Axillary hyperhidrosis is the medical term used to describe excessive underarm perspiration. Typically, a person suffering from this condition will complain that the sweat actually forms ‘pools’ in the underarms, usually, but not always, accompanied by an unpleasant odor. Underarm perspiration stain removal from clothes becomes a daily routine and sufferers avoid wearing certain fabrics and colors, but that is only part of the problem. On a more serious level, excessive sweating causes acute social embarrassment and sends many people into depression because their self-esteem reaches such low levels.

To explore the reasons for excessive underarm perspiration, it is necessary to realize that, in most cases, axillary hyperhidrosis is a primary condition, i.e., a condition that is either genetic or inherent. So why do these people sweat so much? Under normal circumstances, sweating is the human body’s way of regulating temperature. As sweat evaporates from the surface of our skin, the body temperature comes down.

The body has over 3 million sweat glands that produce sweat under instructions from the sympathetic nervous system, which sends neural signals to the glands via a chemical called acetylcholine. However, in the case of excessive underarm perspiration, the glands produce far more sweat than is required to cool the body. Sweat production may increase owing to a number of stress factors, both physical and emotional. Other contributing factors include eating certain kinds of food, intake of alcohol, smoking, and external temperature changes.

At this point, the conventional methods of treating the problem of excessive underarm sweating can successfully monitor, and in some cases cure, the condition, but each has its negative effects, which means there is no single recorded cure for underarm sweating. In order to understand why none of these methods are foolproof, we need to study them in some detail:

Topical Treatments: Both over the counter and prescription antiperspirants have been used to treat mild to moderately severe cases of underarm perspiration. Typically, these antiperspirants plug the pores on the surface of the skin, thus preventing sweat from reaching the surface. Branded antiperspirants containing chemicals like aluminum chloride hexahydrate, formalin, glutaraldehyde, and tannic acid have been used in the treatment of axillary hyperhidrosis.

However, all the chemicals have potentially negative side effects. For instance, formalin not only smells bad, but may also cause contact dermatitis in a significant number of users. Similarly, glutaraldehyde, while a potentially viable treatment method for hyperhidrosis of the feet and hands, is virtually useless when it comes to acute underarm sweating because it causes brownish stains on the skin, which can cause socially embarrassing situations. Again, tannic acid is even less effective than glutaraldehyde and can also cause discolor the skin.

Besides, even the strongest antiperspirants need to be applied continuously in various doses over a long period of time because they do not represent a one-time solution. Put simply, pores that have been clogged unclog over time, necessitating a repeat dose.

Iontophoresis: Iontophoresis most commonly involves the administering of mild electrical shocks to the underarm to thicken the skin and thus reduce the flow of sweat to the skin’s surface. The patient usually immerses the affected part of the body in tap water, through which the electrical current then passes. However, using iontophoresis to treat severe underarm sweating is an extremely cumbersome process, and besides, not everyone is eligible for this treatment. Among those for whom iontophoresis is not recommended are pregnant and nursing women, cardiac patients, and epileptics.

Botulinum injection: Botulinum toxin is a neurotoxin produced by the anaerobic bacterium clostridium botulinum, which commonly causes food poisoning. Marketed under the trade name Botox by Allergan Inc., the toxin prevents the release of acetylcholine when injected into the area that is experiencing excessive sweating. As of now, however, the US Food and Drug Administration has approved the use of Botox in the treatment of acute underarm sweating or axillary hyperhidrosis only, so any medical practitioner who advertises Botox treatment for hyperhidrosis in other areas is immediately suspect.

How does Botox work? Well, both the underarms receive an injection of 50-200 units of Botox, usually under local anesthesia. For those who dread injections, I’d have to say that underarm injections are not particularly painful, though injections in the palms and soles are definitely so. The effects of the Botox injections in the underarms are usually felt in 2-4 days, and most patients report a high success rate. The minimizing of perspiration also rids a patient of underarm odor, which is doubly satisfying.

However, a huge drawback of Botox treatment is that it has only limited effect. A repeat dose may be required as early as 4 months after the first, though the average patient reports that the effects of the first injection last approximately 6 months. Additionally, though higher doses of Botox can lengthen that timeframe, it will push up what is already a very expensive treatment, as well as leave the patient vulnerable to antibody formation. Also, as with iontophoresis, pregnancy, lactation, and motor neuron disease disqualify a patient from receiving Botox injections.

Surgery: The most usual form of surgery to control excessive underarm perspiration is ETS (Endoscopic Thoracic Sympathectomy), but it should only be viewed as a last resort. The two most performed versions of ETS are clipping and cutting. In the clipping method, a titanium clip is placed across a section of the sympathetic nerves to hamper the transmission of signals to the sweat glands. A variation of this method is the graduated clipping, where the titanium clip is placed in a ‘graduated’ manner so that neural transmissions are affected but the nerve is not crushed. This kind of clipping is thought to potentially leave the way open for the nerve to reactivate itself if the clip is removed.

In the cutting method, the sympathetic nerves are cut using sharp scissors. This technique is easier to perform than clipping, but it can potentially damage surrounding tissues and nervous structures, and is an irreversible process. Besides, there is a greater risk of compensatory sweating (sweating in other, larger areas of the body) and other side effects such as internal bleeding and neck pain.