Axillary hyperhidrosis, which causes quality of life problems for many individuals, is a medical condition that dermatologists and aesthetic physicians see a lot of in practice, says Joel Cohen, MD. He adds that often patients who present to the office with this condition aren't even aware that there are treatment options that are available. “These are folks who sweat from the underarm and in some cases buy three of the same shirt just to change during the course of the day to try to hide it,” explains Dr. Cohen. Before ever visiting a physician about axillary hyperdosis, Dr. Cohen says, often individuals look for various topical prducts that they can apply to their skin to cut down on the sweating. These products are often aluminum chloride based, which can be very irritating. But, he says, there are people who certainly respond to those products. Also available are certain “clinical formulations” of deodorant, like Secret Clinical that people can use several times a day to try to cut down on excessive sweating. So by the time patients see a physician for underarm or axillary hyperhidroisis, Dr. Cohen says, they're really interested in something that can be more effective that won't cause them to actually have to change the things that they're doing everyday while they have a busy day at work or at school.


OnabotulinumtoxinA (Botox) is FDA-approved for the treatment of axillary hyperhidrosis. Botox is injected into the skin to treat the symptoms of severe primary axillary hyperhidrosis when topical medicines used on the skin do not work. This treatment is approved for patients 18 years and older. “There are people who respond very nicely for seven to 10 months using Botox for this condition,” says Dr. Cohen, “but there are people out there who want something longer-acting. And there are products that are employed as well and procedures that are employed as well, and one of those is MiraDry, which is using a microwave technology to really shrink up some of the glands.” MiraDry is a non-invasive office procedure that received FDA 510(k) clearance in January 2011 for treatment of excessive underarm sweat. MiraDry delivers microwave energy to the dermal-fat interface to destroy sweat glands. Continuous hydroceramic cooling prevents thermal conduction of heat superficially and creates a heat zone at the level of sweat glands, which results in targeted thermolysis. Alternative options to treatment with Botox or MiraDry are some of the anticholinergics medications like glycopyrronium bromide. Dr. Cohen says these medications can have side effects, from urinary retention to visual changes. There is a lot of excitement regarding the use of injections and/or microwave technology for this chronic condition, according to Dr. Cohen. These modalities have the potential to deliver longer results and offer patients better solutions to the problem of excessive underarm sweating.

Joel Cohen, MD is Director of AboutSkin Dermatology and DermSurgery, Englewood/ Lone Tree, CO.