Sweaty Armpits

 

Underarm excessive sweating, also called axillary hyperhidrosis, is an uncontrollable, annoying, embarrassing, and isolating problem. 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 safe, effective treatments for excessive sweating are available and you have a number of options to choose from — or combine.

ANTIPERSPIRANTS

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 prescription antiperspirants. Most healthcare providers recommend starting with the mildest formulations (such as regular over-the-counter products). If these don't provide enough symptom relief, consider moving to stronger clinical strength formulations and, if needed, prescription antiperspirants.. Certain clinical strength antiperspirants have been shown to provide the same level of sweat management as prescription products, but with less skin irritation. A number of antiperspirants designed specifically for people with hyperhidrosis are available through our Fan Faves page, with discounts for our community. 

How you use antiperspirants is also incredibly important. Check out our information about this for OTC antiperspirants and for prescription antiperspirants. The most important take-aways are: 1. apply antiperspirants before bed for greatest efficacy and 2. apply to totally dry skin to avoid irritation.

Useful additions to the wardrobes of anyone with underarm sweating (excessive or not!) are: absorbent undershirts, absorbent tee shirts, absorbent dress shirts, and absorbent underarm pads.  You can nab a coupon for them on our Fan Faves page — as mentioned above, our Fan Faves page is a great place to learn about different antiperspirants available from companies who support our work and understand Hh. 

BOTOX

If antiperspirants don't give you the relief you need, another option may be Botox (also known as onabotulinumtoxinA). In 2004, the U.S. 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 got relief for over a year. The use of 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'.

BRELLA

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 shows that with Brella, 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 study participants. Eighty percent of people in the study had no side effects and those who did experienced slight redness or slight swelling that resolved within two weeks or less. The initial healthcare offices able to provide Brella will be dermatology and plastic surgery practices with prior experience treating patients with excessive sweating. Information about availability outside the U.S. is not yet available. 

MIRADRY

Another treatment option, miraDry, available for axillary hyperhidrosis (underarm excessive sweating) was cleared by the U.S. 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%. miraDry is promising for those who suffer from underarm sweating, but it cannot be used to treat excessive sweating in any other area. The International Hyperhidrosis Society and miraDry 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 questions about this lasting underarm sweat treatment. For more miraDry info, read the research findings and understand the procedure for miraDry here.

QBREXZA

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) and/or 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.) Any reported side effects were primarily mild to moderate (see above). Qbrexza is FDA-approved for patients who are 9 years or older. 

SOFDRA

In July 2024, the U.S. FDA approved topical anticholinergic gel Sofdra for the treatment of underarm hyperhidrosis for patients ages 9 years and older. A Botanix Pharmaceuticals product, Sofdra is a prescription medicine applied to the skin (topical). The Sofdra gel contains a novel active ingredient called sofpironium 12.45%. Sofpironium is an anticholinergic/antimuscarinic medication that blocks sweating at the level of the sweat glands by binding to a receptor and interrupting sweat signals.

Sofdra went through extensive U.S. studies prior to its approval. Two pivotal trials (called “Cardigan I” and “Cardigan II”) lasted eight weeks (per participant) and included about 350 hyperhidrosis sufferers each. Study volunteers were aged nine years and older and all were diagnosed with primary axillary hyperhidrosis. 

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; and the most common side effects reported were dry mouth and blurred vision. These were usually mild or moderate and temporary. 

Eligible patients can register by January 31, 2025 to receive a FREE SIX-MONTH SUPPLY of Sofdra. That's zero cost for the first 6 months of your Sofdra prescription fills. Visit this page to learn more about Sofdra. Also, get on the manufacturers’ email list.

SURGERY or PROCEDURES

While many people find that the treatments mentioned above, or 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 a surgical approach to treat 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 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 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. For updates about new research, the latest treatments 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.