Hyperhidrosis is the medical term for excessive sweating. Many people suffer from excessive sweating. These individuals can sweat even when the temperature is cool and they are at rest. Although sweating normally occurs in response to heat, physical exertion, and tense emotional situations, excessive sweating occurs without these triggers. The uncontrollable sweating can lead to significant physical and emotional discomfort.
In some cases a medical disorder, such as an overactive thyroid, certain types of infections, and some hormonal conditions, can cause excessive sweating. For this reason, the first step in the treatment of excessive sweating should be a visit to your doctor for a complete medical evaluation to rule out a medical condition that may be causing profuse sweating. However, in most cases, no particular cause of excessive sweating is found. Excessive sweating without apparent cause is called primary hyperhidrosis, and approximately 2%-3% of the U.S. population has this condition (around 6-8 million people).
The treatment of excessive armpit sweating includes antiperspirants, medications such as anticholinergic drugs, surgery, and Botox. Generally, the first treatment tried for excessive armpit sweating is an antiperspirant. Antiperspirants reduce excessive armpit sweating by plugging the ducts of the sweat glands in the armpits. These products generally contain 10%-15% aluminum chloride and are available over-the-counter. Prescription antiperspirant products are also available containing higher concentrations of aluminum chloride. Antiperspirants can decrease the flow of underarm sweat by about 50%. Antiperspirants should be distinguished from deodorants, which do not prevent sweating, but which are helpful in reducing body odor when it is present. Generally, patients will use an aluminum chloride antiperspirant three to seven times a week. If the antiperspirant controls the sweating, the improvement can usually be maintained by ongoing use of the antiperspirant only once every one to three weeks.
When antiperspirants are not effective in controlling excessive armpit sweating, medications such as anticholinergic drugs can be tried. However, they may have side effects such as dry mouth, dizziness, and problems with urination.
In severe cases of sweating, a surgical procedure called sympathectomy can be performed. With this procedure, the nerve associated with the overactive sweat glands is cut. However, the procedure requires general anesthesia and a short hospitalization, and some patients may develop compensatory sweating at other sites on the body following surgical treatment. For these reasons, we do not recommend surgery to treat excessive sweating.
In our office, when excessive underarm sweating is not controlled by antiperspirants, we recommend the use of Botox. The FDA approved Botox in 2004 for the treatment of severe underarm sweating. Botox controls the excessive sweating for up to six months. In the clinical trials that led to the FDA’s approval, 86% of treated patients showed a significant reduction in armpit sweating. When injected into the armpits, Botox acts by blocking the release of sweat by the sweat glands, resulting in a significant reduction in sweating within three to seven days. Our patients have been amazed by the reduction in armpit sweating they have had following the use of Botox.