For people who suffer from more than one of the four (hand, face, feet and armpit) main types of localized hyperhidrosis conditions, excessive armpit sweating is usually the least problematic one. Only around 2-3 percent of the body's 2 million or so sweat glands are located in the armpits. Moreover, armpit sweating is also the most likely type of hyperhidrosis that will respond favorably to basic nonsurgical treatments such as prescription strength deodorants or Botox injections. Some people who only sweat from their armpits decide to get ETS surgery to cure it, and quite often end up regretting this because of the main side effect of compensatory sweating – i.e., their armpits stop sweating, but they start sweating excessively in other parts of their bodies. As a result, many surgeons no longer offer ETS surgery for the sole purpose of stopping armpit sweating.
One unique and bothersome aspect of armpit sweating is that it can often be smelly, a condition called bromhidrosis. Almost all the sweat glands in your body are of a type called eccrine (also called merocrine), and such sweat glands do not emit odor. Eccrine sweat glands primarily emit water and sodium chloride (salt). However, the armpits and groin area contain both eccrine and apocrine sweat glands, and the latter can exhibit significant odor. Apocrine sweat glands increase activity at puberty and contain pheromones that are also said to attract the opposite sex in spite of the bad smell.
I have tried a number of prescription strength antiperspirant products (some with deodorant in them too) for my feet sweating in recent years, but none helped. In contrast, those same products were very effective for my armpit sweating. Some even made my armpits too dry. Note that for my feet, I did not try the most effective method of applying such products (i.e., wash feet at night, apply antiperspirants, saran wrap feet, go to sleep and repeat all over again the next night) because I did not want to do that whole procedure every night for the rest of my life even if it worked. Moreover, my feet don't sweat every day, and when I am fully asleep, they never sweat. Most people who use antiperspirant type products for their excessive hand and feet sweating tend to see little or no benefit. The few who do see significant benefit typically apply the product in the manner I described above after showering or washing and drying their hands or feet. On the other hand, antiperspirant and deodorant use in the armpits can be very effective, especially when the product is clinical/prescription strength with at least a 15 percent aluminium content.
While all antiperspirants have historically been based on some type of aluminium based compound, new entirely different groundbreaking topical products are likely to come to the market in the near future. Perhaps the first major one will be Dermira's DRM04 topical, small-molecule, anticholinergic product. In February 2015, the company successfully completed stage 2b clinical trials for this product, and plans to commence final stage 3 trials in the second half of 2015.Another molecule is Brickell Biotech's BBI-4000 undergoing phase 2-b clinical trials as of 2015. In April 2015, Brickell signed an exclusive licensing agreement with Japan's Kakaen Pharmaceutical with regards to BBI-4000.
Botox can be very effective at stopping armpit sweating, often for even more than six months at a stretch after one round of injections. If you cannot afford Botox injections, you can sometimes get free treatment. For more on that, read my botox hyperhidrosis treatment experience. Also see the overview page on botox and hyperhidrosis.
Most people do not know that besides its most common usage of drug delivery, iontophoresis therapy can also stop excessive hand and feet sweating. Moreover, even people who know this, often don't know that a select few iontophoresis machine suppliers also offer special electrodes that can be used to stop armpit sweating! Both Hidrex and Idromed offer such electrodes.
The above heading is not a joke! Electrolysis is a technique to remove body hair permanently via killing hair cells using a a probe (needle) and electricity. According to some electrologists, clients who get hair removal in the armpit area with electrolysis often (but not always) see significantly less sweating as a side benefit. Perhaps the electricity from the probe is also killing some of the sweat glands?
A new nonsurgical ultrasound therapy called Ulthera has shown some promising results since 2011 and was undergoing FDA clinical trials in 2012, but as of 2013, not much has been reported on the final results.
For greater detail on these, see electromagnetic radiation and wave based hyperhidrosis treatments.
A new nonsurgical electromagnetic therapy that received FDA clearance in 2011. As of 2015, this treatment seems to be extremely popular and usually results in limited to no side effects when done correctly.
Cynosure's PrecisionTx laser technology is developing a good reputation for treating armpit sweating.
SweatX is a proprietary laser treatment from Alma Lasers that claims to be able to cure regular hyperhidrosis and/or osmidrosis (also known as bromhidrosis -- aka smelly sweating).
It seems like retrodermal curettage (see further below) is an improved version of this old method.
I read about this surgery being done by a Dr. Popp in a book on hyperhidrosis that an author from Germany sent me to review. I remember also reading about someone in the UK who also does this procedure too. If anyone has an update on this procedure, please e-mail me or post on the forums.
Retordermal Curettage is a surgery akin to liposuction. Under general anesthesia, a surgeon will scrape off some skin under your armpits and in the process permanently damage sweat glands. Two US-based surgeons who have significant experience with this procedure are:
UK's first laser sweat ablation surgery for armpit sweating performed in 2009 by Dr. Whiteley. The cost of this surgery plus consultation and related work with Dr. Whiteley is 3,000 British pounds as of 2010.
Dr. Whiteley learned this procedure from Dr Guillermo Blugerman of Buenos Aries in December 2008.
Update Jan 8th 2012: Dr. Whiteley just e-mailed me and said that they had performed their 101st LSA procedure.
Dr. Nielsen's SDLA laser procedure that he is now also using to treat other body areas such as the feet and chest
Note that these procedures are all fairly recent, and some people have bad results. Dr. Nielsen told me that between 2009 and 2012 his procedure has improved significantly, but it is still imperative to read about the unsatisfied outcomes such as: a Nielsen patient's results blog before jumping in.
Do not undergo this surgery if you solely sweat from your armpits. ETS might be a good solution if you have both hand and armpit sweating and alternative treatments fail. Most surgeons no longer recommend ETS just to stop armpit sweating.