“I’d like to treat my underarm odor or hyperhidrosis with a topical medication.”
“I want to know the pros and cons of topical treatments.”

If these questions sound familiar, read on.

Topical medications for Underarm Odor (Axillary Osmidrosis) and Hyperhidrosis are applied directly to the affected area to help manage symptoms. Unlike surgery, they do not remove the sweat glands that cause the condition, but they also leave no surgical scars and require no hospital stay.

This page explains three types of topical medications used for axillary osmidrosis and hyperhidrosis, along with their advantages and disadvantages. If you are concerned about these conditions, we encourage you to read on.

At IC Clinic, we propose a treatment plan tailored to each individual patient and are committed to delivering results. We will take the time to listen carefully to your concerns and symptoms, so please use the button below to book a consultation.

What Are Axillary Osmidrosis and Hyperhidrosis? Two Common Concerns About Underarm Sweating

Hyperhidrosis affects an estimated 2–3% of the population (Reference 9) and is known to have a serious impact on patients’ daily and social lives (Reference 1). Axillary osmidrosis is also closely associated with hyperhidrosis and is a significant factor in reducing patients’ quality of life (QOL) (Reference 12).

Axillary osmidrosis is a condition in which sweat secreted from apocrine glands reacts with bacteria on the skin, producing a distinctive odor. Hyperhidrosis, on the other hand, is characterized by excessive sweating in areas such as the underarms, palms, and feet.

The respective symptoms are summarized in the table below.

The following sections explain the symptoms and causes of each condition in more detail.

Symptoms and Causes of Axillary Osmidrosis (Underarm Odor)

Axillary osmidrosis is a condition characterized by a distinctive odor emanating from the underarms.

Symptoms often begin around puberty and may be more pronounced in those with more body hair or a diet high in meat and fat. Accordingly, hair removal and a diet centered on Japanese-style cuisine may help reduce the odor.

Axillary osmidrosis develops when odorless precursor substances secreted by the apocrine glands are broken down by skin-resident bacteria, producing volatile fatty acids such as 3-methyl-2-hexenoic acid and generating the characteristic odor. It has been reported that approximately 60% of patients with axillary osmidrosis also have concurrent hyperhidrosis (Reference 6).

Autonomic nervous system dysregulation has also been suggested to play a role in axillary osmidrosis, and approximately 60% of those with the condition are reported to show symptoms of hyperhidrosis as well.

Symptoms and Causes of Hyperhidrosis

Hyperhidrosis is a condition characterized by excessive sweating in areas such as the underarms, palms, and feet. Examples include sweat that soaks through documents or sweating so profusely that shaking hands with others becomes difficult.

Hyperhidrosis occurs when the sympathetic nervous system becomes overactive, stimulating the eccrine glands to produce sweat. Because this sweat is approximately 99% water, careful and timely management can help minimize odor.

For primary hyperhidrosis, a stepwise treatment approach based on symptom severity is recommended (Reference 2), with topical medications considered the first-line option for mild to moderate cases (Reference 3). Sympathetic nervous system overactivity is the primary cause, and genetic predisposition is also known to be involved (Reference 7).

Hyperhidrosis can also be classified into two types: “generalized hyperhidrosis,” in which excessive sweating occurs throughout the body, and “focal hyperhidrosis,” in which excessive sweating is limited to specific areas of the body.

Focal hyperhidrosis includes conditions such as “palmar hyperhidrosis,” characterized by abnormally heavy sweating of the palms.

Three Types of Topical Medications for Axillary Osmidrosis and Hyperhidrosis

Treatment options for axillary osmidrosis and hyperhidrosis include surgery and local injections, but oral medications and topical medications can also be used to help relieve symptoms.

The three types of topical medications used for axillary osmidrosis and hyperhidrosis are:

• Perspirex (currently not available at our clinic)
• Ecclock Gel 5%
• Aluminum Chloride Solution

Topical medications are used to manage symptoms. In particular, topical medications for axillary osmidrosis can help relieve symptoms by reducing perspiration or removing bacteria from the skin surface.

The following sections explain the effects and usage of each medication.

Perspirex | Medical-Grade Antiperspirant

Perspirex is a topical medication used as a medical-grade antiperspirant. The mechanism by which Perspirex helps manage symptoms of axillary osmidrosis and hyperhidrosis is as follows:

• Aluminum chloride blocks the sweat glands
• Ethanol carries the keratin plug deep into the sweat gland ducts
• Lactic acid components convert acids to lactic acid

Because it can be applied not only to the underarms but also to the palms and soles of the feet, it may be helpful in managing focal hyperhidrosis in those areas as well.

Efficacy of aluminum chloride preparations is assessed using objective measures of sweat production (gravimetric method) and patient-reported outcomes such as the HDSS (Hyperhidrosis Disease Severity Scale) (Reference 2). Effects are generally observed within 1–2 weeks, and satisfactory results have been reported in a substantial proportion of patients (Reference 15).

