Home / Conditions / Underarm sweating
Shirts changed at lunchtime, jackets kept on, colours avoided. The underarms have the densest concentration of sweat glands on the body — and, usefully, more treatment options than anywhere else.
There is no threshold in millilitres. Excessive sweating is any amount that causes you problems or distress — and people who have it recognise the list immediately:
None of that shows up on a test. It is still the reason to treat it.
Sweating is how the body regulates its temperature. You have more than three million sweat glands, and they are not evenly distributed — the underarms, palms, soles and groin carry far more than elsewhere. When the body produces sweat faster than it can evaporate, you see it, and you see it first where the glands are densest.
In hyperhidrosis the nerves controlling those glands signal them to work when there is no need. Anxiety, hormones, temperature, medication and activity all modify how much, but the underlying overactivity is what separates this from ordinary sweating.
One practical consequence worth knowing. Persistently damp skin raises the risk of bacterial and fungal skin infections, and of skin irritation. If the skin under your arms is sore, itchy, discoloured or broken, that is worth having looked at rather than managed with more deodorant.
These will not resolve true hyperhidrosis on their own, but they make a measurable difference alongside treatment — and cost nothing to try.
Antiperspirant and deodorant are not the same thing. Deodorant addresses smell. Antiperspirant reduces sweat by temporarily blocking the ducts, and it works best applied at night when sweating is naturally lowest — which is the opposite of how most people use it.
This is the site with the widest range of options, and where the non-surgical ones are most effective. Treatment works in steps.
Considerably stronger than anything on a supermarket shelf. Applied at night to dry skin, then washed off in the morning. Effective for a good number of people, and the sensible first step.
The mainstay for underarms specifically. Small injections block the nerve signal to the sweat glands across the area, with the effect lasting several months before repeating. It is quick, well tolerated here — considerably more so than in the palms — and for many people it is the answer.
Tablets that reduce the nerve signal throughout the body. Useful where sweating affects several sites at once, with side effects including dry mouth and blurred vision that determine how much can be taken.
Devices that reduce sweat glands in the underarm using targeted heat. Longer-lasting than injections, usually delivered by dermatology services.
This is the practical difference between underarm and palm sweating, and it is worth being clear about it.
Endoscopic thoracic sympathectomy is highly effective for palms. For underarms it is considerably less reliable — results are less predictable, and the risk of compensatory sweating elsewhere is the same. Trading one area of sweating for another is a poor bargain when injections work well here and are repeatable.
Where surgery does come into the conversation is when underarm sweating occurs alongside severe palmar sweating. In that case the palms drive the decision and the underarms may improve as a secondary effect — not the other way round.
A fair question, given the above. If the answer is usually injections rather than surgery, why see a neurosurgeon at all?
A clinic that does not offer sympathectomy can only tell you it is not something they do. Dr Tung performs the operation, which is why he can tell you plainly when it is the right answer and when it is not — and for underarm sweating alone, it usually is not. That judgement is worth more than a referral onwards.
Hyperhidrosis is overactivity of the sympathetic nerves, not a skin condition. That matters for excluding the secondary causes — thyroid, blood sugar, medication, and the less common neurological ones — before anything is treated. Sweating that began suddenly or happens at night is a medical question first.
Many people with axillary sweating also have it in the palms or feet, and the plan changes accordingly — sometimes toward medication that treats all sites at once, occasionally toward surgery where the palms are the dominant problem. An assessment that looks only at the underarms misses that, and it is a common reason treatment stalls.
Injections need repeating, and their effect can change over time. Having the full range of options under one clinician — including the one at the end of the ladder — means the next step is a conversation rather than starting again somewhere new.
Excessive underarm sweating is worth a consultation when it interferes with work or daily life, when antiperspirants have not been enough, or when the skin has become sore or repeatedly infected.
It is also worth assessing if the sweating started suddenly, happens at night, affects your whole body, or comes with weight loss or feeling unwell. Those patterns point to a secondary cause rather than primary hyperhidrosis, and the cause is what gets treated.
No. Deodorant addresses odour; antiperspirant reduces the sweat itself by temporarily blocking the ducts. If you have been using only deodorant, you have not yet tried the first line of treatment.
Because it works by blocking the sweat ducts, and it does that best when the skin is dry and sweating is naturally at its lowest. Applied to damp skin in the morning, much of it simply washes away.
Several months, varying between people, after which it is repeated. It is well established for underarms and much better tolerated here than in the palms.
Usually not. Sympathectomy is far more reliable for palms than for underarms, and carries the same risk of increased sweating elsewhere. With injections working well here, surgery is rarely the right trade.
Sometimes. Sweating that began suddenly, happens at night, affects the whole body, or comes with weight loss or fever should be assessed for an underlying cause rather than treated as primary hyperhidrosis.
No. You can book directly. Note what you have tried, for how long, and whether your palms or feet are affected as well.
Hyperhidrosis · Sweaty palms · Neuropathic pain · Neurosurgery
If antiperspirants have not been enough, there are several options that work well for underarms — most of them not surgery. A consultation establishes which fits, and rules out the causes that need treating instead.
