As a dermatologist I have been trained in the diagnosis and treatment of excessive sweating, and discuss all options including topical prescriptions, oral medications, Botox injections, iontophoresis, surgery, and miraDry® with my patients. MiraDry® is the only long lasting, non-invasive solution for excessive underarm sweat. It is FDA cleared and is done in the physician office setting with local anesthesia. The treatment permanently destroys the sweat glands and they do not regrow. The results are immediate. Side effects include underarm swelling, redness, tenderness/pain, and bumps and can last from several days to several weeks. Typically two treatments are required, at least three months apart.
You can shower the evening of the procedure. I would avoid taking hot showers or using abrasive cleansing techniques- wash cloths, loofahs, etc. Wash the area with warm water, a gentle cleanser and fingertips, and rinse well and pat dry. You should also avoid shaving until the tenderness has resolved, and avoid using deodorant/antiperspirant for the first few days following the procedure. Ice packs wrapped in a towel should be applied to the underarms immediately following the procedure and on and off for the next several days.
The effects of miraDry® start to work immediately after the procedure because the sweat glands are immediately destroyed. As the swelling and inflammation resolve over the following weeks, some sweating may return if any sweat glands that were not destroyed by the treatment were shut down temporarily. Underarm dampness within a short time period following the procedure may be due solutions that were injected during the procedure leaking out of the tissue.
Nerve symptoms (pain, numbness, etc.) can occur as a result of the miraDry® procedure. I would recommend waiting until these symptoms resolve prior to proceeding with the second treatment. For best results, a second treatment is recommended and the minimal amount of time to wait is 3 months. A second treatment can be done any time after this point, and it may be beneficial to wait longer if there is residual inflammation and pain. Sometimes giving oral steroids initially at the time of the treatment can decrease inflammation and lead to a quicker recovery time.
A dermatologist can help confirm the diagnosis of Primary Focal Hyperhidrosis. Armpits are the most common location for this I see in my practice and your history is very typical. My protocol starts with OTC antiperspirants then prescription ones. If these are ineffective or intolerable, often insurance companies suggest oral medications which do help with sweating but frequently have intolerable side effects. The next option is iontopheresis which is an effective procedure mostly for palms and soles but can be time consuming as it is ongoing. Other than experimental procedures, the remaining options are Botox(R), miraDry, and surgery. Botox(R) is an injection to block "nervous" sweating but is expensive if not covered by insurance and needs to be repeated every 4-8 months to maintain the effect. Surgery can be done to damage the nerves responsible for sending the sweating impulse to the armpits but is a surgical procedure and none of my patients has had this done. My favorite option for armpits is miraDry(R) which is an in office procedure under local anesthetic and takes about 2 hours for each session and usually 2 sessions are required to reduce sweating 90%. It is expensive but our patients have all seen demonstrable and long lasting improvement.
