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Local Permanent Treatment Options for Axillary Hyperhidrosis
Written by Katie Crissman
October 01 2020

Axillary hyperhidrosis refers to excessive sweating in the armpit region that many people with primary focal hyperhidrosis suffer from. It can be a challenging issue to deal with, but there are many treatment options for axillary hyperhidrosis. Doctors typically recommend topical treatments as a primary option and move on to botox injections for axillary hyperhidrosis if topical creams have not been effective. However, for some people, these treatments are not sufficient in relieving symptoms. When this is the case, there are other localized treatment options that can be used to manage sweat and produce a more permanent and effective solution. These are often more invasive than other medical treatment options available, but they offer a higher success rate with less recurrence of symptoms. There are both surgical and non-surgical local treatment options available. When pursuing permanent local treatment options, patients need to work with a dermatologist, which are the type of doctors best suited for treating hyperhidrosis.[1]

Local Surgical Options

Surgery is often required for patients who desire a permanent solution to axillary sweating. However, unlike other surgical treatments for primary hyperhidrosis, like endoscopic thoracic sympathectomy, local surgical procedures are less invasive, risky and require less recovery time. There are three types of local surgical procedures surgeons use to treat axillary sweating. These include the removal of glandular (sweat) tissue, curettage or liposuction to remove sweat glands beneath the skin or a combination of skin excision and glandular tissue removal.

Before any surgical procedures are conducted, a doctor will go over a patient’s history and make sure that they are experiencing sweating due to primary focal hyperhidrosis and not the secondary type, which can have a definitive cause. They will also make sure that any person undergoing surgery is a good candidate for the procedure and that there are no contraindications. First, a doctor will most likely perform a minor starch-iodine test to determine the problem areas. An iodine solution is applied to a patient's skin and then a starch powder is placed on top. When sweating occurs it creates dark marks so the doctor can visualize the problem areas. A doctor will also often use an assessment called the Hyperhidrosis Disease Severity Scale (HDSS) to help determine how much axillary sweating patient is experiencing. These tests are usually done before any of the local axillary procedures discussed below.[1]

Excision

An excision procedure refers to the removal of skin and possibly glandular tissue from the axillary area. This is done to remove the overactive sweat glands that are causing issues. There are two main types of excision surgeries performed: radical excision of skin and glandular tissue (RSE) and limited skin excision with glandular tissue removal (LSE). RSE is typically not used as complication rates are very high. When performed, it often leaves scarring from skin removal and requires stitches and wound drainage. LSE is a less invasive procedure that is performed more often. During LSE a doctor will still remove some skin but uses special tools to get under the skin to the subcutaneous fat layer. They are then able to expose sweat glands and cut them out, then the wound is sutured shut. One study found that sweat was reduced by a mean of 63% in patients a year after treatment and 82% of patients said they would undergo the procedure again.[1] There are possible side effects including hematoma (blood trapped under the skin), paresthesia (loss of feeling), loss of hair growth, skin infection and poor wound healing among others.[1]

Liposuction

Liposuction, a procedure often used for cosmetic surgery, can be useful in the treatment of axillary hyperhidrosis. Doctors are able to remove sweat glands without having to remove extra tissue because sweat glands are located near the upper level of the subcutaneous portion of the skin. The liposuction device is called a cannula and it looks like a tube with a hole or multiple holes on it. Different cannulas can be used to produce different results, some provide more aggressive treatment than others. The cannula is used to suck out tissue and sweat glands are scraped away from the surface of the exposed dermis (under layer of the skin). Aggressive cannulas reduce sweating more but can also result in more side effects. One study found between a 44% and 49% reduction in sweating depending on the type of cannula used. Side effects are usually minimal and don’t last long. They can include bruising, hematoma, paresthesia and inability to grow hair.[1]

