What Is Axillary Hyperhidrosis?

Sweating is how your body cools down. Sweat glands, which are especially concentrated in the armpits, palms, soles and forehead, are switched on by nerve signals from the sympathetic nervous system. In axillary hyperhidrosis, those signals overstimulate the underarm sweat glands, so you sweat far more than you need to, including at rest, in cool rooms and in everyday situations such as meetings or social events.

Doctors divide hyperhidrosis into two types:

Primary (focal) hyperhidrosis has no underlying medical cause. It affects specific areas, usually both sides equally, often starts in childhood or the teenage years, and tends to run in families.
Secondary hyperhidrosis is caused by another condition or a medicine. It is more likely to affect the whole body, to start suddenly in adulthood and to happen at night.

The difference matters because secondary hyperhidrosis can improve once the underlying cause is treated, whereas primary hyperhidrosis needs treatment aimed at the sweat glands or the nerve signals that drive them. Our hyperhidrosis treatment page explains how we assess this at consultation.

What Causes Excessive Armpit Sweating?

In primary hyperhidrosis the exact cause is not fully understood, but several factors play a part:

Genetics. Many people with primary hyperhidrosis have a close relative with the condition.
Emotional triggers. Stress, nerves and excitement activate the same nerve pathway that controls sweating, so symptoms are often worse in pressured situations even when you are not hot.
Heat and exercise. These trigger normal sweating, which is exaggerated in hyperhidrosis.

Secondary hyperhidrosis can be caused by:

an overactive thyroid (hyperthyroidism)
diabetes, particularly episodes of low blood sugar
the menopause
infections
some cancers, such as lymphoma
some medicines, including certain antidepressants

If you think a medicine may be causing your sweating, speak to your GP or prescriber before you stop taking it.

How Common Is Hyperhidrosis?

Hyperhidrosis is more common than many people think. A nationally representative US survey of 8,160 people estimated that 4.8% have hyperhidrosis. Of those, 70% described severe sweating in at least one area, yet only half had ever discussed it with a healthcare professional, often because they did not realise it was a treatable medical condition (Doolittle et al., 2016 ↗).

Hyperhidrosis is not dangerous in itself, but it can have a significant effect on daily life. People commonly describe:

visible sweat marks and changing clothes during the day
avoiding certain colours, fabrics or styles
skin irritation and soreness in the constantly damp underarm
embarrassment at work, in social situations and in relationships
anxiety and reduced confidence

Excessive Armpit Sweating in Men

Hyperhidrosis affects men and women in similar numbers. For men, the effects often show up in everyday ways: sweat marks on light-coloured shirts, keeping a suit jacket on at work, and self-consciousness at the gym or during sport. Many men put off seeking help because they assume heavy sweating is simply normal for them, or that nothing can be done.

If your sweating regularly soaks through your clothes, happens when you are not hot or active, or affects your work or social life, it is worth having it assessed. The same treatments work for men and women. For other procedures designed around men, see our guide to cosmetic surgery for men.

How Is Hyperhidrosis Diagnosed?

Hyperhidrosis is usually diagnosed from your symptoms and an examination. Primary focal hyperhidrosis is likely when visible, excessive sweating has lasted for at least six months without an obvious cause, and at least two of the following apply:

it affects both sides of the body roughly equally
it interferes with your daily activities
it happens at least once a week
it started before the age of 25
a close relative has the same problem
it stops while you sleep

Severity is often graded with the Hyperhidrosis Disease Severity Scale (HDSS), which runs from 1 (never noticeable) to 4 (intolerable and always interfering with daily activities). A score of 3 or 4 is considered clinically significant. The Minor starch-iodine test, which turns sweating skin dark purple, can also map exactly where the sweat glands are most active.

Diagram of the four-point Hyperhidrosis Disease Severity Scale and the difference between primary and secondary hyperhidrosis — The Hyperhidrosis Disease Severity Scale (HDSS). A score of 3 or 4 means sweating is clinically significant.

