Alon Pnini MD

Other Treatment Options

There are a multitude of therapies available for hyperhidrosis, from topical treatments to oral medications to surgical procedures. Each treatment is associated with different side effects or complications, as well as different effectiveness, so patients and their doctors must weigh the risks and benefits of each option.

Topical Treatments

The first-line treatment for most people with idiopathic hyperhidrosis, especially he axillary type, is topical treatment with antiperspirants. Many patients may find that commercially available antiperspirants do not have any effect on their sweating. In that case, prescription formulas are available with a high concentration of the active ingredient, which is usually an aluminum salt. These must be applied at night, with plastic wrap or tight clothing providing compression over the affected area, and washed off in the morning. The main side effect associated with this form of treatment is skin irritation. There is also the disadvantage of requiring frequent treatments, which may be difficult to adhere to.


Oral medical therapy for excessive sweating is available in the form of the anticholinergic class of drugs. These work by blocking cholinergic neurons, which are responsible for activating sweat glands. Unfortunately, cholinergic neurons have many other functions as well, and the medications are not specific for those involved in sweating. Therefore, side effects including dry mouth, blurry vision, constipation, and urinary retention are quite common and make these drugs less than ideal for the treatment of hyperhidrosis.


Iontophoresis is a technique in which an electrical current is used to disrupt the function of the sweat glands. Tap water is commonly used in hyperhidrosis treatment, with an efficacy of about 80%. Anti-cholinergics can be added to the tap water, which leads to slightly better results. Treatment with iontophoresis can be somewhat uncomfortable and may lead to skin irritation. It is also time-consuming and requires multiple treatments which must be repeated at frequent intervals to achieve consistent reduction in sweating. One device available for home-use for hyperhidrosis treatment is Drionic. To learn more about the Drionic Device, visit the Drionic website.


Recently, lasers have been used to perform axillary hyperhidrosis procedures. There is very little in the way of published evidence for this, as it is a fairly new technique. However, there are disadvantages to the laser ablation technique. While the underlying principle of removing the sweat glands from under the skin is the same as retrodermal curettage, the high-energy lasers cannot be as accurately controlled as surgical tools and may result in either incomplete ablation or damage to the skin leading to extensive skin loss.


Botox® is a purified derivative of botulism toxin, a powerful neurotoxin. It is best known as a treatment for facial wrinkles, but can also be used for the treatment of hyperhidrosis. Botox blocks neuromuscular transmission by inhibiting the release of the neurotransmitter acetylcholine. Since the nerves that activate the sweat glands use acetylcholine as their neurotransmitter, blocking that pathway will lead to a reduction in sweating wherever Botox is injected.

Botox injections are as effective as surgery at reducing excessive sweating, but the effects wear off in four to six months. Patients may therefore need the injections two or three times a year, which can be costly. Botox injections offer a temporary cure for axillary hyperhidrosis, whereas the surgical cure is permanent.

To learn more about the surgical alternative to Botox and what we can do to help rid you of excessive underarm sweating, contact us by clicking here.

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Office: 310-556 1166
Toll Free: 1(888) 44 SWEAT
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About Dr. Alon pnini.

Dr. Pnini is the pioneer of Retrodermal Curettage as a treatment for Axillary Hyperhidrosis (excessive underarm sweating). The Retrodermal Curettage procedure boasts a 90+% success rate. Alon Pnini, M.D. is a Board Certified Plastic and Recontrucive Surgeon, and Diplomat of the American Board of Plastic Surgery... If you have any questions or would like to know more about Dr. Pnini, please contact us.

Underarm Sweat | Underarm Sweating | Armpit Sweat | Armpit Sweating | Axillary Hyperhidrosis | Excessive Underarm Sweating