Is Botox the best treatment option for Excessive Underarm Sweating? (Underarm Hyperhidrosis)

Botox is not just used for wrinkles. What is less commonly known is that Botox can have huge benefits for those who suffer from excessive underarm sweating (hyperhidrosis).

Underarm hyperhidrosis can be quite embarrassing depending on the social setting because of body odour as well as sweat stains on the clothing.

Read on for more information about how botox injections can help with hyperhidrosis, and read about how botox compares with the other treatment options for hyperhidrosis.

What is Underarm Hyperhidrosis ?

It is a normal physiological response for the body to produce sweat when placed in a hot environment, undergoing physically strenuous activities or when nervous or stressed.

Hyperhidrosis refers to excessive sweating even in a cool and calm setting. It usually manifests in the underarms, hands, and feet.

How does Botox help with Excessive Underarm Sweating?

Sweat is produced by sweat glands when a neurotransmitter called acetylcholine reaches and activates the sweat glands. 

In patients with hyperhidrosis, there could be an overproduction of acetylcholine which results in overstimulation of the sweat glands and hence excessive sweat secretion.

Botox injections into the underarms help to stop the release of acetylcholine which reduces sweat gland activity and ultimately results in lesser sweat production.

Treatment options for Excessive Underarm Sweating 

Treatment options for Excessive Underarm Sweating 

Antiperspirants work by obstructing the sweat glands so that sweat is unable to be secreted. When the sweat glands are blocked, there is a feedback mechanism to the body to reduce further production of sweat. 

However, antiperspirants can sometimes cause side effects such as rashes or skin irritation. 

Compared to Botox, antiperspirants are an affordable option. However, daily compliance is required for it to be effective.

Oral Medications

Anticholinergic drugs such as oxybutynin work by preventing the sweat glands from working. It can work well when combined with topical antiperspirants.

However, side effects may include dry mouth, dry eyes, blurring of vision, and abnormal heart rhythm. Furthermore, in people who stay in a hot climate, a reduction in sweating may impair the body’s ability to cool itself, thereby increasing one’s risk of heat stroke or heat injury.

Iontophoresis (No sweat Machine)

It is a home-based treatment that is only applicable to excessive sweating for the hands or feet. Unfortunately, it does not work well for the underarms.


Excision or laser removal of the sweat glands can be done as a day surgery treatment under anesthesia. 

Side effects include infection, loss of sensation in the underarms, and scarring.

Hand-held medical devices that destroy sweat glands

Specific to the underarms, FDA has approved hand held medical devices that emit electromagnetic energy that can destroy the sweat glands. 

However, this is a relatively new treatment option and more studies have to be done on its safety and efficacy. 

What are the advantages of Botox compared to other treatment options?

Botox for underarm hyperhidrosis is a quick, safe, and effective treatment with minimal discomfort. Each treatment session takes between 15 to 20 minutes and results typically last 4 to 6 months.

Compared to the application of topical antiperspirants or oral medications, undergoing botox injections twice a year is a more convenient option with a lesser chance of skin irritation or rashes.

Botox is also far less invasive than surgery with a lower risk of side effects. Botox for hyperhidrosis has minimal to no downtime whilst surgery usually requires 1 to 2 weeks for the wound to recover and heal. 


Botox is a well-studied treatment for excessive underarm sweating and is recommended for those who prefer to undergo treatment twice a year as compared to the daily cream application or oral medications.

Newer treatments for hyperhidrosis are on the horizon which makes this an exciting space!

Since the invention of botox which is primarily used to treat wrinkles, it has gained popularity over the last few years as a quick, safe, and effective treatment option to control excessive sweating (Hyperhidrosis). This article discusses all the pros and cons of botox for hyperhidrosis and explores whether it's an ideal treatment option for those seeking improvement for sweaty palms.

What are sweaty palms (palmar hyperhidrosis)?

It is normal for individuals to experience sweating over different areas of the body when exposed to heat, anxious or when exercising. However, in hyperhidrosis, individuals experience excessive sweating even without exposure to heat or strenuous activities. 

Excessive sweating can manifest in areas such as the underarms, back, chest palms and the soles of the feet. 

What causes hyperhidrosis?

The exact cause is unknown but may be related to an “overactive” sympathetic nervous system that overstimulates the sweat glands. Unfortunately, this is a process we have no voluntary control over.

Patients may notice worsening hyperhidrosis when they are stressed or emotional.

Impact of Sweaty Palms

Sweaty palms can have a negative impact on one’s social and professional life. 

For example, those with sweaty palms may feel awkward when shaking hands at events or holding hands with their loved ones. On a professional level, sweaty palms may even affect career prospects.

Treatment options for Hyperhidrosis

The broad categories include topical treatments with aluminum chloride, Botox, oral medications, Iontophoresis and Surgery.

Botox is usually the preferred treatment option because it is safe and effective with minimal downtime and little to no side effects.

How does Botox help Hyperhidrosis (sweaty palms)?

Botox treatment of hyperhidrosis is one of the most studied treatment options and is usually considered a first-line therapy. It works by blocking the release of a special chemical called acetylcholine in the nerves which is responsible for the overstimulation of sweat glands. Less acetylcholine = less sweat production.

It is administered in small injections over the targeted area and potentially there may be up to 25 injection points per palm (50 botox units per side).

Treatment results can vary between 4 to 9 months and potential side effects include bruising, discomfort during the injection, and reduced grip strength.

Comparing Botox to other common types of treatments for Hyperhidrosis

20% aluminum chloride hexahydrate is the recommended topical treatment (cream) for sweaty palms. It is applied every night to the affected areas and left on for at least 6 to 8 hours. It works by blocking the sweat glands. Potential side effects include skin irritation. Compared to botox, this method requires discipline as patients have to comply with a daily regime.

Iontophoresis is another type of treatment for palmar hyperhidrosis which involves submerging the palms into a tray of water and concurrently passing an electrical current through the water. Side effects include redness and tingling which are usually mild. The treatment has to be done 3 times a week and the mechanism of action is currently unknown.  application of an electrical current  

Other less common types of treatments include microwave therapy, local surgery, and sympathetic denervation.


Palmar hyperhidrosis or sweaty palms can be safely and effectively treated with Botox injections. Results last for between 4 to 9 months and are more convenient than options such as topical creams, iontophoresis, or oral medications. 

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