Side effects of aluminum chloride preparations are primarily local skin irritation reactions (itching, erythema, contact dermatitis), observed in approximately 15–20% of patients (Reference 10). Serious systemic side effects are rare, and local skin reactions can be minimized with appropriate use (Reference 15).

What Is Perspirex? How It Works to Reduce Underarm Odor and How to Use It

Ecclock Gel 5% | Topical Medication for Axillary Hyperhidrosis

Glycopyrronium topical formulation (Ecclock Gel 5%) is a muscarinic receptor antagonist that blocks acetylcholine receptors in the sweat glands to suppress perspiration. In the ATMOS-1 and ATMOS-2 trials, a statistically significant reduction in sweating was confirmed compared with placebo (Reference 5). Improvement was observed in a large proportion of patients within two weeks (Reference 14), and improvements in quality of life have also been reported.

It is applied once daily to both underarms, with each tube containing approximately a two-week supply. However, the following individuals should not use this medication:

• Those who are pregnant or breastfeeding
• Those under 12 years of age
• Those with narrow-angle glaucoma
• Those with urinary retention disorders

If side effects such as dermatitis, dry mouth, or blurred vision occur, use should be discontinued.

Aluminum Chloride Solution | Topical Medication That Blocks Sweat Glands

Aluminum chloride solution is a treatment that works by blocking sweat gland ducts.

One of its advantages is that in addition to being prescribed as a topical medication at hospitals and clinics, over-the-counter products containing aluminum chloride are also available at pharmacies.

Aluminum chloride preparations form aluminum hydroxide precipitates within the sweat ducts, causing physical blockage. They are positioned as a standard first-line treatment for hyperhidrosis (Reference 8), and continued use may provide long-term sweat suppression (Reference 15).

As itching may occur as a side effect, it is important to apply the solution carefully to the affected area only, for example by soaking a tissue and dabbing it on.

Advantages of Topical Medications for Axillary Osmidrosis and Hyperhidrosis

The advantages of topical medications for axillary osmidrosis and hyperhidrosis include the following three points:

• Avoids the drawbacks of surgery for hyperhidrosis or axillary osmidrosis
• Can help manage symptoms even in children
• Lower risk of side effects compared with oral medications

The following sections explain each advantage in detail.

Advantage ① Avoids the Drawbacks of Surgery for Hyperhidrosis or Axillary Osmidrosis

Topical medications for axillary osmidrosis and hyperhidrosis allow patients to avoid the drawbacks associated with surgery.

The “flap method” surgery used to remove the sweat glands that cause hyperhidrosis and axillary osmidrosis results in a wound that takes time to heal and typically requires a hospital stay of several days.

By contrast, topical medications leave no surgical scarring and require no hospitalization, making them a suitable option for those who wish to avoid the risks associated with surgery.

Advantage ② Can Help Manage Symptoms Even in Children

Topical medications are well-suited for use in children as well, offering a way to manage symptoms for those who cannot undergo surgery.

In pediatric and adolescent patients with hyperhidrosis and axillary osmidrosis, surgical treatment is not recommended because apocrine gland development is not yet complete; conservative treatment with topical medications is therefore the standard approach (Reference 8). For those aged 12 and above, glycopyrronium topical formulation is also an option, providing a safe and effective treatment choice (Reference 5).

For this reason, surgical treatment is generally not recommended for axillary osmidrosis and hyperhidrosis in children.

Topical medications are also a practical choice as a way to manage symptoms until the patient is old enough to be considered for surgery.

Advantage ③ Lower Risk of Side Effects Compared with Oral Medications

Topical medications for axillary osmidrosis and hyperhidrosis also offer the advantage of a lower risk of side effects compared with oral medications.

Systemic anticholinergic agents (such as propantheline bromide) frequently cause side effects including dry mouth, constipation, and drowsiness (Reference 6), whereas topical medications have a more favorable side effect profile. By acting locally, topical medications minimize systemic effects and represent a safer treatment option (Reference 10).

It is also important to note that reducing sweat production with oral medications may impair the body’s ability to release heat through perspiration, which can cause the body to feel flushed or overheated.

Hyperhidrosis treatment guidelines recommend a stepwise approach beginning with conservative topical treatment as the first-line option, with botulinum toxin injections considered if results are insufficient, and surgical treatment explored as a final option (References 2, 10). This treatment strategy aims to achieve optimal therapeutic outcomes while minimizing the burden on the patient.

Disadvantages of Topical Medications for Axillary Osmidrosis and Hyperhidrosis

The main disadvantage of topical medications for axillary osmidrosis and hyperhidrosis is the need for continued long-term use.

Unlike surgery, topical medications work to manage the symptoms of axillary osmidrosis and hyperhidrosis, so the sweat glands that cause these conditions remain in place. As a result, topical medications cannot eliminate symptoms entirely.

Symptoms may improve naturally around menopause (around age 50), but until then, continued use of topical medications may be necessary.

