Artboard 5SOCIAL acadExcessive Underarm Sweating Doesn’t Need to Ruin Summer (or Any Season): Here’s the Axillary Hyperhidrosis Game Plan

Experts say you have about 40,000 sweat glands in your underarms - that’s 20,000 per pit! And in people with hyperhidrosis or excessive sweating, those glands are working OT - generating four or five times more sweat than is necessary or “normal” to keep the body cool or as a reaction to everyday stress and excitement. This type of extreme, uncontrollable sweating can soak through layers of clothing, drip off elbows, and negatively impact confidence, emotional well-being, and everyday life. 

Often, people with axillary (underarm) hyperhidrosis will dictate their entire wardrobes around trying to hide sweat, such as by wearing dark colors or bulky layers, even when it’s hot out. 

Sometimes, those affected by this type of excessive sweating will avoid social, school, career, or other situations to try and decrease the embarrassment and stigma their sweating causes. In tandem, isolation, depression, anxiety, chronic stress, and other mental health concerns can arise. 

But if you're feeling embarrassed—or worse—about your sweaty pits around the barbecue pit this summer, please know that you are not alone. Research says that underarm excessive  sweating is the most common form of hyperhidrosis, affecting about 260 million people worldwide -- that’s more than the entire population of Brazil or Russia!

Better, drier days are possible and we've got the game plan to help you get there.  Keep reading for everything you need to know about the safe, effective treatments for excessive underarm sweating so you can fully participate in summer - and life. 

Clothing Hacks

When choosing clothing for axillary hyperhidrosis, look for quick-drying, moisture-wicking materials and consider patterns, which are often better at concealing wet marks than solid colors. 

Useful additions to the wardrobe are:

Antiperspirants

Basic weapons against unwanted underarm sweating are antiperspirants. 

Antiperspirants are non-invasive, topical (applied on top of your skin), often cost-effective, and available in a number of different strengths including:

Most healthcare providers recommend starting with the mildest forms first (such as regular over-the-counter products). If those don't provide enough sweat relief, consider moving up to stronger clinical strength formulations and, if needed, prescription antiperspirants. Note that certain clinical strength antiperspirants have been shown to provide the same level of sweat management as prescription products, while often being gentler on the skin. 

A number of antiperspirants designed specifically for people with hyperhidrosis are available through our Fan Fave Products page, with discounts for our community. 

How you use antiperspirants matters—a lot. Proper application can maximize effectiveness and help prevent skin irritation. Visit our pages about OTC antiperspirants and prescription antiperspirants for deep dives into this.  But for now, here are the two most important takeaways: 

1. Apply antiperspirant before bed for greatest efficacy
2. Apply to completely dry skin to avoid irritation

Botulinum Toxin Injections

If antiperspirants don't give you the relief you need, another option may be botulinum toxin injections (commonly known by the brand name Botox). In 2004, the U.S. FDA approved Botox for the treatment of primary axillary hyperhidrosis. A trained medical professional can inject botulinum toxin (Botox or a similar brand) into the underarms to significantly reduce sweating, often with dramatic results.

In a 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 maintained sweat relief for at least 200 days (nearly seven months) and some saw results lasting over a year. 

Botulinum toxin injections for the treatment of hyperhidrosis are most effective when performed by a healthcare professional who has received special training and 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 are “IHhS-Educated.”

miraDry

Another treatment option for excessive underarm sweating (as well as for unwanted odor and underarm hair) is miraDry. Available since 2011, this in-office procedure uses an FDA-cleared, microwave energy medical device to permanently destroy or alter sweat glands and hair follicles. After treatment, hair growth is reduced and underarm glands no longer produce watery eccrine sweat or the thicker, odor-linked apocrine 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% and 88% of people treated with miraDry were no longer bothered by underarm odor 12 months later. Patients rated their satisfaction with the treatment at 90%. 

To learn more about miraDry, watch our "Ask Me Anything about miraDry" webinar with two miraDry experts now.

Qbrexza

Qbrexza became available in the U.S. in October 2018. This treatment comes in individually packaged cloths (or wipes) designed for once-daily, at-home use—one wipe is designed for both underarms. Qbrexza works by blocking the receptors responsible for sweat gland activation. Its active ingredient, glycopyrronium tosylate, is an anticholinergic that helps reduce sweat production.

Clinical trials showed that Qbrexza can begin improving sweating symptoms within just one week of starting treatment.  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.) Reported side effects were generally mild to moderate. Qbrexza is FDA-approved for use in patients aged 9 and older.

In addition to being available in the U.S., Qbrexza is also being commercialized in several Asian countries through licensing by the Japanese company Maruho Co. These countries include Japan, South Korea, Taiwan, Hong Kong, Macau, Thailand, Indonesia, Malaysia, the Philippines, Singapore, Vietnam, Brunei, Cambodia, Myanmar, and Laos.