When Should You See a Doctor About Excessive Sweating?

See your GP promptly if your sweating:

started suddenly in adulthood
affects your whole body rather than specific areas
happens at night and soaks your bedclothes
comes with weight loss, fever, a racing heartbeat or feeling generally unwell
started after you began a new medicine

These features can point to secondary hyperhidrosis, which needs investigating before any treatment aimed at the sweat glands.

How to Stop Armpit Sweating: Treatment Options

Treatment usually starts with the simplest option and moves on only if it does not help enough.

Clinical-strength antiperspirants

Antiperspirants containing aluminium chloride partly block the sweat ducts. Stronger clinical-strength products are the usual first step for hyperhidrosis. Apply them at night to completely dry skin and wash them off in the morning. Skin irritation is the main side effect.

Tablets that reduce sweating

Your GP or a dermatologist may suggest tablets that reduce sweating across the whole body. Side effects such as a dry mouth, blurred vision and constipation limit their use for some people.

Anti-sweat injections

Anti-sweat injections use botulinum toxin, the same medicine used in anti-wrinkle injections, to block the nerve signal that switches on the sweat glands. A series of tiny injections is placed across each underarm, usually after numbing cream, and treatment takes around half an hour. Sweating usually reduces within one to two weeks.

In a 52-week randomised trial of 322 patients, 75% of those treated with 50 or 75 units per underarm had a significant improvement in sweating severity, compared with 25% of those given a placebo, and the effect lasted a median of around six and a half months (Lowe et al., 2007 ↗). Most people therefore need one or two treatments a year. Side effects are usually mild, such as bruising or tenderness at the injection sites.

Morpheus8 radiofrequency microneedling

Morpheus8 delivers radiofrequency energy through fine needles to heat and damage sweat glands under the skin. It is given as a course of treatments, and redness and small scabs are common for a few days afterwards. The evidence is less established than for injections: in a small randomised trial, fractional microneedle radiofrequency gave a moderate reduction in sweating but was less effective than botulinum toxin at 12 months and more painful (Eid et al., 2024 ↗). It may suit people who want to avoid repeat injections and accept a less predictable result. Read more in our guide to Morpheus8 for excessive armpit sweating.

Suction curettage

Suction curettage is a minor surgical procedure that physically removes sweat glands from the underside of the underarm skin. It is performed as a same-day procedure under local anaesthetic with oral sedation, or under TIVA if you would prefer to be asleep. After mapping the most active sweat zone with the starch-iodine test, the surgeon makes one or two tiny incisions in each armpit and uses a fine cannula to scrape and suction the glands away. The procedure takes around 60 to 90 minutes for both sides.

Most people return to desk-based work after two to three days, to gentle exercise from the second week and to the gym after three to four weeks. Studies show a substantial, long-lasting reduction in sweating. In one study, sweat production fell by 85% at one month, 77% at one year and 61% at two years, with the gradual return thought to be caused by nerve regrowth (Feldmeyer et al., 2015 ↗). Another found a 58% reduction at rest and an 85% reduction during exercise after one year, with the greatest benefit in people who sweated most beforehand (Darabaneanu et al., 2008 ↗). A small number of people choose a second procedure.

Risks include bruising, temporary numbness, infection, a fluid collection (seroma), small scars and, rarely, damage to the underarm skin.

Iontophoresis

Iontophoresis passes a mild electrical current through water to reduce sweating. It works best for the hands and feet and is difficult to use for the underarms.

miraDry

miraDry uses microwave energy applied through the skin to destroy underarm sweat glands. It avoids incisions, but may need more than one session and usually causes several days of swelling and tenderness. We do not offer miraDry at Centre for Surgery, but we can discuss whether it would suit you.