While topical medication treatment represents symptomatic management, it has been shown to significantly improve patients’ quality of life (QOL) (Reference 4) and to reduce the impact of these conditions on social and occupational functioning (Reference 1). Continued use enables long-term symptom management, and a satisfactory level of treatment effect has been reported in many patients (Reference 14).

Frequently Asked Questions About Treatment of Axillary Osmidrosis and Hyperhidrosis

Below are answers to frequently asked questions about the treatment of axillary osmidrosis and hyperhidrosis.

Q. Are there treatment options other than medication for axillary osmidrosis and hyperhidrosis?

Other treatment options beyond medication include:

• Surgery (flap method)
• miraDry
• Botulinum toxin injections
• Quadracut method

Among these, miraDry is notable for not requiring any incisions, while botulinum toxin injections can suppress sweating for approximately 4 to 9 months with a single treatment session.

Other treatment options for hyperhidrosis include “sympathectomy” and “iontophoresis.”

For more information on surgical and other treatment options for axillary osmidrosis and hyperhidrosis, please also refer to the page linked below.

What Is Surgery for Hyperhidrosis and Palmar Hyperhidrosis? Symptoms and Treatment Options for Hyperhidrosis and Axillary Osmidrosis

Q. Is there any way to manage underarm odor or hyperhidrosis on my own?

Axillary osmidrosis and hyperhidrosis affecting the face, underarms, hands, and feet cannot be resolved through self-management alone.

However, adjusting your lifestyle may help relieve symptoms.

To help reduce axillary odor, it is advisable to focus on a vegetable-centered diet and limit intake of oily and fatty foods.

If stress is a contributing factor to hyperhidrosis symptoms, try incorporating gentle activities such as yoga, walking, or stretching. Since hyperhidrosis is related to psychogenic sweating, improving overall mental and physical wellbeing may help relieve symptoms.

Q. Is topical medication treatment for axillary osmidrosis and hyperhidrosis covered by insurance?

Among topical medication treatments for axillary osmidrosis and hyperhidrosis, only Ecclock Gel 5% is covered by insurance.

Perspirex and aluminum chloride solution can be used on areas beyond the underarms, such as the palms and soles, but they are not covered by insurance, meaning the full cost is borne by the patient. (Please note that Perspirex is currently not available at our clinic.)

 

References

1. Kamudoni P, Mueller C, Halpert E, et al. The impact of hyperhidrosis on patients’ daily life and quality of life: a qualitative investigation. Health and Quality of Life Outcomes. 2017;15(1):121.
2. Solish N, Bertucci V, Dansereau A, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatologic Surgery. 2007;33(8):908-923.
3. Hoorens I, Ongenae K. Primary focal hyperhidrosis: current treatment options and a step-by-step approach. Journal of the European Academy of Dermatology and Venereology. 2012;26(1):1-8.
4. Campanati A, Penna L, Guzzo T, et al. Quality-of-life assessment in patients with hyperhidrosis before and after treatment with botulinum toxin: results of an open-label study. Clinical Therapeutics. 2003;25(1):298-308.
5. Glaser DA, Hebert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. Journal of the American Academy of Dermatology. 2019;80(1):89-98.
6. Lakraj AA, Moghimi N, Jabbari B. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins. 2013;5(4):821-840.
7. Benson RA, Palin R, Holt PJ, Loftus IM. Diagnosis and management of hyperhidrosis. BMJ. 2013;347:f6800.
8. Haider A, Solish N. Focal hyperhidrosis: diagnosis and management. CMAJ. 2005;172(1):69-75.
9. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Archives of Dermatological Research. 2016;308(10):743-749.
10. Walling HW, Swick BL. Treatment options for hyperhidrosis. American Journal of Clinical Dermatology. 2011;12(5):285-295.
11. Reinauer S, Neusser A, Schauf G, Hölzle E. Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. British Journal of Dermatology. 1993;129(2):166-169.
12. Amir M, Arish A, Weinstein Y, Pfeffer M, Weinstein EJ. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Israel Journal of Psychiatry and Related Sciences. 2000;37(1):25-31.
13. Nestor MS, Park H, Neel D. Treatment of axillary hyperhidrosis using a microwave device: a randomized controlled trial. Dermatologic Surgery. 2014;40(11):1243-1250.
14. Hebert AA, Glaser DA, Pariser DM, et al. Topical glycopyrronium tosylate for primary axillary hyperhidrosis: Patient-reported outcomes from the ATMOS studies. American Journal of Clinical Dermatology. 2019;20(1):135-145.
15. Wechsler B, Lanier BJ, Feldman SR. Therapies for primary focal hyperhidrosis: a review. Skin Pharmacology and Physiology. 2014;27(4):180-188.

At IC Clinic, we propose a treatment plan tailored to each individual patient and are committed to delivering results. We will take the time to listen carefully to your concerns and symptoms, so please use the button below to book a consultation.