Curettage

Curettage is a surgical procedure in which scraping or cleaning is done with the use of a curate, a surgical tool with a hook or loop at the end.[2] A variety of techniques can be used. Incisions are made on the edges of the armpit area and then the area of the dermis containing sweat glands is scraped, or curetted, and sewn up with sutures. This can be done using local anesthesia. Studies have shown that sweating can be reduced by up to 50% in 90% of patients. Unfortunately, there is a relapse rate of 29%.[1] One study compared the effectiveness of curettage compared to Botox injections and found that both treatments were equally effective in treating axillary sweating 6 months after treatment.[3] Curettage is a fairly safe and long lasting treatment option. There are possible side effects which include hematoma, paresthesia, alopecia (baldness) and hyperpigmentation.[1]

Liposuction-Curettage

This is a procedure that combines both liposuction and curettage techniques. A special type of local anesthesia is given and both a liposuction cannula and a curate are used to remove sweat glands. This procedure has been used safely for a long period of time and there are several ways a doctor can choose to perform it. It takes several days to remove to fully recover afterwards. There is a 60.4% to 69% reduction in sweating in nearly 90% of patients, so it has a good success rate. Side effects are mild and do not last long. They can include hematoma, paresthesia, seroma formation, and skin infection. It is important to find a surgeon who is familiar with this technique as it can greatly impact the surgical outcome.[1]

Nonsurgical Treatment Options - MiraDry

MiraDry is a relatively new device that is FDA approved to treat axillary hyperhidrosis. It uses microwave energy to destroy sweat glands. Microwave energy is most readily absorbed by tissue that contains high amounts of water and so sweat glands are specifically targeted. The heat created by the microwaves essentially destroys the sweat glands and thus reduces sweating. Before treatment, either the Minor iodine-starch test or a hair bearing test is performed to determine the areas that need to be treated. Lidocaine is usually used prior to performing the procedure. Microwaves are initially targeted superficially and then deeper as the treatment progresses. Afterwards, an ice pack is applied to the treated area and patients are told take an NSAIDs for the first two days after treatment. Results are favorable as 90% of patients experienced a 50% reduction of symptoms.[1] MiraDry is an excellent option for patients with severe axillary sweating and it has been shown to provide permanent results and it also reduces or eliminates body odor.[4]

Patients with axillary hyperhidrosis often struggle with their symptoms, but they can find relief by managing their hyperhidrosis with a doctor. There are many potential treatments, and with the advent of devices like MiraDry there are options that are less invasive and which offer permanent solutions. There are other future treatments for hyperhidrosis that are being developed and offer hope to those struggling with difficult symptoms. Unfortunately, the many of these permanent treatment options are very expensive and not covered by insurance, this issue is what make the cost of treating hyperhidrosis so expensive for many patients.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
  2. Curettage. 2018. In Merriam-Webster.com. Retrieved August 20, 2018, from http://www.meririam-webster.com/dictionary/curettage
  3. Budamakuntla, L., Loganathan, E., George, A., Revanth, B., & Sankeerth, V. (2017). Comparative study of efficacy and safety of botulinum toxin a injections and subcutaneous curettage in the treatment of axillary hyperhidrosis. Journal of Cutaneous and Aesthetic Surgery;, 10(1). doi:10.4103/JCAS.JCAS_104_16
  4. Owen, K. (2016). Excessive Sweating: Are Patients Suffering Unnecessarily? The Journal for Nurse Practitioners, 12(1). doi:10.1016/j.nurpra.2015.09.015
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Antiperspirant

What You Need to Know About Carpe Clinical Regimen

By Katie Crissman /

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen - it combines several high performing products with a specific care routine to provide long term sweat reduction for even the heaviest sweaters. Read on to see if Carpe Clinical Regimen is right for you!

Antiperspirant is great - for most people. You apply it once a day and it stops your sweat! It’s easy. But, what if that’s not what happened? You bought it, read the label, and used it exactly as directed and, unfortunately, you’re still sweating - excessively. If this is you, then you’ve come to the right place. There are products specifically made for heavy sweaters who haven’t had luck with traditional antiperspirants. These products typically include the words “extra strength”, “clinical strength” or “prescription strength” and they are, thankfully, available over the counter without a doctor’s prescription. 


