Underarm excessive sweating, also called axillary hyperhidrosis, is an uncontrollable, annoying, embarrassing, and isolating problem (to say the least). From the discomfort of sweat running down your sides, to the embarrassment of obvious sweat stains, to the fear of being "discovered," uncontrollable underarm sweating can feel like it's ruining your life.
But, there is good news:
Safe treatments for excessive sweating are available, the treatments work, and you have a number of options to choose from--or combine.
The first line of defense against excessive underarm sweating is antiperspirants. Antiperspirants are non-invasive, topical (applied on top of your skin), and available in a number of different strengths including "regular" over-the-counter products, "clinical strength" over-the-counter products, and perhaps even prescription antiperspirants. Most healthcare providers recommend that you start with the mildest formulations ("regular" over-the-counter products), and if they don't give enough symptom relief, work your way up to the stronger clinical strength formulations and then, perhaps prescription antiperspirants. The recent advent of clinical strength antiperspirants has been shown to provide the same level of sweat management as prescription products, but with much less irritation. We are glad to see these new, and greatly improved, formulations on the drugstore shelves and easily available to everyone.
How you use antiperspirants is also incredibly important. Check out our information available about this, but the most important take-aways are: 1. apply antiperspirants before bed and 2. apply to totally dry skin to avoid irritation.
A wonderful addition to the wardrobe of anyone with underarm sweating (excessive or not!) is absorbent undershirts, absorbent tee shirts, absorbent dress shirts, and absorbent underarm pads. You can nab a sweet coupon for them in our Fan Faves page -- note that our Fan Faves page is also a great place to learn about different antiperspirants available from companies who support our work and who understand Hh.
Another treatment option, miraDry, available for axillary hyperhidrosis (underarm excessive sweating) was cleared by the US FDA in January 2011. Treatment with miraDry involves a healthcare provider using the miraDry medical device to permanently alter or destroy, through microwave technology, the sweat glands in the underarms so they can no longer produce sweat. Clinical data from two study sites affiliated with the University of British Columbia showed miraDry to be successful in reducing underarm sweat in over 90% of patients. The average sweat reduction was 82%. Patients rated their satisfaction with the treatment at 90%. While miraDry is promising for those who suffer from underarm sweating, it cannot be used to treat excessive sweating in any other area. The International Hyperhidrosis Society and miraDry recently recorded an "Ask Me Anything About miraDry" session with two miraDry experts, and you can watch the 40 minute video now. In it, experts answer our hyperhidrosis community's most pressing questions about this lasting underarm sweat treatment. For more miraDry info, read the research findings and understand the procedure for miraDry here.
If antiperspirants don't give you the relief you need and miraDry is not in your budget, your next option may be Botox (also known as onabotulinumtoxinA). In 2004, the US FDA approved Botox for the treatment of primary axillary hyperhidrosis. An experienced medical professional can inject Botox into your underarms to dramatically reduce sweating. In one clinical study involving 322 patients with severe underarm sweating, 81% of the patients receiving injections achieved more than 50% reduction in sweating. And, 50% of the patients had their excessive sweating relieved for at least 201 days (nearly 7 months). Some, for over a year.
The use of miraDry and Botox for the treatment of hyperhidrosis is most effective when performed by a healthcare professional who has received special training and who has experience with the procedure. To find a healthcare professional in your area who is familiar with hyperhidrosis treatments, use our Clinician Finder and search for those who have the notation 'IHhS-Educated'.
Qbrexza (pronounced kew brex' zah) became available in October 2018 as a treatment option for hyperhidrosis of the underarms. It comes in individually packaged cloths or wipes that can be used at home once per day to reduce underarm sweating. One wipe is intended to be used for two underarms. The treatment works by blocking receptors responsible for sweat gland activation. The active ingredient in Qbrexza is glycopyrronium tosylate, an anticholinergic formulation. In research studies of Qbrexza, the most common side effects were:
- Dry mouth (in 16.9-24.2% of patients)
- Erythema/area redness (in 17% of patients)
- Burning/stinging (in 14.1% of patients)
Qbrexza was shown in clinical trials to improve sweating symptoms as soon as 1 week after starting the regimen. Studies also found that patients using Qbrexza wipes once daily for four weeks improved their “sweating severity” by nearly 25% to 30% (compared with 4% to 5% with placebo) and that measured sweat volume was reduced by 50% or more (in most patients.) The wipes were well-tolerated, and any reported side effects were primarily mild to moderate (see above). Qbrexza is FDA-approved for patients who are 9 years or older. Talk to your healthcare provider about whether Qbrexza might be a good choice for you, or not.
In April 2023, the U.S. FDA cleared for use the Brella™ SweatControl Patch™ for the treatment of excessive underarm sweating (primary axillary hyperhidrosis). The Brella™ patch is a prescription product designed and cleared to be applied at a healthcare provider’s office or clinic for approximately 3 minutes and works via a method called targeted alkali thermolysis (TAT). When the Brella patch is applied to the underarm, there’s an interaction between the water in sweat and the ingredients in the patch that generates a targeted amount of heat, causing microthermal injury to the sweat glands that inactivates those glands for a period of time. The process is non-invasive and does not involve needles. Results have been reported to last 2 to 4 months. Research on Brella was presented early in 2023 at the American Academy of Dermatology Annual Meeting and showed that measured sweat production decreased by more than 50% for most (60%) of treated patients. There were no reported serious or severe adverse events (side effects) among the study participants. Eighty percent of people in the study had no side effects at all and those who did experienced slight redness or slight swelling that resolved within two weeks or less.
Brella will be available in certain areas of the U.S. in late summer of 2023 through a “Brella Early Experience Program.” The initial healthcare offices able to provide Brella will be dermatology and plastic surgery practices with prior experience treating patients with excessive sweating. Later, Brella will be launched more generally in the U.S. Information about availability outside the U.S. is not yet available.
SURGERY or PROCEDURES
While many people find that antiperspirants, Botox injections, miraDry, or a combination of these hyperhidrosis treatments (or these treatments combined with an oral medication) are enough to manage even the most severe case of excessive sweating in the underarms, there are those who seek a surgical approach to treat their axillary hyperhidrosis. LOCAL underarm surgery techniques include excision, curettage, liposuction, and laser. During excision, sweat glands may be cut out. Similarly, during curettage, they may be scraped out. During liposuction, they may be removed by suction. Using lasers, tissue containing sweat glands is liquefied. Combinations of curettage and central excision, or of curettage and liposuction may be used, as well as combinations of liposuction and laser treatments. Dermatologists often have good results with these techniques. Each of these procedures can be done under local anesthesia (meaning that the patient is not completely "out"), and in an office setting (as opposed to in a hospital setting). To learn more about these local surgical options for axillary (underarm) hyperhidrosis, click here.
Please note that, in most cases, we do not recommend endoscopic thoracic sympathectomy (ETS) for excessive underarm sweating. While ETS is perhaps the most commonly discussed (as well as criticized) surgery for hyperhidrosis, there are other, far less risky, and far more predictable, options for people who suffer from excessive sweating of the underarms.
We hope that you'll find the information on this site helpful as you search for the best way to manage your underarm sweating problem. For updates about new research, the latest treatments, free treatment clinics, and daily management tips, be sure to sign-up to receive our free News Blog. We also have an extensive library of hyperhidrosis articles from peer-reviewed medical journals, so you can see where we get our facts and can share reliable medical data with your healthcare provider.