- Best Results8 days
- Treatment Recovery0-8 days
- Procedure TimeVariable
- Skin SpecialistDavin Lim
- Duration of ResultsVariable
- Back to Work0-8 days
- Cost$-$$ Medicare
Sweaty underarms or axillary sweating is one of the most common areas of hyperhidrosis. This condition affects 2-3% of the population. It has significant emotional, social & professional aspects of a patient’s life. Highly effective treatments can be covered by Medicare & cost less than a cup of coffee a day.
FactsFacts On Axillary Hyperhidrosis / Underarm Sweating
- Axillary hyperhidrosis or excessive underarm sweating is a common condition
- Severe sweaters are intolerant to clinical strength antiperspirants
- Anti-sweat injection is a proven treatment for severe underarm sweating
- Injections by a dermatologist cost less than cosmetic clinics
- Anti-sweat injections can stop sweaty armpits for up to 6-7 months
- This treatment is subsidised by Medicare
What is the definitive treatment that works?
Anti-sweat injections give a predictable response in most patients. The confidence interval exceeds 96%.
Keep in mind that sweat stopping treatments management is not the treatment of choice for all people with underarm sweating. These injections are only indicated if you have failed clinical strength antiperspirants.
If you are a candidate for sweat stopping treatments, under the PBS rules, you are entitled to up to 3 injections per year, subsidised under Medicare. The sweat stopping treatments procedure takes only 2 minutes to perform, and each armpit will receive 10-12 injections. You will start to notice a reduction in sweating within a week or two, and this sweat reduction will last up to 6-8 months.
I normally perform these injections on the day of the consult; however, you will require a referral from a GP in order to claim from Medicare. As a guide, your out-of-pocket cost is around $590. This is half what cosmetic clinics charge (the reason is because Medicare subsides this treatment.)
How do you know if sweating impacts your life?
Underarm sweating is a common condition; however, the severity will be different for each person. When underarm sweating gets in the way of your personal and work life, the condition does have a significant impact for you!
Ask yourself the following questions to gauge the impact of underarm sweating:
Are you worried that people notice your sweat stains and patches?
Are you worried to raise your arms because of sweat patches and stains?
Does underarm sweating limit your choice of clothes?
Do you usually wear only black or white colours?
If you answer ‘yes’ to any of these questions, underarm sweating does have an impact on your life, and yes, we can help!
What is the cause of excessive sweating?
Excessive sweating is a common condition that is not well managed in our community. No one really talks about it; however, it affects 2-3% of the population. In some races, sweating excessively is seen in 5% of the population.
Hyperhidrosis can affect many areas of the body including the hands, feet, face – scalp and commonly the underarms. Most cases of underarm sweating are primary and idiopathic. The cause is unknown, but in many cases patients who suffer from sweaty armpits will have a family member with a sweat disorder. The underarm area or axillary vault, like your hands, feet and face, contain a large number of sweat glands (eccrine units), these areas are primarily involved in hyperhidrosis.
How do we quantify sweat severity?
Severe axillary or armpit sweating is a medical condition that involves overactive eccrine or sweat glands. A simple set of questions can gauge the impact of this condition on your life.
Examination of the underarms can provide the most useful clue to the severity of your sweating. Most patients will have beads of sweat on the underarm skin. In severe cases, sweat flows freely.
An accurate way to measure the area of maximal sweating is called the starch iodine test. This test is not routinely performed; however it is a simple and accurate method of ‘mapping out’ your maximal sweat areas. Other techniques include blotting paper.
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What is the treatment algorithm for underarm sweating?
Apart from injections, other methods that I employ for underarm sweating include-
Clinical antiperspirants and deodorants. Look for aluminium chloride hexahydrate. They are available without prescription from your pharmacy. If applied correctly, they can help reduce underarm sweating by blocking sweat ducts, thereby reducing the amount of sweat that reaches the skin’s surface. They are most useful for mild to moderate underarm sweating.
Prescription tablets for sweating. These groups of tablets are called anticholinergic medications and can be obtained via a prescription from your GP. The most common tablets are oxybutynin, glycopyrrolate & propantheline bromide. Side effects such as sedation, dry mouth and blurred vision may occur.
Alternative therapies & lifestyle changes. See the section on natural remedies. St John’s Wort, Nat Mur, Sage, Chamomile and Argentum have been reported to reduce underarm sweating. If you are inclined to trial these methods, see a naturopath, acupuncturist, herbalist or book in with a meditation class.
Topical pads can be purchased in the United States & Canada. They have varying concentrations of glycopyrrolate (0.5 to 2%). They can be effective in up to 25% of cases.
Biofeedback & CBT can be very useful if stress plays a part in excessive armpit sweating. This is done by a clinical psychologist.
Iontophoresis is a method that treats your sweat glands with an electrical current. It works better for palmar (sweaty hands) as well as plantar (sweat feet) hyperhidrosis. Iontophoresis of the armpits can be achieved with a pad, and can be effective in 20% of patients.
Microwave & RF technology can help. Miradry, as well as RF can improve up to 80% of underarm sweating. The risks & benefits of these treatments are discussed elsewhere on this site.
Surgery. There are several surgical techniques for underarm or axillary sweating. The most promising surgical procedure is known as ETS or endoscopic thoracic sympathectomy. This procedure can be used for underarm sweating, facial sweating, and palmar (sweaty hands) hyperhidrosis.
What’s the go with miraDry?
miraDry is another answer for excessive underarm sweating. It works by electromagnetic energy that is delivered to the eccrine or sweat glands in your armpit. Each treatment takes one hour to perform. After miraDry treatment, your armpit will be red, inflamed & swollen for 4-10 days. This procedure is repeated again in 12 weeks.
I was the first doctor in Australia to get the device, in fact I was trained overseas before miraDry obtained TGA approval. I do think it works well in some but not patients. The side effects are under-reported as it causes significant nerve pain in many patients, especially lean-low body fat individuals. I tend not to use it much now-a-days, as I am awaiting the release of miraDry 2. This model will be more effective with much less side effects.
How much are treatments?
Excessive underarm sweating is cheaper than you may think! Paradoxically, seeing a dermatologist is much more cost effective compared to cosmetic clinics, nurses & cosmetic GPs. The main reason is that you get stuff back from Medicare if you see a dermatologist.
Depending on your Medicare status, treatments range from $160 to $590 out of pocket.
Davin’s Viewpoint on Treating Underarm Sweating
Axillary hyperhidrosis is a very common condition, affecting over 2% of the population. A family history is present in 25% of cases. Like most cases of excessive sweating, it ranges from mild to very severe. The impact of underarm sweating can be assessed by asking only a few very basic questions- does sweating limit what you wear? Are you apprehensive to raise your hands due to sweat patches? Are you embarrassed if people notice your sweat patches? If the answer is yes, then you should treat your condition.
For patients who have mild sweating, a clinical grade antiperspirant is the first step. For patients who suffer from moderate to severe underarm sweating, this will create skin irritation in most patients. Since the withdrawal of Driclor for the Australian market, look for 10-20% aluminium chloride hexahydrate. Apply as directed.
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