When traditional antiperspirant products have failed to sufficiently manage excessive sweating, medicinal products or procedures can be recommended by your doctor, pharmacist or a healthcare professional.

Medications
Oral medications called anticholinergics drugs (e.g. propantheline, glycopyrrolate) work by preventing the stimulation of sweat glands in your body. However, the use of anticholinergic drugs can interfere with the stimulation of other important structures in the body, causing side effects such as dry mouth, constipation and blurred vision. As such, the long term use of anticholingeric drugs is not normally recommended for the treatment of excessive sweating or hyperhidrosis.1,2,
An alternative drug that has been found to be very effective at treating underarm hyperhidrosis is botulinum toxin A, also known as Botox. Botox is administered by a series of injections given in the armpit area to stop nerve signals reaching the sweat glands and prevent sweating. This treatment is effective for a few months, after which the effects wear off and therefore Botox treatments need to be repeated at regular intervals.1
Medical procedures
In cases where all other treatments have failed to manage excessive sweating, a range of medical / surgical procedures are available.
There are two main surgical approaches; the first being to sever the nerves that supply signals to the sweat glands in the hands – this is known as endoscopic thoracic sympathectamy (ETS). However, ETS can trigger increased sweating in other parts of the body, called ‘compensatory sweating’. As ETS is irreversible and the occurrence of compensatory sweating is very unpredictable, ETS is regarded as a last resort for treatment for excessive sweating.1
Alternatively, surgical removal of sweat glands is possible in the armpit area. This can involve removal of the area of underarm skin containing the sweat glands, or ‘scraping’ or suction of the sweat glands via a small incision in the skin.1
Iontophoresisis another process of reducing sweat, whereby a small electric current is passed through the surface of the skin, disrupting the sweating process enough to effectively reduce the amount of sweat produced. The exact mechanism of how this works is unknown. Devices are available that can be used on the hands, feet, face and underarms.1
Invasive treatments, such as these, are extreme procedures and can cause adverse effects such as scarring or sweating imbalances and are normally considered as a last resort. It is important to consult your doctor or a healthcare professional before considering any of these treatments.
References- Patient.co.uk. Excessive sweating. http://www.patient.co.uk/health/Excessive-Sweating.htm (Last accessed 15.12.12)
- Mayo Clinic. Excessive Sweating. http://www.mayoclinic.com/health/hyperhidrosis/DS01082/METHOD=print (Last accessed 15.12.12)