Armpit Sweating (Axillary Hyperhidrosis)

Axillary sweating or excessive armpit sweating as an isolated type of excessive sweating presents surgeons a somewhat complicated and difficult issue. The sweat glands in the armpit area are made of two types of sweat glands; Apocrine and Eccrine glands.

The Eccrine glands are responsible for the production of watery and clear sweat that does not produce odor. They are innervated by sympathetic fibers. The Apocrine glands are responsible for the production of more of the thick sweat which also is the cause of the odor in the armpits. Attempts to control excessive armpit sweating should always start with conservative measures (Maxim, Drysol, Odaban, Drionic, Botox and others). In cases of severe excessive armpit sweating those measures are not always helpful.

In regards to what the most effective surgical procedure is, this is a very difficult issue. 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 in need of help.

Cure for Excessive Armpit Sweating
As we have stated in other parts of this website Dr. Reisfeld believes that in cases of combined excessive sweating (meaning more than one type of sweating) that includes the hands, armpits and feet then endoscopic thoracic sympathectomy at the level of T3, T4 and T5 will provide those patients with a good success rate for their armpit problem. In this very specific combination the success rate for the hands is about 98-99% and for the feet about 15%. In order to truly understand this in a clear way you would also need to review our hyperhidrosis surgical treatment page.

It should be understood that isolated surgical procedures for excessive armpit sweating provide great results but almost never provide a 100% solution. There are basically two main surgical methods to stop excessive armpit sweating. In the past excision of the skin in the armpit area provided a solution but it was associated with scarring and sometimes slight movement limitations. Even with this method the success rate was never 100% The newer method which is called axillary suction currettage provides an equal success rate to the excisional method but with a much easier recovery, extremely small scars and no loss of the hair bearing area.

The benefit of this method is the small incisions, the easy recovery, and the preservation of the hair bearing area. The success rate is about 80%. There are some side effects that can happen such as skin loss, scarring (minimal), all of which can treated easily. The formation of fibrotic bands can also be a problem but generally speaking it is a limited one. Axillary curettage or superficial liposuction does not eradicate all the apocrine in the axillary gland which is almost impossible to do unless you excise the entire skin from axillary area. As a matter of fact leaving about 5 to 10% of those apocrine glands helps because it might prevent over dryness which might be somewhat irritating to a patient. The basic principle is to reduce the overall number of apocrine glands which in turn will reduce the amount of sweating and hopefully the amount of smell in cases of bromhidrosis.

Causes of Axillary Hyperhidrosis
The patho-physiology of excessive armpit sweating is somewhat complicated but basically it represents overstimulating of the sympathetic nervous system. There are some other reasons such as specific food, anxiety, stress, and emotional stimuli, all of which can add to the problem.

Diagnosis
Basically the clinical history is the main source of diagnosis. Patients can describe their conditions very vividly and easily and obviously there are different grades of severity (mild, moderate, to severe). One has to exclude the possibility of a secondary axillary sweating which can be a manifestation of other medical ailments. For further evaluation about these possibilities one should consult a physician.

Insurance Issues:
Unfortunately the insurance companies typically disregard severe armpit sweating as a medical problem and do not cover it in most cases. We hope this will change in the future but in the meantime we have to charge the patient for these services. It is important for every patient to try conservative methods (see above) given by a doctor, keep the records, and this might give the patients an ability to bill their insurance companies after the operation. To discuss it further with Dr. Reisfeld or the office staff do not hesitate to call at any time. Our experience with these issues should be of benefit to you.

Summary
The experience of Dr. Reisfeld obtained since about 1995 shows that for cases that involve only armpit sweating one should try all the above methods before embarking on the suction curettage procedure. ETS is not recommended for isolated excessive armpit sweating.

Hyperhidrosis Testimonials:

"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 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.

Other topics of interest:

• Sweaty Hands
• Sweaty Feet
• Facial Sweating and Blushing
• What is ETS - Endoscopic Thoracic Sympathectomy
• Details of the surgery
• Patient Testimonials
• Younger Age Hyperhidrosis
• Frequently asked hyperhidrosis questions
• Ask Dr. Reisfeld a question
• Request an information packet and evaluation

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