Underarm Sweating

Deodorants and antiperspirants do not serve the same function.

Deodorants

They are mainly intended to reduce or mask body odor. They usually do not reduce the amount of sweat.

Antiperspirants

They aim to reduce the amount of sweat reaching the skin surface by temporarily affecting the sweat ducts. Some products may have both deodorant and antiperspirant properties, but the two terms do not mean the same thing.

Are Antiperspirants Used for Underarm Sweating?

Antiperspirants containing aluminum salts are among the first nonsurgical methods that may be considered for axillary hyperhidrosis. These products aim to reduce the amount of sweat reaching the skin surface by temporarily affecting the sweat ducts. Possible side effects include:

• burning,
• itching,
• redness,
• dryness,
• skin irritation

Applying them to completely dry skin may reduce the likelihood of irritation. Freshly shaved, damp, or already irritated skin may be more sensitive. Because products differ in their ingredients and concentrations, how often they are used may vary depending on the person and the product.

Topical Medications

Certain prescription medications applied to the underarms aim to reduce the nerve signals that stimulate the sweat glands. In some countries, topical anticholinergic medications may be available in different forms, such as wipes, gels, creams, or solutions. Possible local or systemic side effects include:

• skin irritation,
• burning,
• dryness,
• dry mouth,
• blurred vision,
• dilation of the pupil if the medication comes into contact with the eye,
• difficulty urinating

Because medications applied to the underarms can be carried to the area around the eyes by the hands, instructions for use and hand washing are important. The approved uses, age limits, and availability of these products may vary from country to country.

Oral Medications

Certain anticholinergic medications can be used systemically to reduce the nerve stimulation reaching the sweat glands. These medications can affect sweating not only in the underarms but also in other areas of the body. Possible side effects include:

• dry mouth,
• constipation,
• blurred vision,
• dry eyes,
• difficulty urinating,
• changes in heart rate,
• drowsiness,
• problems with concentration,
• difficulty regulating body temperature

Sweating is one of the body's natural cooling mechanisms. For this reason, suppressing sweat production over large areas is a particular concern during hot weather, fever, or intense physical activity. Whether a medication is suitable is evaluated based on the person's age, health status, and other medications they take.

Is Botulinum Toxin Used for Underarm Sweating?

Botulinum toxin aims to temporarily reduce chemical signaling between certain nerve endings and the sweat glands. It is one of the treatment options used for primary axillary hyperhidrosis. During the procedure, many small injections are made into the skin of the area that sweats excessively. Its effect is not permanent. Sweating can increase again as nerve function is restored over time. Possible side effects include:

• discomfort during the injections,
• temporary tenderness,
• bruising,
• headache,
• local irritation,
• rarely, temporary weakness of nearby muscles

The duration of the effect can vary from person to person. The approved uses of botulinum toxin for hyperhidrosis may differ depending on the product and the country.

Is Iontophoresis Used for Underarm Sweating?

Iontophoresis is a method used mainly for hand and foot hyperhidrosis. Although some special devices have been developed for use in the underarm area, the procedure may be less practical than for the hands and feet because of the anatomy of the area and the sensitivity of the skin. Repeated initial treatments followed by maintenance sessions may be needed. Possible effects include:

• dry skin,
• redness,
• burning,
• irritation,
• tingling

Suitability is evaluated separately during pregnancy and in people with certain implanted electronic medical devices.

What Localized Procedures Target the Underarm Sweat Glands?

Some procedures aim to directly reduce the number or activity of the sweat glands in the underarms. Different methods may use:

• heat- or energy-based treatments,
• mechanical reduction of the sweat glands,
• curettage,
• liposuction-like techniques,
• limited surgical procedures

These methods differ in how they are performed, the level of scientific evidence supporting them, and their availability. Possible effects and complications include:

• pain,
• swelling,
• bruising,
• changes in skin sensation,
• firmness under the skin,
• infection,
• scarring,
• changes in skin color,
• irregularity of the underarm skin,
• insufficient reduction in sweating,
• sweating increasing again over time

Because some localized procedures can cause permanent or long-lasting tissue changes, the potential benefits and complications are weighed together.

Is There a Role for Anxiety and Stress Management?

Because stress can increase axillary hyperhidrosis, psychological or behavioral approaches may be supportive for people with marked anxiety or avoidance behaviors. These may include:

• relaxation techniques,
• breathing exercises,
• cognitive behavioral therapy,
• evaluation of marked social anxiety,
• reducing avoidance behaviors

These methods do not directly stop the sweat glands from working. The aim is to reduce the impact of the cycle in which anxiety increases sympathetic activity and the increased sweating in turn leads to new anxiety. Using psychological support does not mean that axillary hyperhidrosis is imaginary or purely emotional.

