Excessive Armpit Sweating Sweaty armpits are not pleasant for anyone!  The medical term for the armpit is the axilla. Excessive axillary sweating (or axillary hyperhidrosis!) can make anyone’s life a misery. There are obviously antiperspirant sprays and in particular Aluminium Chloride based preparations (Anhydrol Forte, Driclor and ZeaSORB). Hand and foot sweating can be helped by Glycpyrronium bromide 0.05% solution (Robinul). They are applied 2-3 times a week at night and washed off in the morning to avoid damage to clothes. Application can be very effective especially for underarm sweating. However they can cause the skin to become irritated over time.  There are treatments that can be taken by mouth:   Antimuscarinic drugs – these are tablets or capsules that reduce the activity of the nerves supplying the sweat glands. They do affect the body’s entire nervous system and can cause side effects like dry mouth, drowsiness and constipation.  Beta-blocker drugs also act on the nervous system but their side effects are usually less troublesome. They may help if sweating is made worse by stress and feelings of anxiety. They are not suitable for everyone because some people with certain medical conditions cannot take them.  Anxiolytic drugs (tranquillisers) may be helpful if anxiety is found to be a problem but there are side effects and they are often not recommended long term.  However, there is an extremely effective treatment for armpit sweating ….. Botox.  The axilla has a multitude of sweat glands and each gland has a tiny muscle that extrudes the sweat (sebum) onto the skin.  Botox can paralyse these tiny muscles and can give months of very effective abolition of sweating.  The procedure takes about 30 minutes:  Firstly you need to be happy with all the information about botox itself – its side effects and risks. The axilla is a very forgiving place to inject and there are very few complications associated with this area. There are no cosmetic blunders that can occur here.  The physician will firstly observe the area to see where the sweating occurs. This is usually quite well linked to the hair-bearing areas. If there is any doubt, a iodine starch test can be performed which clearly stains the sweat producing areas.  A local anaesthetic and ice are then applied to the area. It is a sensitive area and this part is, in truth, a little uncomfortable – but this procedure is so effective that it is usually well worth it.  Each armpit will receive about 4 local anaesthetic injections and once it is all numbed up – the procedure can begin.  The physician will draw a grid of 1cm squares over the sweaty areas and will place a small volume of botox in each square. On average this will mean about 20 tiny injections in each axilla (a total of 50 units each side) – and that’s it.  This will not abolish sweating completely, but you should notice a dramatic reduction. Many patients don’t even use deodorant at all.  The effect should last about 6 months, but many report that they only ever need the procedure once per year.  Other Treatments Iontophoresis  Iontophoresis is the delivery of mineral or drug ions through a mild electrical current in a shallow pan of water.  Ordinary tap water is the usual medium, but some clinicians add the anticholinergic glycopyrrhonium bromide to enhance the effects.  A person’s natural electrical charge being negative, positive ions in the water flow straight through the sweat ducts, interrupting the sweating process by an unknown mechanism.  It is a treatment that has been in clinical use for several decades, and is not dangerous.  Few people report any discomfort, save some tingling, and sometimes a dry mouth.  (For safety’s sake, anyone who is pregnant, has an orthopaedic implant, or has problems with their heart or breathing should not undergo iontophoresis.)  The treatment is mild enough overall that patients often perform their own follow-up sessions at home.   Surgery - There are two types of surgery:  Subcutaneous sweat gland curettage This is the surgical removal of the over active sweat glands under anaesthetic. It is generally thought to reduce sweating by up to 50% in sufferers.  Transthoracic sympathectomy (cutting of the nerves that supply the glands) A direct electrical current is applied through a laparoscope (key hole surgery) to cause destruction of tissue and if needed partial removal of the involved nerve fibres and ganglia in the spine (t2 and t3)  under general anaesthetic, to provide long-term elimination of palmar (hands) and axillary hyperhidrosis. It is highly effective at stopping the sweating on the palms and under the arms but there is between 40-69% risk of compensatory hyperhidrosis (new areas of excessive sweating, usually on the trunk and lower parts of the body). Patients are usually required to stay in hospital overnight.   There are several things that you can do that might be helpful Choose clothing that will keep you cool. Natural fibres like cotton are cool but they absorb sweat and can stay damp once they get wet; some synthetic fibres are warm but they draw sweat away from the body and feel dry. You may find it more comfortable to have a change of clothing available during the day. If your feet are the problem try using absorbent insoles and leaving shoes to dry out rather than wearing the same pair on consecutive days. Keep your work environment cool and well ventilated.