Sunday, July 17, 2011

Excess Armpit Sweat / Axillary Hyperhidrosis

NYC Plastic Surgeons Hyperhidrosis articles~NYC Cosmetic Surgeons Hyperhidrosis Articles~ NYC articles on  Hyperhidrosis

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 ?

-Diabetes Mellitus
-Carcinoid Syndrome
-Parkinson's syndrome
-Lung Disease
-Heart Disease
-Tricyclic antidepressants
Normal Physiologic States
-Emotional excitability
-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

-In the Paper test. Special paper is placed on the affected area to absorb the sweat, it is then weighed to determine the amount of sweat contained in it.

-The most accurate to determine the presence of hyperhidrosis is with a device called a VapoMeter which provides an objective measurement for the amount of sweat. It measures the relative humidity in grams per meter square per hour and is quite accurate. Three measurements are done in the clinic and a control site such as the forearm is used as a control.

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.
Surgical Options:
-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.
This last procedure can be done in under an hour under general anesthesia and provides lasting effects by permanently excising the local sweat glands. It is done by marking the hair bearing area of the Axilla, after which 0.5% lidocaine is infiltrated for hemostasis (to reduce bleeding). A small incision is made in the crease area and the Arthroscopic Shaver is introduced and the eccrine glands (Sweat glands) are ablated by "Shaving" them off. This procedure does not damage the hair follicles.

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

Stay tuned.....

1. : Accessed 7/20/2011 4:28pm
2.Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. F Herbst, E G Plas, R Függer, and A Fritsch, Annals of Surgery 1994 July; 220(1): 86–90.
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 ; 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

Recommended Reading:
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.

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