Many people suffer from more than one of the four (hands, face, feet and armpits) main types of localized focal hyperhidrosis conditions. For most, excessive underarm sweating is usually the least problematic one of the four. Only around 2-3 percent of the human body's two million or so sweat glands are located in the armpits. Moreover, underarm sweating is also the most likely type of hyperhidrosis that will respond favorably to basic nonsurgical treatments such as clinical strength antiperspirants or Botox injections.
Some people who only sweat from their axillary region decide to get ETS surgery to cure it, and quite often end up regretting this choice because of the main side effect of compensatory sweating. i.e., while their armpits stop sweating, they start sweating profusely in other parts of their bodies. As a result, many surgeons no longer offer ETS surgery for the sole purpose of stopping axillary sweating.
It can seem like one's sweaty armpits are occurring for no reason and without cause when the problem is genetic. However, stress and heat can exacerbate underarm sweating in most people. Some people choose to use armpit sweat pads or liners on a daily basis in order to prevent embarrassing shirt stains and wet patches. Others try various home remedies and natural treatments in order to reduce the sweating. However, there are many tried and tested dermatologist recommended treatment options for this condition.
One unique and bothersome aspect of armpit perspiration 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). 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. The latter can exhibit significant odor that causes embarrassment. Apocrine sweat gland activity increases 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 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 underarms excessively dry. Note that for my feet, I did not try the most effective method of applying such products. i.e., wash and dry feet at night; then apply antiperspirants immediately; then saran wrap feet; and then go to sleep. I did not want to maintain that whole routine every night for the rest of my life even if it worked. Most people who use aluminum chloride antiperspirant type products for their excessive hand and feet sweating tend to see limited to no benefit.
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. I had great results when using Certain Dri for my sweaty armpits.
All antiperspirants usually include some type of aluminium based compound as the key ingredient. However, new entirely non-aluminium based topical products are now coming to the market for the first time.
The first major one is Dermira's Glycopyrronium Tosylate (formerly called DRM04) topical, small-molecule, anticholinergic product. In 2016, the company successfully completed trials for this product and hen filed a new drug application with the US FDA in the second half of 2017. In 2018, Demira released Qbrexza to treat primary axillary hyperhidrosis.
Another molecule is Brickell Biotech's Sofpironium Bromide (BBI-4000) gel that successfully completed Phase 3 clinical trials in late 2021. the company expected to submit a New Drug Application (NDA) for sofpironium bromide gel 15% to the US FDA in mid-2022. However, in May 2022, it sold the rights to this product to Botanix Pharmaceutical.
Moreover, in September 2020, Brickell's Japanese partner Kaken Pharmaceutical received regulatory approval to manufacture and market sofpironium bromide gel 5% (under the brand name ECCLOCK®) for daily treatment of primary axillary hyperhidrosis. This marked the first commercial use of sofpironium bromide for any indication worldwide. An April 2022 study from Japan found that after just 1 week of treatment with sofpironium, 50% of patients saw a clinically significant improvement in primary axillary hyperhidrosis.
In May 2022, Dr. Wollf Group (Germany) announced the release of Axhidrox for severe armpit sweating. This is a topical cream containing 1% glycopyrronium bromide (i.e., glycopyrrolate anticholinergic).
Also of interest, in 2023, an entirely new product called Brella SweatControl Patch will come to market. It is based on a proprietary Targeted Alkali Thermolysis (TAT) technology from Candesant.
One must not forget that existing anticholinergic products such as Robinul and Robinul Forte are also effective for treating excessive armpit sweating. Note that sofpironium bromide is designed as a structural analog of anticholinergic glycopyrrolate. Among other products, a recent study found that topical Oxybutynin 10% gel was effective at treating primary axillary hyperhidrosis.
Botox can be very effective at stopping armpit sweating, often for 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 feet sweating treatment experience. Also see the overview page on botox and hyperhidrosis.
In recent years, a number of studies have come out that analyze various unique means of applying botox to the armpits without injections. For example, a 2018 study from Thailand found that applying topical Botulinum Toxin Type A in a liposomal cream formulation was effective at treating axillary hyperhidrosis.
Copyright: Lakraj, Moghimi and Jabbari, 2013.
Most people do not know that besides its most common usage of drug delivery, iontophoresis hyperhidrosis therapy can also stop excessive hand and feet sweating. Moreover, even people who know the above fact, often have no idea 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. A 2019 study found iontophoresis treatment to reduce armpit sweating intensity by an average of 70 percent.
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 2020, this miraDry treatment seems to be the most popular armpit sweat reduction treatment at clinics. It usually results in durable results with 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).
Some dermatologists have successfully treated primary axillary hyperhidrosis (PAH) with fractional microneedle radiofrequency (FMR) treatment. One new device for doing this type of targeted sweat gland destruction is the Morpheus8 device.
It seems like retrodermal curettage (see further below) is an improved version of this old fat removal related 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. One US-based surgeon who has significant experience with this procedure is Dr. Pnini.
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.
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 underarm sweating and alternative treatments fail. Most surgeons no longer recommend ETS just to stop armpit sweating.