The difference between clinical strength products and their weaker counterparts are the active ingredients they use. Clinical strength lines typically use one of several newer types of metallic salt ingredients that are known to be both stronger and less irritating than aluminum chloride (which is the standard active ingredient in antiperspirants) [1]. While there are many clinical strength products on the market, we are going to focus on a new clinical strength regimen that combines a strong active ingredient with a specific care routine to get excessive sweating under control. 


Carpe Clinical Regimen -  What It Is and How It’s Different

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen. It’s different from other prescription grade products because it combines several strong products with a specific care routine to ensure maximum product performance. It’s also different from Carpe’s other products because it uses a stronger active ingredient and delivery system. The system is geared toward people who experience intractable armpit sweating, but Carpe also makes products for people who struggle with other types of sweat. The Carpe Clinical Grade Underarm includes three specific products that, when used together, have been found to be highly effective at reducing sweat production. These products include:

  • Carpe Clinical Grade Underarm Antiperspirant 
  • Carpe Clinical Grade Exfoliating Wash
  • Carpe Clinical Grade Underarm Wipes[2]

Carpe Clinical Grade Regimen uses an active ingredient called Aluminum Zirconium Tetrachlorohydrex GLY (20%) combined with other soothing inactive ingredients to effectively stop sweat in its tracks while reducing skin irritation.[3] Aluminum Zirconium Tetrachlorohydrex is a newer generation metallic salt that stops sweat production and is known to be more effective than other types of active ingredients antiperspirants typically use. One study mentioned in the journal Dermatologic Clinics found that antiperspirants using Aluminum Zirconium Tetrachlorohydrex were, on average, 34% more effective than antiperspirants that used aluminum chloride as an active ingredient.[1] Carpe’s traditional products use an active ingredient called Aluminum Sesquichlorohydrate at 15% which is effective, but less potent than Aluminum Zirconium Tetrachlorohydrex.[4]


It’s important to note that Carpe’s Clinical Grade Regimen provides a long term impact on sweat reduction from making short term lifestyle changes. This is because the results build up over time and peak at about 4 weeks. It takes 4 weeks of using the Carpe clinical grade products once each morning and every other night to see the full effect of what they can do. This is typical of all antiperspirants as their effects tend to build up with consistent use. Consistently using antiperspirant products is especially important for those with hard to treat sweat problems because it can be the difference between treatment success or failure.[1][2] 


If you’re frustrated with the way your current antiperspirant is working or how it isn’t working, then consider giving Carpe’s Clinical Grade Regimen a try! It’s active ingredient is comparable to other prescription strength products on the market but it’s multistep system with easy to use wipes is completely unique! Remember, an easy to use, consistent antiperspirant routine is going to give you long term sweat reduction so it’s important to find a system that works for your lifestyle. 


Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0>https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
  2. How It Works (Clinical). Carpe. https://mycarpe.com/pages/how-it-works-clinical. 
  3. Clinical Underarm  PM Wipes. Carpe. https://mycarpe.com/products/clinical-grade-underarm-antiperspirant-wipes?variant=34814174724229
  4. Underarm Antiperspirant for Excessive Underarm Sweating. Carpe. https://mycarpe.com/products/underarm-antiperspirant-tube?variant=39247505358981
Body Areas Affected by Hyperhidrosis

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating

By Daniel McCarthy /

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating


On my first day of work a few years ago, I got dressed to impress and walked the 20 minutes to my new office to meet my new colleagues for the first time. Having just moved to the southern US, I’d been getting used to the unbearable humidity and its effects on my excessive armpit sweating. Luckily (I thought), the sun wasn’t out and the temps dropped below 80, so maybe my sweat glands wouldn’t take center stage! Well...I arrived to meet my colleagues looking like a wet bass in business clothes. Thank goodness I arrived 15 minutes early, which brings me to the first outrageous thing people try to avoid armpit sweating. 

