There are three choices for underarm sweating that we typically use here in the practice. One you've already mentioned is a prescription strength antiperspirant, usually aluminum chloride 20%. If this is too irritating on the skin for a particular patient or if it simply doesn't work, we'll often resort to using botulinum toxin in the armpit – which we can typically get covered by insurance. This method can be very successful in treating excessive underarm sweating for three to six months.
Additional options for underarm sweating include an oral medication called Glycopyrrolate. This medication has the potential side effects of dry mouth, blurry vision, dry eyes and even occasionally dizziness. With this being said, the risks, benefits, and alternatives should be discussed fully prior to embarking upon this therapy. It should also be noted that this medication works systemically on all areas of sweating, not just the underarms.
A fourth, less commonly used option, is iontophoresis. This is when a little electric current is used to deactivate apocrine sweat glands in the armpit.