How to Treat Axillary Hyperhidrosis (Excessive Sweating)

September 3, 2020

Young woman with axillary hyperhidrosis

We’ve all been there. We stand up to give a presentation at work or show up for our first date, and there’s a little half-moon of perspiration under our arms letting everyone know exactly how nervous we are. This can certainly be embarrassing, but if you live with these half-moons of underarm perspiration every day – you may be dealing with more than embarrassment. Frequent, excessive underarm sweat may be a condition called axillary hyperhidrosis. According to Dr. Lauren Snitzer of U.S. Dermatology Partners in Sugar Land, Texas, “Many people don’t know that excessive sweating in the armpits, medically called axillary hyperhidrosis, is treatable. Those who do know there are treatments for this condition may not know their dermatologist is the right professional to contact for help. While sweating can be triggered by internal systems, the majority of axillary hyperhidrosis symptoms and side effects are related to the skin and pores. In these cases, treating excessive sweating is the domain of dermatology.” If you’re struggling with excessive sweating, the team at U.S. Dermatology Partners can help. Learn more from Dr. Snitzer about how to treat axillary hyperhidrosis in this blog.

What is Axillary Hyperhidrosis?

The body needs to sweat. It’s part of the internal process for regulating body temperature, so a little glisten on a run or when your temperature rises due to nervousness is perfectly natural. It becomes a problem when you start to sweat more than is necessary or expected during an activity or you seem to be constantly sweating. When you sweat excessively, you may actually be experiencing hyperhidrosis. Dr. Snitzer says, “For a few patients, hyperhidrosis (excessive sweating) is generalized, meaning it happens all over the body. But, most people have a localized form of hyperhidrosis. Specifically, plantar hyperhidrosis that impacts the feet, palmar hyperhidrosis that impacts the hands, or axillary hyperhidrosis that impacts the underarms. Axillary hyperhidrosis is the form of excessive sweating we’re talking about treating, but there are treatment options for all types of hyperhidrosis. Let your dermatologist know if you need help with excessive sweating on any part of your body.”

If excessive sweating is infrequent or you’re able to control it with the use of antiperspirants, you may not need to seek professional support. If axillary hyperhidrosis impacts you more than once a week, it’s time to talk to your dermatologist.

What Causes Excessive Sweating Under the Arms?

According to Dr. Snitzer, “The eccrine glands are responsible for sweat production, and they regulate our body temperature. People with excessive underarm sweating have overactive eccrine glands, but there’s usually not a specific cause for this eccrine gland dysfunction. That means the vast majority of cases of hyperhidrosis are considered idiopathic – of unknown origin.” In addition to generally overactive eccrine glands, some risk factors and potential underlying causes of excessive sweating include:

  • Genetics – If you have a family history of excessive sweating, let your dermatologist know. This may play a role in your chances of developing the condition.
  • Illnesses – In rare cases, infections, endocrine disorders, lymphoma, and other medical issues can cause excessive sweating. During an intake visit, your dermatologist may ask several general health questions to help rule out other conditions.
  • Medications – Another area we’ll cover during your intake session is any current or past medication use. Certain prescription medications list excessive sweating as a potential side effect. When necessary, your dermatologist can work with your other healthcare providers to find alternative medications or treatment options.
  • Neurological injuries – Strokes and other neurological (brain and nervous system) injuries will impact the body in myriad ways. For some people, this includes triggering eccrine gland overproduction and excessive sweating.
  • Hormonal changes – Anyone can develop hyperhidrosis, but adolescents and teens who are experiencing dramatic hormonal fluctuations are most likely to develop this condition as their endocrine systems are taxed by bodily changes.

Does Axillary Hyperhidrosis Have Symptoms Other than Sweating?

During your intake consultation, we will spend time talking about your medications, health history, and symptoms to ensure axillary hyperhidrosis is the appropriate diagnosis. Frequent or excessive sweating more than once a week is the most common symptom of this condition, but you may also be experiencing related effects like chronic itching or skin irritation due to excessive moisture. You may also be more prone to bacterial and fungal infections of the skin.

When Should I Seek Treatment for Axillary Hyperhidrosis?

Many people have mild hyperhidrosis or experience excessive sweating infrequently, and they may be able to manage symptoms at home. However, you should seek professional treatment if you engage in any of the following behaviors regularly:

  • Hiding stained clothing (T-Rex arms to keep people from seeing underarm stains)
  • Experiencing self-consciousness and even social withdrawal or difficulty making eye contact may occur due to embarrassment or shame about the condition
  • Having difficulty finding and maintaining employment, especially in fields where regular contact is necessary like healthcare professions
  • Investing significant time and energy in tasks related to managing excessive sweating (changing clothes, showering, etc.)
  • Worrying constantly about body odor or appearance of noticeable sweat stains when interacting with other people

On fighting excessive hyperhidrosis on your own, Dr. Snitzer says, “No one should have to accept worrying about their appearance or smell or feeling embarrassed as a ‘normal’ part of life. Sure, it happens to all of us sometimes, but excessive sweating doesn’t need to be something you just learn to live with, especially if the condition makes you feel self-conscious or keeps you from meaningful interactions. Treatment options for axillary hyperhidrosis are typically minimally invasive and highly effective, so please get in touch with a trusted dermatologist if you’re spending all of your time worried about excessive sweating.”

Can I Prevent Excessive Sweating?

