Yes.. sweaty armpits happen...
Axillary Hyperhidrosis (AH) is a condition characterized by excessive sweating in the armpit area. It is uncomfortable to patients who suffer it and can result in depression in some cases. It may exacerbated by different emotional states such as nervousness or anxiety. In the stricter sense, Hyperhidrosis is sweating in excess of the required amount normally needed for thermoregulation.
The ethiology (cause) of AH can be divided into primary and secondary. The primary has no recognizable cause for the excess activity of the Eccrine glands (Sweat Glands). Secondary Hyperhidrosis is caused by a concomitant illness or recognizable associated causes including certain medications.
What are the causes of secondary AH ?
Normal Physiologic States
-Hot environment and/or exercise
Prior to treatment, a thorough history and physical exam should be done to exclude any causes of secondary hyperhidrosis.
Diagnistic tests for this condition include:
-The Starch-iodine test. In this test, an iodine solution is applied to axillary area bilaterally. Once it has dried, starch is sprinkled on the site. The combination of excessive sweat and starch results in a dark blue color yielding a positive result in the presence of hyperhidrosis. This is often patchy in nature, revealing the most concentrated sites of sweat secretion
What are the treatment options?
Non Surgical treatments include:
-Antiperspirants: Usually in the form of aluminum chloride hexahydrate which will occlude the outlet of the gland decreasing the actual perspiration versus a deodorant which does not address the amount of sweat being perspired
-Iontophoresis: This method is FDA approved and uses a small electrical stimulus to reduce the amount of secretion in the affected area. It is most effective in the soles of the feet and the palms. The mechanism of action seems to be mild thickening of the regionally affected skin.
-Systemic Medications:Usually in the form of Anticholinergics such as Glycopyrrolate which decrease the amount of sweat being produced. These medications may have side effects such as a dry mouth, Dizzines and sometimes produce difficulties urinating.
-Botox: Type A botullinum type toxin is FDA approved for the treatment of Hyperhidrosis. It is generally effective in decreasing the symptoms associated to AH. It's mechanism of action consists in blocking the signal from the regulating nerve to the actual gland. Downsides to this treatment are that it is temporary and should be repeated every 3-6 months, may be locally painful and also produce a some local transitory weakness. It may be applied with a pre-fabricated grid shape, or with a more targeted fashion by following the the "Minor's Starch Iodine test enhanced sites which are sometimes scattered.
-Endoscopic Thoracic Sympathectomy : This procedure is done via 2 incisions in the axilla. The sympathetic chain is localized next to the vertebral column anteriorly and then divided, thus cutting the nerve supply to the sweat glands. In the right hands, this procedure has a high success rate of 90-95%. There may be recurrence a small percentage of the time, or compensatory sweating in other parts of the body as a result of the sympathectomy.
-Suction assisted Arthroscopic Shaving*
*Definitive Diagnosis and Management of Axillary Hyperhidrosis: The VapoMeter and Suction-Assisted Arthroscopic Shaving.
There are support groups for this condition such as the International Hyperhidrosis Society
*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.
Rafael Magana MD
1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004518/ : Accessed 7/20/2011 4:28pm
3. The use of a grid to simplify Botulinum Toxin for Axillar Hyperhidrosis;Gina M. Kavanagh, M.R.C.P.
Department of Dermatology Royal Infirmary of Edinburgh Lauriston Clinic Lauriston Place Edinburgh EH3 9YW, Scotland firstname.lastname@example.org. ; Letter to the Editor~ Plastic and Reconstructive Surgery • January 2006
4.Definitive Diagnosis and Management of Axillary Hyperhidrosis;The VapoMeter and Suction-Assisted Arthroscopic Shaving David L. Larson, MD,Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Aesthetic Surgery Journal July 2011vol. 31 no. 5 552-559
1. Kleyn, E., and Hepburn, N. C. The management of localised hyperhidrosis. Dermatology in Practice 10: 22, 2002.
2. Simonetta, M., Cauhepe, C., Magues, J., and Senard, J. A doubleblind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br. J. Dermatol. 149: 1041, 2003.
3.To¨gel, B., Greve, B., and Raulin, C. Current therapeutic strategies for hyperhidrosis: A review. Eur. J. Dermatol. 12: 219, 2002.