What Is the Role of Surgery in Underarm Sweating?

In isolated axillary hyperhidrosis, surgery is generally not considered a first-line treatment. Nonsurgical or local options are available, such as antiperspirants, topical medications, botulinum toxin, and various methods that directly target the underarm sweat glands. Thoracic sympathetic surgery, on the other hand, does not act on the sweat glands in the underarms directly, but on the sympathetic nerve pathways located inside the chest. The role of this surgery is more clearly established in severe primary palmar hyperhidrosis than in cases involving underarm sweating alone. For this reason, sympathetic surgery for underarm sweating is considered only in carefully selected cases in which appropriate less invasive methods have already been evaluated.

What Is ETS?

Endoscopic thoracic sympathetic surgery, commonly referred to as ETS, refers to surgical methods based on interrupting certain sympathetic nerve pathways inside the chest. These nerve pathways play a role in transmitting the signals that influence sweating. ETS can reduce sweating in some types of primary focal hyperhidrosis. However, when only the underarms are affected, results can be more variable than in severe primary hand sweating. For this reason, ETS is not considered a routine early-stage treatment for isolated axillary hyperhidrosis.

Is ETS Reversible?

Sympathetic nerve surgery should not be regarded as a reliably reversible procedure. In different surgical techniques, the sympathetic nerve pathway can be affected in different ways. Although some operations use surgical clips instead of physically cutting the nerve, removing the clip later does not necessarily mean that nerve function or the pre-operative sweating pattern will return. Nerve compression, scar tissue, and other permanent changes can occur. For this reason, sympathetic nerve surgery is evaluated with its possible long-term consequences in mind.

What Are the Possible Risks of Thoracic Sympathetic Surgery?

The use of a minimally invasive (closed) surgical technique does not mean that thoracic sympathetic surgery is risk-free. Possible outcomes and complications include:

• compensatory sweating,
• excessive dryness,
• persistent underarm sweating,
• recurrence of sweating,
• different results on the two sides,
• gustatory (taste-related) sweating,
• pneumothorax,
• hemothorax,
• bleeding,
• infection,
• chest or nerve-related pain,
• slowing of the heart rate,
• Horner syndrome,
• anesthesia-related complications

The likelihood of these risks can vary depending on the surgical technique, the extent of the procedure performed on the sympathetic nervous system, the person's anatomical features, and their general health.

What Is Compensatory Sweating?

Compensatory sweating is the appearance of new or increased sweating, after sympathetic surgery, in areas that previously sweated less. It is most often seen in areas such as the:

• back,
• chest,
• abdomen,
• lower back,
• hips,
• groin,
• legs

Its severity can vary considerably from person to person. In some people it appears as slight dampness, while in others it can become intense enough to affect clothing and daily life. It may be more noticeable during hot weather, physical activity, or stress. There is no reliable test that can determine with certainty before surgery who will develop compensatory sweating or how severe it will be. No sympathetic surgery method completely eliminates this possibility.

Can Underarm Sweating Recur After Treatment?

The effects of many methods used for axillary hyperhidrosis are not permanent. When treatment is stopped or its effectiveness decreases over time, sweating can increase again. Sweating can also persist or return after a localized procedure or sympathetic surgery. Possible reasons for this include:

• sweat glands that remain active,
• individual anatomical differences,
• differences in the method used,
• changes in nerve conduction over time,
• the presence of a secondary cause of sweating

Some physiological moisture in the underarms does not always mean that treatment has failed.

Why Is Follow-Up After Treatment Important?

Follow-up is not only about checking whether the underarms are completely dry. The following may also be considered:

• changes in daily life,
• the amount and distribution of sweating,
• skin dryness or irritation,
• body odor,
• compensatory sweating after sympathetic surgery,
• changes in sweating in other areas of the body,
• recurrence of sweating,
• the effects and side effects of medications being used,
• social and psychological effects.

The effectiveness and tolerability of nonsurgical methods can change over time.

When Is a Medical Evaluation Important for Underarm Sweating?

Underarm sweating does not always indicate a disease. However, evaluating the cause of sweating becomes important when any of the following features are present:

• Sudden onset of sweating
• One underarm consistently sweating much more than the other
• Heavy sweating during sleep at night
• Sweating that affects the whole body
• Accompanying fever, palpitations, shivering, or unexplained weight changes
• Symptoms that appear after starting a new medication
• Recurrent skin infections or marked irritation
• Sweating that significantly affects daily life
• If sudden sweating is accompanied by chest pain, shortness of breath, fainting, or other acute symptoms, urgent medical evaluation may be needed.