  1. The Hand Dryer 

I anxiously scurried to the nearest bathroom, declothed, and put the hand dryer to good use on my shirt stains and sweat stains. More outrageously, I awkwardly hovered my sweaty extremities (including my sweaty underarms) over the hand dryer. Thankfully, I reapplied my antiperspirant and headed out to meet my colleagues a decently dry man. That was the day I knew I really needed clinical strength antiperspirant for my excessive armpit sweating (and a car). 


  1. Pantyliners


Many with excessive underarm sweating already know that underarm pads are one way to help with sweating armpits. But if you find yourself sans pad and worried about your excessive armpit sweating, you would not be the first person to try pantyliners. That’s right, pantyliners have been used in a pinch to help keep sweat stains at bay. 

  1. Give a shirt

In 2019, a reddit user posted that to combat his excessive armpit sweating, he skipped the typical clothing and made his own shirt. He posted asking others to try out his creation and received over 250 replies! By creating and giving others shirts, this innovative reddit user designed his way into the hearts of many with smelly armpits. 

  1. Get inked

If you’ve been debating whether to get a tasteful tattoo and you have hyperhidrosis, this finding may just help you make your decision. A 2017 study found that getting inked helped reduce sweat [1]! Now, I don’t recommend choosing a tattoo as a means of treatment for excessive armpit sweating (and maybe don’t tattoo your armpit), but the connection is a fun little fact nonetheless. 

  1. Become a naked mole rat

If you can’t pull the trigger on an armpit tattoo, another method some people have tried is hair removal. Yes, like Steve Carrell (who actually has hyperhidrosis himself) in the hit movie 40-year Old Virgin, removing hair can help reduce sweat buildup for you too. Many likely already “naturally” lose hair thanks to some sweat prevention products, but more natural hair removal may just be the trick to solving excessive sweating. 

  1. Armpit art

Even though we know most sweaty armpit causes, like too much caffeine or spicy foods, it’s no fun to cut these out completely. A more outrageous approach to excessive underarm sweating is actually turning sweating armpits into art. Multiple users of the Reddit community r/Hyperhidrosis have created shirts, sweatshirts, and other clothing that includes beautiful tie-dye in the armpits. Creative, fun, and beautiful, and even better when combined with sweat prevention like antiperspirant or carpe underarm. 

  1. Vinegar your armpit

You may already know how to get rid of pit stains with vinegar, but there are other interesting ways it can help with excessive armpit sweating. Splashing vinegar on your sweaty underarms  is one method many recommend. Those that swear by this method also recommend using deodorant or antiperspirant, too. 

While we don’t know how this was discovered, I like to think someone accidentally splashed vinegar on their pits hundreds of years ago and voila! Too bad the first person to splash his pits with vinegar didn’t also have access to the best antiperspirant for his excessive armpit sweating. 

  1. Baking soda your sweaty underarms

If you find deodorant or antiperspirant irritating, one creative way to help alleviate your excessive underarm sweating is baking soda. Many crafty people with hyperhidrosis swear that not only can baking soda help reduce sweat, but it can also help alleviate pesky underarm smell with some of the best sweat prevention. 

  1. Restart the plaid fad

Black t-shirt, black sweatshirt, black button down, black tank top. If this sounds like your closet, you’re clearly an expert on the hyperhidrosis wardrobe. But if you want some variety as you fight excessive armpit sweating, add some plaid, a trick many with hyperhidrosis use that you may not know. Hey, you just may be starting the resurgence of the plaid fad, and at worst, you’ll add some fun, lumberjack variety to your dark closet. 


