How to Prevent Excess Sweating Like Sweaty Armpits- Treatment Options for Hyperhidrosis

by Natan Schleider, M.D.

June 23rd, 2018

With temperatures on the rise here in New York City now that summer is here (and special thanks to climate change), I find myself sweating profusely. While this may be normal, when shirts, armpits, and back are sticking to your shirt, I feel quite uncomfortable. This may be due to dehydration but frankly, seeing patients with sweat dripping down my brow and back, I feel unprofessional, to say the least.

While excess sweating is known to cause ‘social, emotional, and work impairment’ (American Family Physician Vol 97 Number 11 June 1st, 2018), up to 3% of the United States population may suffer from hyperhidrosis (the fancy medical word for sweating beyond which is normal).

To stay cool and dry when your antiperspirant deodorant isn’t cutting it, here are management and treatment options from a medical doctor’s perspective. (I will leave natural remedies to any naturopathic doctors but would love to hear if you have any natural or herbal remedies that work (other than a recycled paper towel):

  1. First-line treatment for sweaty underarms is aluminum chloride (Drysol) 20% applied to affected skin nightly or every other night depending on how much you sweat. Note this may cause skin irritation and I would not use this on the face. For the face (craniofacial hyperhidrosis) your pharmacist can compound (mix) topical 2% glycopyrrolate cream applied every one to three days.
  2. Iontophoresis (passing of water through the skin by electrical current–sounds like quackery to me but data supports this apparently) for hyperhidrosis of palms of hands and soles of feet.
  3. Botulinum Toxin like onabotulinotoixnA (aka Botox) can be first or second-line treatment and can be injected into the skin of axillae (armpits, palms, and soles and lasts 6-9 months. I have had trouble getting this covered by insurance but the stuff works.
  4. If you don’t like the idea of smearing cream on regularly ot getting injections, two oral prescription medicines are available: oxybutinin 2.5 mg to 10 mg daily and glycopyrrolate.
  5. Noninvasive microwave zapping of sweat glands in the armpits is relatively new with at least 2 treatments needed to reduce sweating by about 50%.
  6. Fractionated microneedle ablation (another way to zap and kill sweat glans) using local anesthesia can work well with at least 1-3 treatments required in general.
  7. If all else fails for hyperhidrosis, we turn to surgery which can be done: liposuction curettage; endoscopic thoracic sympathectomy (very small incisions in skin of chest) cutting the nerves to the problematic sweaty areas.

If you don’t like the above, stay inside, relax if a cool air-conditioned room if available, and take your Vitamin D as you won’t be getting sun exposure indoors (although some UV sunlight does come through windows but that’s a different topic.

Any questions, comments, ideas, critiques, I’d love to hear them on or

Doctor In The Family