According to Dr. Snitzer, “You can’t really prevent axillary hyperhidrosis, but you can limit the impact it has on your life by working with a dermatologist to develop a treatment plan to minimize the impact of excessive sweating on your life and prevent the most serious symptoms.” Specifically, Dr. Snitzer recommended taking the following steps to mitigate the effects of axillary hyperhidrosis:

  • Visit a dermatologist and create a personalized daily care plan, including prescription medications and other regular interventions
  • Apply antiperspirants daily
  • Minimize time spent in high temperatures and humidity
  • Avoid prolonged activity that can increase sweating (exchange a morning run for a swim)
  • Reduce stress and anxiety, which can trigger sweating, whenever possible

What are the Available Treatments for Axillary Hyperhidrosis?

Treatment plans for hyperhidrosis typically include a combination of solutions, and Dr. Snitzer says, “The first step is to determine that there is no specific underlying medication, injury, or illness causing the excessive sweating, and if there is, we start by addressing these concerns. Then, we develop a personalized plan for controlling your symptoms. Prescription or store-bought antiperspirants should be used daily. Additionally, you may receive a prescription anticholinergic, which is a topical or oral medication that targets and blocks neurotransmitters that are causing sweating. In rare cases, we may recommend a surgical procedure called a thoracic sympathectomy to interrupt the nervous system’s signal to produce sweat. Finally, we may also recommend periodic Botox injections – yes, the stuff we use for wrinkles! Botox can also help to limit nerve impulses that cause the eccrine glands to produce sweat.”

Most people, even those who don’t struggle with axillary hyperhidrosis, are familiar with and have used antiperspirants. Anticholinergics may be less familiar, but they work in much the same way, drying up sweat glands and preventing unnecessary and excessive sweat production. Botox is not necessarily as familiar of a treatment to patients, so Dr. Snitzer provides additional information about this treatment option below.

Can Botox Really Prevent Excessive Underarm Sweat?

Botox is the brand name of a neurotoxin that uses controlled doses of botulinum toxin injected into the body to limit or prevent specific, involuntarily muscle movements. Botox is most commonly used in cosmetic dermatology to reduce wrinkles, to address muscle spasms, and as part of treatment plans for migraine headaches. But, it can also be used as an effective treatment solution for many people who struggle with axillary hyperhidrosis. In treating excessive underarm sweating, Botox is used to target and prevent the nerve impulses that trigger the production of sweat.

When Should I Use Botox for Excessive Sweating?

Even though Botox is U.S. Food and Drug Administration (FDA) approved for use in axillary hyperhidrosis, your dermatologist will typically recommend less invasive options like antiperspirants and anticholinergics before Botox. For those with moderate to severe axillary hyperhidrosis that isn’t responsive to these treatments, Botox is a treatment option that may allow us to avoid the more invasive surgical treatments.

What Happens During Botox Treatment Sessions?

During your treatment sessions, a controlled and precise application of botulinum toxin is injected directly into the underarm area. Your dermatologist applies Botox injections in a predetermined grid pattern that is designed to ensure the entire affected area is covered. After your treatment, you’ll come back to our office for a follow-up visit where we assess the efficacy of our original plan, administer additional injections, and adjust our treatment plan for ongoing Botox maintenance injections.

On the comfort of the Botox procedure, Dr. Snitzer says, “People often say they’re scared of needles or worried the process will be painful. We actually use very small-gauge needles, which means you’ll barely feel the injections, but for larger treatment areas or more sensitive skin, we also use numbing or local anesthetics to further improve comfort during the process. The small needles also mean less discomfort or sensitivity after treatments.”

Immediately after your Botox treatment session, you may still notice excessive sweating for up to two weeks. We know this can be frustrating, but trust us, the Botox is working, It just takes time for your body to catch up. At around week three, we will schedule your first follow up visit. If you are still experiencing symptoms of axillary hyperhidrosis at this time, we may provide additional injections or retreatment. If there is no change at all after the first round of Botox, we may recommend alternative treatment options.

Do I Need More Than One Botox Treatment Session?

Each person responds differently to Botox treatment for excessive sweating. Your dermatologist will need to carefully monitor your experience (with your help) to determine the appropriate frequency of retreatment. Depending on the individual, there is a great amount of fluctuation in retreatment frequency. Some patients need to receive a course of Botox three or four times a year to sustain results. Others can go 15 months or longer without seeing an increase in sweat production. For this reason, it’s important to keep up with regular follow-up visits to your dermatologist’s office.

Does Botox Have Side Effects?

Most people have little to no adverse response after Botox treatment. You can expect some minimal bruising, swelling, or discomfort immediately after treatment that is cleared up within a few days. These effects can usually be addressed at home by following aftercare instructions from your dermatologist, including using ice packs and over the counter pain relievers as directed. There are certain factors that may increase the risk of issues after receiving injections. Before you begin Botox treatment, your dermatologist will review personal and family medical history and current medication usage. Dr. Snitzer says, “Make sure to mention anything even if it doesn’t seem relevant. You’d be surprised at what could impact your treatment results. For instance, people who take blood thinners may need to suspend use for a few days before Botox to prevent excessive bleeding during and after injections and minimize bruising.”

We’ll do our best to prepare you for any potentially adverse effects you can expect after Botox treatment, but for the most part, these side effects should be minimal. However, if you notice extreme effects like severe swelling, headache, body aches, or flu-like symptoms, especially if they worsen instead of abating over time, you should seek immediate medical help from an urgent care facility or the emergency room. The extreme effects of Botox sound scary, but they are extremely rare.

Contact U.S. Dermatology Partners to Schedule a Consultation

If you’re interested in learning more about your treatment options for excessive sweating, please contact U.S. Dermatology Partners today. You can use a simple scheduling form to set up an in-office visit at the practice location near your home or office.

Additionally, we are happy to offer virtual consultation visits if you want to talk through some of your questions and concerns before scheduling a treatment visit. Use our teledermatology form to request a virtual visit with one of our knowledgeable dermatologists.

After we receive your form, we’ll be in touch to review the details and schedule your treatment.

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