Sofdra

In July 2024, the U.S. FDA approved topical anticholinergic gel Sofdra for the treatment of underarm hyperhidrosis in patients aged 9 and older. Sofdra is a prescription medicine applied directly to the skin (topical). Its active ingredient, sofpironium 12.45%, is a novel anticholinergic/antimuscarinic agent that works by blocking the receptors responsible for activating sweat glands—interrupting the signals that trigger excessive sweating.

Sofdra went through extensive clinical testing in the U.S. prior to its approval. Two pivotal studies, each lasting eight weeks per participant, enrolled approximately 350 individuals diagnosed with primary axillary hyperhidrosis. Participants ranged in age from 9 years and up. 

Results showed that: 

  • 85% of patients using the sofpironium gel experienced a clinically meaningful improvement in their condition
  • More than 60% of study participants had a 50% or greater reduction in sweat production 
  • Reported side effects were generally mild to moderate and temporary 

Click here to learn how to access Sofdra and find out more. 

Anticholinergics

You probably noticed that both Qbrexza and Sofdra (described above) contain anticholinergic medications that are specially formulated to be absorbed by the skin.  There are also other prescription oral anticholinergics (like glycopyrrolate, oxybutynin, benztropine, and propantheline) that can be taken by mouth to help manage excessive sweating, ideally in combination with antiperspirants, injections, miraDry, and/or iontophoresis. 

Oral anticholinergics work to systemically (in your body's whole "system") limit sweating by helping to prevent the stimulation of sweat glands. They are best used with other therapies so you can get some of their benefits while minimizing their side effects (which can include overheating, dry mouth, dry eyes, muscle cramps, constipation, and urinary retention). To learn more, click here. 

Iontophoresis

Iontophoresis has been around since the 1940s and is often recommended for excessive sweating of the hands and/or feet. One study found that iontophoresis helped 91% of patients with excessive palmoplantar (hands and feet) sweating. Another study showed that iontophoresis reduced palmoplantar sweating by 81%. 

During iontophoresis, an at-home medical device is used to pass a mild electrical current through water (usually using shallow pans for hands or feet or wet pads for other body areas like the underarms) and through the skin's surface. There are no significant or serious side effects and the benefits are long-term, provided you keep up with the maintenance schedule your practitioner recommends (usually once per week). 

While we have solid data to support the use of prescription, FDA-cleared iontophoresis devices to treat hyperhidrosis on the hands and feet, there isn’t the same quality of information available about using iontophoresis for the underarms. If you’d like to consider this option, do your research and look for reputable iontophoresis device makers (like those on our Fan Fave Products page). 

At first glance, an iontophoresis device may seem pricey, but the expense is relatively reasonable when you realize that the devices last for many years (even decades), you can self-manage your treatments at home, and devices can be shared among family members (a key benefit given that hyperhidrosis frequently runs in families). Check our Fan Fave Products page for discount codes.

Brella

A unique, newer treatment for underarm excessive sweating is the Brella SweatControl Patch (FDA cleared in 2023). The prescription patch is applied in a healthcare provider’s office or clinic for approximately 3 minutes. Brella works through targeted alkali thermolysis: when the sodium patch is applied to the underarm, there’s an interaction between the water in sweat and the sodium in the patch that generates controlled heat, creating microthermal injuries that temporarily inactivate the sweat glands. The process is non-invasive, there’s no needles, and no pain control or anesthesia is required.  In studies, most patients treated with Brella found that their sweating decreased by 50%. 

Currently, Candesant Biomedical—the company behind Brella—is in the process of being sold, and no Brella sales representatives are available at this time. As a result, access to the treatment is limited. If you're interested in Brella, we recommend reading more about it, contacting local dermatology clinics to ask if they offer it, and checking our news blog for updates.

Underarm Surgeries or Procedures

While many people find that the treatments mentioned above, or - importantly - a combination of hyperhidrosis treatments, or treatments combined with an oral medication, are enough to manage excessive sweating in the underarms, there are those who seek surgical approaches. 

Specific underarm-only 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 and can perform them under local anesthesia (meaning that the patient is not completely "out") in an office setting (as opposed to in a hospital). To learn more about such 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 a commonly discussed (and criticized) surgery for hyperhidrosis, there are other (far less risky and far more predictable) options for people who suffer from excessive sweating that should be tried, exhaustively, first. ETS surgery can have serious long-term compensatory sweating side effects that are often more distressing than even the original sweating problem.

Thanks for making us part of your beach reads! If you’d like to learn even more about axillary hyperhidrosis research and treatments, check out our extensive library of hyperhidrosis articles from peer-reviewed medical journals.

We hope you find this information helpful as you search for the best way to manage your underarm sweating this summer and all year long. 

Coming Soon: Smart Sweat Solutions for Back-to-School, Plus Our Face & Scalp Sweating Game Plan

Want to learn even more about hyperhidrosis? Stay tuned to this blog for the best ways to tackle sweating during back-to-school season AND the topic so many of you have been asking for…our Craniofacial (face and scalp) Hyperhidrosis Game Plan. 

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