Axillary hyperhidrosis is the medical term used for excessive armpit sweating. We all experience some sort of armpit sweating, but about 1% of the population have axillary hyperhidrosis. Axillary hyperhidrosis involves extreme dripping sweat from the armpit area. This type of excessive armpit (axillary) sweating is resistant to all types of deodorants and odor controlling medications. In some cases, the excessive axillary sweating can be accompanied by the more common condition of palmar hyperhidrosis. This condition is also known as excessive hand sweating.
Axillary sweating or excessive armpit sweating as an isolated type of excessive sweating can present surgeons with a complicated or difficult issue. The sweat glands in the armpit area are made up of two types of sweat glands; the Apocrine and the Eccrine glands.
The Eccrine glands are responsible for the production of watery clear sweat that does not produce odor. They are innervated by sympathetic fibers. The Apocrine glands are responsible for the production of the order causing thick sweat in the armpits.
Attempts to control excessive armpit sweating should always begin with conservative measures (Sweat Block, Maxim, Drysol, Odaban, Drionic, BOTOX® Cosmetic and others). In cases of severe excessive armpit sweating, those conservative measures are not always useful in relieving symptoms.
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. He believes that a better understanding can also help with their options, including a surgical one.
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 endoscopic thoracic sympathectomy at the level of T3, T4, and T5 can provide patients with a high success rate. Combined excessive sweating means more than one type of sweating, this usually includes sweating of the hands, armpits, and feet.
In this very specific combination, the success rate for hand sweating is estimated at 98-99%, armpit sweating is estimated at 85-90%, and feet sweating is estimated at 15%. In order to gain a clear and complete picture of this treatment, please also review our hyperhidrosis surgical treatment page.
It should be understood that isolated surgical procedures for excessive armpit sweating provide great results. However, this is not a 100% solution. There are two main surgical methods to help stop excessive armpit sweating. In the past, excision of the skin in the armpit area has been used as a solution. However, this procedure was associated with scarring and sometimes slight movement limitations. Even with this method, the success rate was never 100%. The other method, known as axillary suction curettage, provides an equal success rate to the older excisional method, but with an improved recovery. This procedure also has the benefit of extremely small scars, and no loss of the hair in the underarm area.
Isolated armpit sweating, also known as 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 this condition is unknown. The main reason for this is that the degree of excessive sweating varies from one person to another. Conservative methods should always be tried first, and since there are several items on the market patients can start with some of these things before resorting to surgery.
Patients can try over the counter antiperspirants, medication, and other methods. However, when these methods fail to help patients there are other options. In the past, surgical options included more extensive operations such as excision of the skin around the armpit area. This method involved a difficult and long healing process. Other more limited procedures were also tried with a low success rate. It was not until over the last two decades that new devices appeared to assist with treating this condition. These include ultrasound treatments, laser ablation, and the application of thermal energy to the armpit area. None of these methods offered a long-term solution. Despite heavily advertised campaigns seen throughout the media, the final verdict is still pending.
Currently, axillary suction curettage offers patients minimally invasive surgical procedure that can be done with only a small amount of temporary discomfort. The results on other areas of the body, the other than the hands, have varied results from person to person. Patients interested in the procedure should have a discussion with the performing surgeon before any surgical steps are taken.
Axillary Hyperhidrosis (Armpit Sweating) – Why ETS is not recommended:
In some isolated axillary hyperhidrosis cases, there can be some uncertainty about the exact location of the ganglia responsible for the isolated axillary hyperhidrosis. It is for this reason, that Dr. Reisfeld does not recommend endoscopic thoracic sympathectomy for targeting a specific location within the sympathetic chain to control axillary hyperhidrosis.
Causes of Axillary Hyperhidrosis
The pathophysiology of excessive armpit sweating is fairly complicated. Overall Axillary Hyperhidrosis, represents overstimulating of the sympathetic nervous system. There can be some other reasons causes for this condition, such as specific food, anxiety, stress, and emotional stimuli, All of these things can add to the symptoms of this condition.
The clinical history of the patient is usually the main source for a diagnosis. Patients can describe their conditions very vividly and easily. There are different grades of severity, ranging from mild, moderate, to severe. The possibility of a secondary axillary sweating, which can be a manifestation of another medical ailment, should also be considered. For further evaluation of this condition or other causes of excessive sweating, patients should consult a physician.
Over the last few years, clinical trials have been conducted to see whether laser ablation of the axillary (armpit) sweat glands is an effective treatment for excessive armpit sweating. This method is known as subdermal laser ablation (SDLA). So far the number of patients involved in these studies is small, and the follow-up time is short. Therefore, more time is needed to obtain definite results for this treatment. This procedure is very similar to axillary suction curettage, which involves a more mechanical removal of the sweat glands. As Dr. Reisfeld researchers this treatment we will update his findings here. You are also welcome to contact our office.
As more experience is gained it seems that the combination of the subdermal laser ablation (SDLA) and axillary suction curettage 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 will need to be conducted in order to better understand this phenomenon.
Unfortunately, insurance companies typically disregard severe armpit sweating as a medical problem. Therefore, it is not covered in most cases. We hope this will change in the future, but in the meantime, we have set up a self-pay option for patients for these services. It is important for every patient to try conservative methods (see above) given by a doctor. It is also important for patients to keep the records, since this may give patients the ability to bill their insurance companies after the operation. To discuss it further with Dr. Reisfeld or the office staff please call at any time. Our experienced staff will be happy to help with these issues.
Bromhidrosis is related to the smell or odor aspect of armpit sweating. The odor is not necessarily caused by the sweating, but by a certain bacteria on the skin combined with a person’s sweat. This combination causes the odor. This smell can pose embarrassing situations in social settings.
Since the source of this problem is the bacteria located on the skin surfaces, it is difficult to eradicate this specific 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. Other treatments, such as axillary suction curettage or any other related procedures such as laser ablation, will have a very low success rate. Some deodorants and other skincare products may not provide much success in treating the odor. Presently, we do not have enough medical information to treat people suffering from bromhidrosis. We hope that this changes one day soon.
The experience Dr. Reisfeld has obtained since 1995 shows that for cases involving only armpit sweating patients 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 the 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.
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