Whether you're running to a meeting or sitting in a cubicle, sweat happens. In fact, nearly 3% of the U.S. population has been diagnosed with hyperhidrosis (excessive sweating). Of this segment, most experience profuse underarm sweating, known as axillary hyperhidrosis. In this guide, you'll learn 8 popular axillary hyperhidrosis treatments and insight into each.
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 the underarms — such as the hands, feet, head/face, groin and torso.
How Axillary Hyperhidrosis Develops
Within the hyperhidrosis umbrella are two types of excessive sweating: 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 heavy sweating primarily in the underarm area.
- Secondary hyperhidrosis refers to generalized sweating — meaning perspiration occurs across the body and not one area. Medications or certain behaviors (like alcoholism, taking food supplements, obesity, etc.,) activate the disorder, typically in adulthood.
Axillary Hyperhidrosis Treatments
If you deal with axillary hyperhidrosis, you understand the daily struggle of shielding embarrassing underarm sweat marks. 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:
Antiperspirants and deodorants are often used interchangeably. But deodorants don’t contain any anti-sweat ingredients; they simply combat the smell associated with underarm sweating. Most over-the-counter antiperspirants are also deodorants, but deodorants are not antiperspirants (unless clearly labeled as both).
Because of their sweat-blocking abilities, antiperspirants are the first line of defense against underarm sweating. Most over-the-counter, clinical-strength antiperspirants contain aluminum salts that slow sweat from leaving the sweat glands. Some prescription antiperspirants also contain high levels of aluminum chloride, which is even more effective at fighting wetness.
Antiperspirants work best when applied at night and in the morning, but this hyperhidrosis treatment is not for everyone. The most common side effects include skin irritation, but newer antiperspirants contain aluminum zirconium compounds, which are less likely to cause skin sensitivity.
Armed with the patented Hydro-Shield technology, the Thompson Tee offers a safe yet effective axillary hyperhidrosis treatment. This undershirt is guaranteed to lock in underarm sweat so it doesn’t seep through to your outerwear. All Thompson Tees are made in the U.S. and backed by an unconditional 30-day guarantee.
3. Oral medications
Anticholinergics are the most commonly used medications for excessive sweating. These hyperhidrosis drugs were designed to treat gastrointestinal disorders and work by drying out the body. Anticholinergics have not been studied in clinical trials for hyperhidrosis, so their use 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 hyperhidrosis medications must watch their water intake, temperature, exertion and symptoms of overheating (dizziness, headache, nausea and muscle cramping). Oral anticholinergic drugs can stop the activation of sweat glands, but side effects include blurred vision, heart palpitations and urinary problems.
Beta blockers (propranolol) and benzodiazepines are two other oral hyperhidrosis medications. These drugs work by “blocking” the physical effects of anxiety.
Acting on the central nervous system, these medications work best for patients who experience situational hyperhidrosis like weddings, job interviews and public speaking. Certain side effects limit their long-term use. Benzodiazepines can be habit-forming, and many patients cannot tolerate the sedative effects these medications cause.
Botox is a cosmetic drug that's injected in the skin to treat wrinkles and fine lines. Botox injections also block the secretion of the chemical that triggers 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.”
Botox is made from a toxin produced by the bacterium Clostridium botulinum — the same toxin that causes the life-threatening food poisoning called botulism.Be sure to check with your doctor if you're pregnant, plan to become pregnant, breastfeeding or plan to breastfeed (it's unknown whether 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 with small shallow pans) and the skin's surface.
Some patients have success with this method. However, doctors don't typically recommended iontophoresis for axillary hyperhidrosis patients because the skin in the armpits is more susceptible to irritation. The shape of underarms also makes iontophoresis difficult to accomplish.
There are no significant or serious side effects of iontophoresis, and the results vary. Unlike Botox, you can experience long-term benefits if you keep up with the maintenance schedule (typically weekly) your doctor recommends.
This new noninvasive hyperhidrosis treatment uses microwave technology to destroy sweat glands in the underarms and suppress sweating. (This procedure does require local anesthetic in each armpit). 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 for hyperhidrosis target and destroy sweat glands but have not been proven in clinical trials. They are also an expensive option that few doctors offer (each treatment costs approximately $3,000). Side effects include bruising, numbness and swelling.
8. Underarm surgery
After exhausting all other options, your physician might consider surgery to treat 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.
Most patients undergoing underarm surgery have to pay for the procedure out of pocket. (Health insurance providers do not typically cover local surgeries as a treatment for hyperhidrosis.) Underarm surgery techniques include:
- Excision (cutting out sweat glands – NO LONGER RECOMMENDED)
- Curettage (scrapping out the sweat glands)
- Liposuction (removing sweat glands via suction)
- ETS (endoscopic thoracic sympathectomy: cutting/destroying the nerve paths of overactive sweat glands – NO LONGER RECOMMENDED).
While these treatments can be effective, they are the most invasive and expensive option, require the use of local anesthesia and can leave irreversible effects.
Risk Factors of ETS Surgery
It's important to note that excision (the complete removal of underarm tissue containing sweat glands) is NO LONGER RECOMMENDED. This approach can leave heavy scarring that seriously limits your range of motion. Most physicians also DO NOT recommend ETS (endoscopic thoracic sympathectomy) surgery because of the serious irreversible side effects.
- Results vary: 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."
- Serious side effects can occur: As with any surgery, there are potential complications such as infection. Patients can also experience bruising, swelling, loss of sensation in the underarms and scarring depending on the size and number of incisions.
Which axillary hyperhidrosis treatments have you found to be most effective? Let us know in the comments below.
*PLEASE NOTE: As with any medical-related issue, it's best to seek advice from a qualified medical practitioner. Do not use the information provided for any diagnostic purposes or as a substitute for professional diagnosis and treatment.