENDED because heavy scarring can seriously limit your range of motion. Also, most physicians DO NOT recommend ETS (endoscopic thoracic sympathectomy) surgery because of the serious irreversible side effects.
Sweat glands are too small to be seen, even with surgical instruments, so even experienced dermatologists are going in "blind." It is difficult for them to know how many sweat glands are actually being removed or damaged, so the results vary considerably.
According to Dr. Glaser, "...dermatologists may use a number of different techniques and say that they can get consistent good results, but these aren't procedures that are commonly performed and it's difficult to predict results...Sweat glands are not like tumors or lesions that we can see and remove easily. It's not going to work for everyone."
As with any surgery, there are potential complications such as infection. There also may be bruising, swelling, loss of sensation in the underarms, and scarring depending upon the size and number of incisions the physician uses.
Which treatments have you found to be most effective at fighting axillary hyperhidrosis? We’d love to hear your thoughts in the comments below!
*PLEASE NOTE: As with any medical related issues, it's best to seek the advice from a qualified medical practitioner. The information provided is not to be used or relied on for any diagnostic purposes and should not be used as a substitute for professional diagnosis and treatment.