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Medical Spa West LA & La Cañada Flintridge | Skin Specifics | Hyperhidrosis
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Many Americans have a medical condition named Severe Primary Axillary Hyperhidrosis (SPAHH) better known to you as severe underarm sweating. Severe underarm sweating is a medical condition that involves overactive sweat glands. Sweat is your body’s temperature regulator. In severe primary axillary hyperhidrosis, sweating significantly exceeds the body’s normal requirements for cooling. People with the severe underarm sweating do a lot to cope, they:

  • Change clothes frequently
  • Put absorbent materials under clothing
  • Avoid certain fabrics and styles of clothes
  • Seek medical attention and treatment

While people with severe underarm sweating may choose many different antiperspirants, in some instances those products do not work well enough for their sweating. Clothes can be a real issue, because the wrong choice can reveal your severe underarm sweating condition rather than hide it. Your wardrobe can be very limited and you may have to purchase new clothing frequently. When clinical strength antiperspirants do not work well enough, Botox maybe the answer. At the consultation we will ask you some specifics about your underarm sweating so that we may evaluate if you are in fact a good candidate for axiallary/underarm Botox treatment. A group of international experts have come up with some criteria that help us diagnose focal axiallary hyperhidrosis. Focal axiallary hyperhidrosis, is when you havefocal, visible, excessive sweating of at least 6 months duration without apparent cause with at least 2 of the following characteristics:

  • The sweating is bilateral and relatively symmetric
  • It Impairs your daily activities
  • You have at least 1 episode per week
  • Age of onset less than 25 years
  • You have a positive family history of excessive sweating
  • There’s an absence of focal sweating during sleep

A number of different treatments and products are available to help people with severe underarm sweating. Here’s an overview of some you may have heard about or considered trying.




Often considered the “first line” of treatment for severe underarm sweating.  Over-the-counter antiperspirants work by blocking sweat ducts, thereby reducing the amount of perspiration that reaches the skin. The most widely used ingredients in antiperspirants are metallic salts, including aluminum chloride hexahydrate. Deodorants help control body odor, which is caused by a reaction between bacteria and sweat. The deodorants work by making the skin more acidic, and hence less attractive to bacteria. They are often used in combination with antiperspirants to help control sweating in addition to odor.

Prescription Antiperspirants/Deodorants

Your doctor may prescribe a stronger antiperspirant for your severe underarm sweating, available from your pharmacist. Like over-the-counter antiperspirants, these also work by blocking sweat ducts, thereby reducing the amount of perspiration that reaches the skin.

Alternative Therapy

Herbal remedies such as sage tea or sage tablets, chamomile, valerian root, and St. John’s wort, as well as biofeedback, acupuncture, hypnosis, and relaxation techniques, are sometimes suggested as treatments for severe underarm sweating.

Botox Treatment

Botox is approved by the FDA to treat the symptoms of severe underarm sweating when medicines used on the skin (topical) do not work well enough. Botox Neurotoxin is injected into the affected areas to help control this condition by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating stops.


This procedure involves sending a small electrical current to the surface of the affected area while it is submerged in water. In general, treatments must be repeated 3-4 times per week. The procedure can be done at home using a home device. Iontophoresis can be used for treating severe underarm sweating.


A variety of surgical approaches have been used to treat severe underarm sweating, but they are usually reserved for the most extreme cases that do not respond to other treatments. One of the most common types of surgery used today for this condition is called Endoscopic Thoracic Sympathectomy (ETS). With ETS, the patient is put to sleep with general anesthesia and then the surgeon attempts to interrupt the transmission of nerve signals between the spinal column and sweat glands in the affected area. This procedure requires special training. Other types of surgery sometimes used for severe underarm sweating include liposuction and removal of the sweat glands under the armpits.

Botox (onabotulinumtoxinA)

Temporarily blocks the nerves that trigger your sweat glands and is FDA approved for Hyperhidrosis and works quite well in most cases (not all). Injections are placed in the axilla (arm pit) to lessen sweat gland activity. At Skin Specifics we use an average of 50 units of Botox per axilla. (total 100 units of Botox) which should be effective for an average of 6 to 7 months. Though this sounds painful, axilla botox injections are surprisingly not so uncomfortable.

Some Preparation Prior to Receiving Botox for Severe underarm sweating.

  • Shave Underarms
  • Abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to treatment.
  • Rest comfortably without exercise, hot beverages, etc for approximately 30 minutes prior to treatment.

FAQ’s Regarding Botox for Severe Axillary Hyperhidrosis or severe Underarm Sweating

How does Botox work to control Underarm Sweating?

Botox is a prescription medicine that is injected into muscles and used to treat the symptoms of severe underarm sweating when medicines used on the skin do not work well enough. Botox temporarily blocks chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the excessive sweating stops.

What are the possible Side Effects of Botox?

Botox can cause serious side effects. See “What is the most important information I should know about Botox?” in Medication Guide.

Other side effects include:

  • Dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of the eyelids, and dry eyes may occur.
  • Symptoms of an allergic reaction to Botox include: itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness, or feeling faint. Tell your doctor or get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.

Who Should Not Receive Botox?

Patients should not be treated with Botox Neurotoxin if:

  • They are allergic to any ingredients in Botox
  • They have had an allergic reaction to any other Botulinum Toxin product such as Myobloc and Dysport
  • They have had a skin infection at the planned injection site
  • They have certain neurological disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome. These may increase the risk of serious side effects

What is the Procedure Like?

The actual procedure takes about 15-20 mins. You will have multiple injections to the area after we outline the area.

Is the Procedure Painful?

It causes little discomfort; most patients compare the sensation to a bug bite. Overall, the discomfort is minimal and temporary. You will not need anesthesia we may numb the injected area with a cold pack or anesthetic cream before the actual treatment.

Will Botox work? How long will it last? How soon will I see results?

  • You should notice a significant reduction in underarm sweating within 4 weeks of your first treatment.
  • A Botox treatment lasts about 201 days or up to 6.7 months.
  • Botox injections are not a permanent cure for severe underarm sweating and your symptoms will gradually return. When symptoms return, the time is right for another treatment.

Where Does the Sweat Go? Is it not unhealthy to stop sweating?

  • People who need Botox for SPAHH (Severe Primary Axillary Hyperhidrosis) that is inadequately managed by topical agents have overactive sweat glands in their underarms. Botox neurotoxin injections temporarily stop production of sweat in the treated areas only. Sweat continues to be produced elsewhere.
  • Your sweat doesn’t go anywhere else or get backed up because the sweat simply isn’t produced in the areas treated with Botox.
  • The rest of your body is free to release moisture normally.
  • If you were to stop Botox treatment, or when it wears off months later, the sweating function returns to the same level you experienced before starting treatment.