Axillary hyperhidrosis, is the medical term used for excessive armpit sweating . 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.
Axillary sweating or excessive armpit sweating as an isolated type of excessive sweating presents surgeons a somewhat complicated and difficult issue. The sweat glands in the armpit area are made of two types of sweat glands; Apocrine and Eccrine glands.
The Eccrine glands are responsible for the production of watery and clear sweat that does not produce odor. They are innervated by sympathetic fibers.
The Apocrine glands are responsible for the production of more of the thick sweat which also is the cause of the odor in the armpits. Attempts to control excessive armpit sweating should always start with conservative measures (Sweat Block, Maxim, Drysol, Odaban, Drionic, Botox and others). In cases of severe excessive armpit sweating those measures are not always helpful.
Based on his extensive experience Dr. Reisfeld believes that a very thorough explanation is needed in order to help people suffering from excessive armpit sweating understand their surgical options.
Surgical Solution for Excessive Armpit Sweating
As we have stated in other parts of this website Dr. Reisfeld believes that in cases of combined excessive sweating (meaning more than one type of sweating) that includes the hands, armpits and feet then endoscopic thoracic sympathectomy at the level of T3, T4 and T5 will provide those patients with a good success rate for their armpit problem. In this very specific combination the success rate for the hands is about 98-99%, for the armpits about 85-90% and for the feet about 15%. In order to truly understand this in a clear way you would also need to review our hyperhidrosis surgical treatment page.
It should be understood that isolated surgical procedures for excessive armpit sweating provide great results but almost never provide a 100% solution. There are basically two main surgical methods to stop excessive armpit sweating. In the past excision of the skin in the armpit area provided a solution but it was associated with scarring and sometimes slight movement limitations. Even with this method the success rate was never 100%. The next method which is called axillary suction currettage provides an equal success rate to the older excisional method but with a improved recovery, extremely small scars and no loss of the hair bearing area.
Isolated armpit sweating or as it is called, axillary hyperhidrosis, is somewhat of a difficult problem when it presents on its own without associated palmar and plantar hyperhidrosis. The exact percentage of people who suffer from that is not really known mainly because of the fact that the degree of excessive sweating varies from one person to another. As a problem obviously a conservative method should be tried first and there a plethora of items on the market starting with over the counter anti perspirants continuing with prescribed anti perspirants, pills, etc. If those fail to help there were many surgical options in the past including a more extensive operation such as excision of the skin around the armpit area which was involved with difficult healing process. More limited procedures were tried without good success rates. Over the last two decades new devices appeared on the market including ultra sound treatments, laser ablation or the application of thermal energy to the armpit area. None of the above mentioned modalities really offer a long term solution and even though a very heavy advertisement campaign is seen all over the media the final verdict is not out yet. At present axillary suction curretage offers a descent minimally invasive surgical procedure that can be done with minimal and temporary discomfort. The results on the other hand are varied and for the interested person a discussion with the performing surgeon is advised before any steps are being taken.
Axillary Hyperhidrosis (Armpit Sweating) – Why ETS is not recommended:
With regard to the exact location of any responsible ganglia in isolated axillary hyperhidrosis cases there is some uncertainty with regard to an exact location of the ganglia responsible for isolated axillary hyperhidrosis. This is the reason Dr. Reisfeld does not recommend endoscopic thoracic sympathectomy targeting a specific location within the sympathetic chain to control axillary hyperhidrosis.
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.
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.
Over the last year or two clinical trials are being conducted to see whether laser ablation of the axillary (armpit) sweat glands is a satisfactory treatment for excessive armpit sweating. The method is known as sub dermal laser ablation (SDLA). So far the amount of patients involved in these studies is small and the follow-up time is short so more time is needed to obtain definite results. Basically the procedure is very similar to axillary suction curettage which involves a more mechanical removal of the sweat glands. As Dr. Reisfeld researches this more we will update his findings here and or you are welcome to contact our office.
As more experience is gained it seems that the combination of the sub dermal laser ablation (SDLA) and axillary suction currettage have the best results compared to either method by itself. To be clear Dr. Reisfeld has seen better results when he combines both methods to address armpit sweating. As a world leader in the field of hyperhidrosis Dr. Reisfeld is continually working on developing improved techniques for better results.
Recent observations have shown reduced success rates for patients of African American descent. More research needs to be conducted in order to better understand this phenomenon.
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.
Bromhidrosis is related to the smell/odor aspect of armpit sweating. It is not necessarily caused by sweating but by the fact that certain bacteria on the skin combined with the persons sweat causes a very bad odor. This smell can pose a very embarrassing situation to those affected in social settings. Since the source of this problem are those bacteria located in the skin surfaces it is very difficult to eradicate the problem with any type of surgical intervention. This issue affects a very small percentage of the population. Endoscopic thoracic sympathectomy has no value in treating bromhidrosis and also axillary suction curretage or any related procedures such as laser ablation, etc have a very low success rate.
Deodorant’s and other skincare products also do not have a great deal of success. At present we do not have a very good answer for those suffering from bromhidrosis.
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.
“I admire your impeccable professionalism and your utmost skill in the performance of this highly technical and precise surgical procedure. I have waited many years since I was a young girl to properly get rid of this problem. My knowledge as a dermatologist led me to the best procedure and to the best doctor.”
Ligaya.B, M.D. Read More From Doctor Ligaya
“I had the ETS surgery for palmar hyperhidrosis in 2003 and wanted to thank you and your staff for all of help. Taking a standardized test in the past was nearly impossible without handing in a sopping wet ScanTron sheet. Since my surgery date, I was able to take the paper and pencil medical school entrance exams. I applied to medical school and now I am a second year medical student in Ohio! This surgery changed my life.”
Sarah Read More From Sarah
“I would also like to thank all of your staff for such a pleasant experience. They were very friendly and helpful from the first time that I made a phone call to your office up to the time in the recovery room. Everyone made me feel very comfortable and well taken care of.”
Peggy.P Read More From Peggy
Read from several touching thank you letters Dr. Reisfeld has received over the years since 1996.
Do you have questions about Excessive Armpit Sweating?
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Other topics of interest:
- Sweaty Hands
- Sweaty Feet
- Facial Sweating and Blushing
- What is ETS – Endoscopic Thoracic Sympathectomy
- Details of the surgery
- Patient Testimonials
- Frequently asked hyperhidrosis questions
- Ask Dr. Reisfeld a question