Sources: 

[1] Luetkemeier, M. J., Hanisko, J. M., & Aho, K. M. (2017). Skin Tattoos Alter Sweat Rate and Na+ Concentration. Medicine and science in sports and exercise, 49(7), 1432–1436. https://doi.org/10.1249/MSS.0000000000001244
Body Areas Affected by Hyperhidrosis

How to Cure Sweaty Hands Permanently at Home

By Daniel McCarthy /

How to Cure Sweaty Hands Permanently at Home 

Scenario 1: You’re invited into the office, confident you will land the job. You’ve prepared, you’re highly qualified, you have absolutely nothing to worry about. You walk in and confidently reach out to shake the CEOs hand. But then, your confidence turns to dread as the CEO pulls her hand back, wet with your sweat. 

Scenario 2: You’re at home, playing video games with your friends and absolutely dominating. They get so upset, they tell you to take a break to let another friend play. But there’s another problem... nobody wants to use your controller after you finish. Despite your domination, your palmar hyperhidrosis (excessively sweaty hands) has taken center stage. 

Do these scenarios sound familiar? Wondering how to cure sweaty hands permanently? Although you may not have had these exact things happen to you, your sweaty hands likely have caused something similar and you’re looking for a home remedy. To stop sweating these situations, let’s talk about how to cure sweaty hands permanently at home. 

One of the best ways to cure sweaty hands at home is actually not related to the hands at all. Instead, working on reducing anxiety can have immensely positive results on how to cure sweaty hands permanently naturally. There are many root causes of anxiety, and some or many may be related to your hyperhidrosis. Likewise, it is easier said than done to reduce anxiety. But there are also many ways to work on reducing anxiety that are worth a try. One interesting way to reduce anxiety, and in turn, sweaty hands, is to be grateful. Specifically, Petrocchi and Couyoumdjian found that “grateful people experience less anxiety mostly because they are able to encourage and be compassionate and reassuring toward themselves when things go wrong in life” [1]. Other ways include stepping outside for a walk, drinking tea, or even distracting yourself. In general, starting with anxiety reduction not only can help with how to cure sweaty hands, but also your wellbeing in general. 

Another great way to cure sweaty hands at home permanently is to reduce consumption of coffee and alcohol. Now you may be reading this and thinking “Hey, those are all my favorite things! I’m done with this article!”. And while I wholeheartedly agree and enjoy coffee and alcohol myself, consumption in moderation is key, especially with hyperhidrosis. Caffeine, for example, activates part of the brain that is already a main part in causing hyperhidrosis symptoms. Instead of giving it up, try to reduce consumption to under 200 mg or add in decaf to your routine. Alcohol can affect hyperhidrosis in a similar manner, but like coffee, 1-2 glasses of alcohol may be okay. When figuring out how to cure sweaty hands permanently naturally, it is important to find a balance of coffee, alcohol, and managing your hyperhidrosis. And remember to always drink responsibly, in moderation. 

Tackling how to cure sweaty hands permanently, naturally, and at home may require more than behavioral changes we’ve talked about so far. Luckily, there are other great remedies you can try at home! First, finding the right antiperspirant is of paramount importance, especially appropriate antiperspirant for hands. Another possible over the counter option is anti-sweat wipes. If neither of these work for you, another option to cure your sweaty hands permanently is to buy your very own iontophoresis machine for at-home use. This machine delivers mild electrical currents to your hands (or other affected body part) while submerged in water. A combination of these treatments may have your hands feeling less clammy in no time! 

Ultimately, your palmar hyperhidrosis may not be treatable at home and permanently, but these recommendations may help alleviate some of your symptoms. If symptoms persist, consult a medical professional for further assistance with how to cure sweaty hands. 



Sources

Sources

1. Nicola Petrocchi & Alessandro Couyoumdjian (2016) The impact of gratitude on depression and anxiety: the mediating role of criticizing, attacking, and reassuring the self, Self and Identity, 15:2, 191-205, DOI: 10.1080/15298868.2015.1095794

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