Axillary (armpit) Hyperhidrosis

Excessive underarm sweating or Axillary Hyperhidrosis involves extreme dripping sweat in the armpits with constant odor that is resistant to antiperspirants. Individuals often experience excessive sweat dripping down the arms and chest, preventing them from wearing certain fabrics or colors. Excessive armpit sweating also causes clothing stains. Most people with excessively sweaty armpits have tried many different methods to alleviate the sweaty armpit problem, but have been frustrated with results.

Symptoms of axillary hyperhidrosis

  • Excessive sweat dripping from underarms and chest during normal activity
  • Foul body odor
  • Sweat/odor resistant to antiperspirants
  • Stained clothing around the armpit and chest area
  • Low self esteem
  • Resistance to attending activities that could cause sweating such as dances or sporting events.

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Treatment Options for axillary hyperhidrosis

  1. Topical agents (Drysol, Odaban)
  2. Treatment with topical agents should be tried as a first line defense against axillary hyperhidrosis. The product should be applied only at bedtime after bathing, when relaxed, to DRY skin. The following morning the treated areas should be washed to remove any excess possibly left on the skin. Topical agents are usually ineffective against most forms of excessive axcillary sweating, but should be attempted.

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  3. BOTOX® –  Botolinum Toxin
  4. BOTOX® is a brand name for a bacterial toxin that is used medically to paralyze the nervous activity of the sweat ducts which prevents the production of perspiration. It was first approved for use on humans by the United States by the FDA in December 1989, and approved as a treatment for underarm sweating in 2004.

    Although BOTOX injections are commonly used and highly effective in the  treatment of  sweaty armpits, the treatment requires multiple treatments a year.

    On average, each armpit requires approximately 25 injections.

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  5. Anticholinergic – medication
  6. An anticholingeric is a synthetic medication that blocks the transmission of acetylcholine thereby inhibiting the message to produce excessive sweat in the glands.
    Robinul and Robinul Forte are common brand name tablets that contain the synthetic anticholinergic glycopyrrolate and are used to reduce excessive sweating.

    Side effects
    As with any medication, there are potential side effects, which you must understand. The most common are blurred vision, dizziness, drowsiness, dry eyes and dry mouth. Some people also experience abdominal bloating and constipation.

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  7. Endoscopic Thoracic Sympathectomy (ETS)Sympathectomy is a surgical procedure that divides nerves in the sympathetic system. It is designed to decrease excessive sweating. Although sympathectomies were considered major surgery in the past, significant advancements have been made over the past 10 years.Now sympathectomies are performed endoscopically using VATS. One or two small incisions (5 mm) are made on each side of the chest cavity through which a fiber optic camera and other instruments are inserted. These outpatient procedures result in speedy recovery and minimal scarring with immediate results.Endoscopic Thoracic Sympathectomies are best performed by a well-trained thoracic surgeon. The procedure takes place under general anesthesia,  and typically lasts 30 minutes. Once the instruments are removed, the tiny incisions are closed with glue. Sweat relief is immediately noticed by the patient upon waking up from anesthesia. Most patients can resume physical activity, and return to normal activities within 48 hours of surgery.While endoscopic thoracic sympathectomies are extremely effective for most forms of hyperhidrosis, it was specifically designed to treat palmar hyperhidrosis or sweaty palms. Endoscopic Thoracic Sympathectomy (ETS) treatment has been proven to cure hyperhidrosis or excessive sweating in 95-99% of all cases of hand sweating.Side Effects
    Although ETS is a viable alternative for many patients, it is important to understand the potential side-effects of the surgery. In addition to the normal risks associated with most surgeries, ETS side-effects are very specific to the surgery and should be discussed in detail with your physicians. Any surgery under anesthesia carries risks from anesthetics in addition to possible local wound infections. Both are extremely rare with this minimally invasive technique for ETS.

    • Compensatory sweating
      In approximately 50% of patients who undergo ETS, a condition called compensatory sweating may occur. It is the most common side effect and is characterized by increased sweating on the back, abdomen and/or thighs. In a small number of patients, (<5%) compensatory sweating is problematic and may require oral and/or topical medication. The newer surgical technologies that we offer may reduce the incidence of compensatory sweating.
    • Horner’s Syndrome
      In rare instances (.03%), patients may experience droopy eyelids, constricted pupils, and absence of sweating in the face following ETS, and is usually temporary.
    • Gustatory Sweating
      Eating or smelling certain types of foods can cause facial sweating after ETS. This happens in a small number of patients following the operation, but usually does not appear to be a major problem.
    • Neuritis and Neuralgia
      Following surgery, a very small number of patients experience a nonspecific pain in the back between shoulder blades. It is caused by an irritation of the nerve endings and usually resolves spontaneously. It can be treated with non-steroidal anti-inflammatory drugs.

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