Axillary Hyperhidrosis - Armpits sweat

Occurrence

Excessive armpit sweating is the most common type of hyperhidrosis, affecting almost 3% of the population. Compared to palmoplantar HH, starting mostly in early childhood, the onset of axillary HH occurs in adolescence or even later.

Symptoms

Big wet marks on the cloths are cause of embarrassment in many situations in professional and private life. Clothing has to be changed and washed frequently, resulting in shorter lifetime. The salty haloes stain and damage delicate tissues.
A minority of people affected by severe axillary HH may suffer major psychological distress, depression and end up in avoiding social contacts.

Causes

In most cases, the causes are unknown. There is without doubt a genetic component in many cases, but environmental factors are often determining the onset, e.g. stressful experiences or particularly demanding periods in life. Elevated temperatures with or without high degrees of humidity, heavy physical work and exercise, or a combination of these factors trigger or worsen sweating.

Treatment

• Antiperspirants
  Treatment starts usually with local applications of antiperspirants. These products contain specific chemical compounds, the most widely used of which is aluminum chloride. the skin in the armpit is rather delicate, and not rarely it shows irritation and reacts with itchy rashes and eczema, forcing to interrupt the treatment periodically or definitively.
• Botulinum toxin
  If antiperspirants are insufficient or cause irritative reactions, botulinum toxin (Botox, Dysport) represents the second (for some the first) line of treatment. It yields excellent results in most cases, reducing sweating to imperceptible levels for several months, and has practically no side-effects if properly applied. The downside are the costs and the need of being injected.
• Iontophoresis
  Many patients get satisfactory results with iontophoresis also in the axillae, even if statistically the results do not match those of botulinum toxin. For use in the armpit, devices have preferably to be of the pulsed current type, in order to reach sufficient energy output without causing pain, and be equipped with special electrodes (foam pads).
• Surgery
  
  • Local excision of the sweat glands eliminates sweating only if performed radically, i.e. the hair bareing has to be excised completely. The resulting skin defect is difficult to cover and lieves usually an aesthetically precarious scar. Partial excisions, often carried out to enable primary closure of the skin, deliver often poor results, requiring additional treatment like botulinum toxin.
    
  • Curettage and aspiration of the sweat glands, techniques that aim at ablating the sweat glands subcutaneously while leaving the covering skin, do show relatively good results in the beginning, but recurrences are common.
    
  • Sympathetic surgery cannot be recommended for axillary hyperhidrosis because of compensatory sweating on the trunk often outweighing the good outcome in the armpit. The level of side-effects is mainly determined by the technique used. Surgery involving the T2 ganglion produces only side effects and has definitively no place in treating isolated axillary hyperhidrosis. T3 ganglionectomy, the preferred method for treatment of palmar hyperhidrosis, works well also for the axilla, though not without generating some compensatory sweating, and it is therefore not ideal for patients suffering from axillary hyperhidrosis alone. Techniques limited to the T4 ganglion have been advocated to reduce the risk of compensatory sweating, but well designed and documented studies regarding short- and long term effects and side-effects are lacking so far (N.B.: T2, T3 and T4 refer exclusively to the ganglia, not to the ribs).