Armpit sweating or axillary hyperhidrosis is a disturbing and socially embarrassing condition for many individuals. Treatment of axillary hyperhidrosis or excessive armpit sweating involves patient education, ruling out other causes of sweating, topical medications, injections, and, finally surgery.
What is Axillary Hyperhidrosis?
When excessive sweating occurs in both armpits without any apparent cause and remains for more than six months, axillary hyperhidrosis is diagnosed. Axillary hyperhidrosis may be accompanied by excessive sweating of the palms, soles (palmoplantar hyperhidrosis), face and scalp. The sweating involves both sides. Patients notice that they do not have sweating during sleep. Majority of patients have similarly affected family members.
What is the Cause for Axillary Hyperhidrosis?
The exact cause is unknown, though the sweating is known to occur following overstimulation of eccrine and apocrine sweat glands by the autonomic nervous system. Most experts now believe that primary axillary hyperhidrosis is not due to stress or anxiety, but because of a familial (hereditary) tendency causing increased sensitivity of the sweat glands to the autonomic nervous system stimulation.
What are the Negative Effects of Excessive Armpit Sweating?
In addition to being socially embarrassing, excessive axillary sweating can interfere with one’s daily activities both at home and work place. According to quality of life estimation studies, the negative effects of excessive sweating or hyperhidrosis were comparable to conditions like severe psoriasis, rheumatoid arthritis etc. Patients shy away from personal or social relationships. Secondary bacterial infection can cause heavy body odors. Many patients have to change their dresses several times a day.
How to Get Rid of Excessive Armpit Sweating?
Treatment of axillary hyperhidrosis involves the following:
- Patient Education: Patients should be educated in the proper use of anti-perspirants. Most people mistake deodorants from antiperspirants. Deodorants will not help control excessive armpit sweating.
- Treatment with aluminum chloride hexahydrate 10-25% solution or gel is the most effective way to get rid of axillary hyperhidrosis. To reduce irritation, the treatment is started at a dilution of 10% and gradually increased till 25% strength is achieved. The solution or gel should be applied to dry arm pits at bed time and washed off after 6-8 hours. This is continued daily till the sweating becomes normal or controlled. Then a maintenance application of once in a week or two will suffice to maintain the control.
- If irritation occurs after using aluminum chloride hexahydrate solution, 1% hydrocortisone cream can be used twice daily for a few days. Cortisone cream should not be used for more than two weeks at a stretch in body folds. The interval between applications may also be prolonged.
- If there is bad odor emanating from the armpits, a course of antibiotic will help get rid of the bacteria. Later deodorants may be used on the dress; not directly to the skin as this may induce irritation in treated skin.
- In case the treatment with topical application fails, intradermal injection of botulinum toxin is the next choice of treatment. This provides relief for 7 to 16 months.
- Systemic anticholinergic medications can reduce sweating, but also cause side effects like dry eyes, dry mouth, urine retention etc.
- Tap water iontophoresis is another alternative therapy for axillary hyperhidrosis, but patient acceptance is less as it is messy, and, at times, irritating.
- If all the above treatment fails and the sweating is interfering with the patient’s daily life, surgery is the final option. There are different surgical techniques like removal of sweat glands through subcutaneous curettage, tumescent liposuction, and, finally, endoscopic thoracic sympathectomy where the sweat inducing autonomic nerves are resected. The biggest disadvantage of surgery is that the patients may get compensatory sweating in other body areas.
- Some anecdotal reports cite beneficial effect of diet control (avoidance of red meats, fried, spicy, fast foods), biofeedback techniques, meditation, yoga and hypnotherapy in the management of axillary hyperhidrosis.
Reference
J Hornberger et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274-86.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
