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Armpit Sweating (Axillary Hyperhidrosis)

Axillary hyperhidrosis, (also known as armpit sweating) is the medical term used for excessive sweating in the armpit of a person. All human beings have some sort of armpit sweating but for about 1% of the population axillary hyperhidrosis involves extreme, dripping sweat in the armpit area. This type of excessive armpit(axillary) sweating is resistant to all types of deodorants and odor controlling medications. At times the excessive axillary sweating is accompanied by the more known entity of palmar hyperhidrosis or excessive hand sweating.

Potential patients should realize that the surgical treatment for excessive armpit sweating should be offered only after conservative treatments have failed. A patient with severe armpit sweating should always try some strong antiperspirants such as Maxim or Drysol before considering surgical treatment.

Excessive armpit sweating usually appears around puberty and can become a socially impairing problem. Patients who are afflicted with excessive severe armpit sweating might have to change their clothing two to three times a day. They may also limit the clothing they wear to certain colors to try and hide the problem. In these severe cases people may also be subject to negative comments and attention from their peers or co workers.

Causes of Axillary Hyperhidrosis
The patho-physiology of excessive armpit sweating is somewhat complicated but basically it represents overstimulating of the sympathetic nervous system. There are some other reasons such as specific food, anxiety, stress, and emotional stimuli, all of which can add to the problem.

Diagnosis
Basically the clinical history is the main source of diagnosis. Patients can describe their conditions very vividly and easily and obviously there are different grades of severity (mild, moderate, to severe). One has to exclude the possibility of a secondary axillary sweating which can be a manifestation of other medical ailments. For further evaluation about these possibilities one should consult a physician.

Treatments
As in any other medical problem one should first start with conservative measures. Change of clothing (more absorbing clothing) or dietary changes (unique to each person) can help but they are very unlikely to do so in the severe cases. The next steps are the different antiperspirants that one can obtain over the counter and there is no unique recommendation for any of them other than trying them through personal trials. Medicated antiperspirants such as Drysol or Maxim are effective in certain cases. Drysol comes in different strengths and usually requires a prescription. Maxim can be obtained online and many patients describe good results. Maxim is also less irritating than drysol since it is less acidic.

The Iontophoresis treatment (Drionic Machine) is another conservative method used to treat excessive cases of axillary sweating. It requires steady use and the results are not always satisfactory. Certain medications can be tried but they have a very limited use.

Botox
This treatment modality represents a unique approach for the treatment of focal hyperhidrosis. In this treatment the injections of the Botolinum Toxin A^TM into sweat producing areas can minimize the sweat production on a temporary basis. The disadvantage of this treatment is the temporary solution it gives and the cost. It can be a good solution to certain people who need it in certain periods of their life.

Surgical Treatments
There are few solutions in the surgical options. The old methods involved excision of the sweat bearing areas of the armpit. In this particular method the skin and the subcutaneous area were excised so the sweat production was eliminated. It is a good solution but it leaves the patient with scarring, axillary hair loss, and possible contraction in that area making movement somewhat difficult. Over the last 10 years suction curettage was introduced into the surgical practice in order to treat this ailment. In this particular procedure through very small skin incisions the sweat bearing area is being suctioned and scraped(currettage).

In this particular method through very small incisions in the armpit area cannulas (suction tubes) are inserted into the planned suction surfaces and with a criss cross type of movement the underlining layer of the skin is scrapped. This destroys about 90 to 95% of the sweat gland hence reducing the amount of sweating dramatically. Alco though these holes certain scrapping instruments are inserted to help with the suctioning of the sweat glands.

The benefit of this method is the small incisions, the easy recovery, and the preservation of the hair bearing area. There are some side effects that can happen such as skin loss, scarring (minimal), all of which can treated easily. The formation of fibrotic bands can also be a problem but generally speaking it is a limited one. The success rate is about 90%. Axillary curettage or superficial liposuction does not eradicate all the apocrine in the axillary gland which is almost impossible to do unless you excise the entire skin from axillary area. As a matter of fact leaving about 5 to 10% of those apocrine glands might prevent over dryness which might be somewhat irritating to a patient. The basic principle is to reduce the overall number of apocrine glands which in turn will reduce the amount of sweating and hopefully the amount of smell in cases of bromhidrosis.

Update April, 2007:
In the last meeting of the International Society for Sympathetic Surgery there were a lot of papers discussing the value of endoscopic thoracic sympathectomy for patients with only axillary sweating. Even though some papers recommended the performance of T4 sympathectomy for excessive armpit sweating Dr. Reisfeld believes that, still local measures such as suction curettage is a better option, since it does not have the generalized side effects (compensatory sweating - compensatory hydrosis) that are an inevitable part of the sympathectomy.

As you read below, we would like to emphasize again that Endoscopic Thoracic Sympathectomy (ETS) is not recommended as the surgical solution for severe axillary hyperhidrosis (excessive armpit sweating). Excessive hand sweating/ palmar hyperhidrosis is the only indication at present for which we recommend Endoscopic Thoracic Sympathectomy (ETS). For excessive armpit sweating, as you will read below, suction curettage is the only recommended procedure.

Normal sweating is necessary for our body as it helps regulate the temperature of the body as well as excretion of some waste products of our body. Another variety of axillary hyperhidrosis is bromhidrosis. In this case certain bacteria (cornebacteria) that are on the skin convert the sweat to a malodoros (foul smelling) end product. There are two types of glands in the axillary area, eccrine and apocrine glands. The eccrine are responsible for the watery production and the apocrine glands secrete a protein-like substance.

Insurance Issues:
Unfortunately the insurance companies typically disregard severe armpit sweating as a medical problem and do not cover it in most cases. We hope this will change in the future but in the meantime we have to charge the patient for these services. It is important for every patient to try conservative methods (see above) given by a doctor, keep the records, and this might give the patients an ability to bill their insurance companies after the operation. To discuss it further with Dr. Reisfeld or the office staff do not hesitate to call at any time. Our experience with these issues should be of benefit to you.

Summary
The experience of Dr. Reisfeld obtained since about 1995 shows that for cases that involve only armpit sweating one should try all the above methods before embarking on the suction curettage procedure. ETS is not recommended for isolated excessive armpit sweating.

Other topics of interest:

• Sweaty Hands
• Sweaty Feet
• Facial Sweating and Blushing
• What is ETS - Endoscopic Thoracic Sympathectomy
• Details of the surgery
• Patient Testimonials
• Younger Age Hyperhidrosis
• Frequently asked questions
• Ask Dr. Reisfeld a question
• Request an information packet and evaluation

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