Sympathectomy

Endoscopic thoracic sympathectomy (ETS) is a keyhole operation inside the chest that cuts or clamps the nerves controlling sweating. It is reserved for severe cases that have not responded to other treatments, because it often causes compensatory sweating, where sweating increases elsewhere on the body, and this can be severe. ETS is not performed at Centre for Surgery.

Which Treatment Is Right for You?

Mild sweating: start with clinical-strength antiperspirants and the home measures below.
Moderate to severe sweating, happy to repeat treatment: anti-sweat injections once or twice a year.
Wanting to avoid injections and surgery: a course of Morpheus8, accepting a less predictable result.
Severe underarm sweating, wanting a longer-lasting solution: suction curettage.
Sweating in several areas, such as the hands and feet as well: anti-sweat injections, sometimes with iontophoresis for the hands and feet.
Severe sweating that has not responded to anything else: referral to discuss sympathectomy, with a clear understanding of the risk of compensatory sweating.

A consultation will help you decide which option suits your symptoms, lifestyle and preferences.

How to Manage Sweaty Armpits at Home

Use a clinical-strength antiperspirant at night on dry skin. Ordinary deodorants mask odour but do not reduce sweating.
Wear loose, breathable fabrics such as cotton, and darker or patterned colours that hide sweat marks.
Try sweat shields or an undershirt to protect your clothes.
Keep a spare shirt at work or in your bag.
Cut down on triggers such as spicy food, caffeine and alcohol if you notice they make things worse.

These measures help many people but rarely control true hyperhidrosis on their own. If they are not enough, clinic treatment is the next step.

How Much Does Hyperhidrosis Treatment Cost?

The cost depends on the treatment. Anti-sweat injections are charged per session and usually repeated once or twice a year, while suction curettage is a single procedure with a one-off fee. Current prices are shown on our anti-sweat injections and hyperhidrosis treatment pages, and finance options are available, subject to status. Over several years, a one-off procedure can work out cheaper than repeated injections, although this depends on how often you need treatment.

Frequently asked questions

Will hyperhidrosis go away on its own?

Primary hyperhidrosis usually persists without treatment, although some people find it eases with age. Secondary hyperhidrosis may improve once the underlying cause is treated.

Is hyperhidrosis hereditary?

It often runs in families, which suggests a genetic link, although no single gene has been confirmed as the cause.

What is the difference between deodorant and antiperspirant?

Deodorant masks odour but does not reduce sweating. Antiperspirant reduces sweating by partly blocking the sweat ducts, so it is the one to use for hyperhidrosis.

Are anti-sweat injections safe to repeat?

Yes. Botulinum toxin has been used to treat underarm hyperhidrosis for many years, and repeat treatments are generally well tolerated. Side effects are usually mild and short-lived.

Is suction curettage permanent?

The sweat glands that are removed do not grow back, and most people have a long-lasting reduction in sweating. However, studies show that some sweating can return over the following years, and a small number of people choose a second procedure.

Will I sweat more elsewhere after treatment?

Compensatory sweating, where sweating increases in other areas, is a well-known effect of sympathectomy. It is uncommon after treatments that act only on the underarm, such as injections or suction curettage.

Will suction curettage leave scars?

The incisions are only a few millimetres long and are placed in the armpit, so scars are usually small and hard to see once healed.

Does treating underarm sweating affect how my body cools down?

No. The underarms contain only a small share of your sweat glands, so your body can still control its temperature normally.

Can men and women have the same treatments?

Yes. Hyperhidrosis treatments work in the same way for men and women.

Speak to a specialist

If excessive armpit sweating is affecting your life, a consultation at our CQC-regulated clinic at 95–97 Baker Street, London, is the first step. We will assess your symptoms, check for signs of secondary hyperhidrosis and explain which treatments suit you, from anti-sweat injections to suction curettage performed by a plastic surgeon. We recommend a two-week cooling-off period before any surgery. Call 020 7993 4849 or book a consultation online.

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