Axillary hyperhidrosis refers to excessive sweating in the armpit region that many people with primary focal hyperhidrosis suffer from. It can be a challenging issue to deal with, but there are many treatment options for axillary hyperhidrosis. Doctors typically recommend topical treatments as a primary option and move on to botox injections for axillary hyperhidrosis if topical creams have not been effective. However, for some people, these treatments are not sufficient in relieving symptoms. When this is the case, there are other localized treatment options that can be used to manage sweat and produce a more permanent and effective solution. These are often more invasive than other medical treatment options available, but they offer a higher success rate with less recurrence of symptoms. There are both surgical and non-surgical local treatment options available. When pursuing permanent local treatment options, patients need to work with a dermatologist, which are the type of doctors best suited for treating hyperhidrosis.
Local Surgical Options
Surgery is often required for patients who desire a permanent solution to axillary sweating. However, unlike other surgical treatments for primary hyperhidrosis, like endoscopic thoracic sympathectomy, local surgical procedures are less invasive, risky and require less recovery time. There are three types of local surgical procedures surgeons use to treat axillary sweating. These include the removal of glandular (sweat) tissue, curettage or liposuction to remove sweat glands beneath the skin or a combination of skin excision and glandular tissue removal.
Before any surgical procedures are conducted, a doctor will go over a patient’s history and make sure that they are experiencing sweating due to primary focal hyperhidrosis and not the secondary type, which can have a definitive cause. They will also make sure that any person undergoing surgery is a good candidate for the procedure and that there are no contraindications. First, a doctor will most likely perform a minor starch-iodine test to determine the problem areas. An iodine solution is applied to a patient's skin and then a starch powder is placed on top. When sweating occurs it creates dark marks so the doctor can visualize the problem areas. A doctor will also often use an assessment called the Hyperhidrosis Disease Severity Scale (HDSS) to help determine how much axillary sweating patient is experiencing. These tests are usually done before any of the local axillary procedures discussed below.
An excision procedure refers to the removal of skin and possibly glandular tissue from the axillary area. This is done to remove the overactive sweat glands that are causing issues. There are two main types of excision surgeries performed: radical excision of skin and glandular tissue (RSE) and limited skin excision with glandular tissue removal (LSE). RSE is typically not used as complication rates are very high. When performed, it often leaves scarring from skin removal and requires stitches and wound drainage. LSE is a less invasive procedure that is performed more often. During LSE a doctor will still remove some skin but uses special tools to get under the skin to the subcutaneous fat layer. They are then able to expose sweat glands and cut them out, then the wound is sutured shut. One study found that sweat was reduced by a mean of 63% in patients a year after treatment and 82% of patients said they would undergo the procedure again. There are possible side effects including hematoma (blood trapped under the skin), paresthesia (loss of feeling), loss of hair growth, skin infection and poor wound healing among others.
Liposuction, a procedure often used for cosmetic surgery, can be useful in the treatment of axillary hyperhidrosis. Doctors are able to remove sweat glands without having to remove extra tissue because sweat glands are located near the upper level of the subcutaneous portion of the skin. The liposuction device is called a cannula and it looks like a tube with a hole or multiple holes on it. Different cannulas can be used to produce different results, some provide more aggressive treatment than others. The cannula is used to suck out tissue and sweat glands are scraped away from the surface of the exposed dermis (under layer of the skin). Aggressive cannulas reduce sweating more but can also result in more side effects. One study found between a 44% and 49% reduction in sweating depending on the type of cannula used. Side effects are usually minimal and don’t last long. They can include bruising, hematoma, paresthesia and inability to grow hair.
Curettage is a surgical procedure in which scraping or cleaning is done with the use of a curate, a surgical tool with a hook or loop at the end. A variety of techniques can be used. Incisions are made on the edges of the armpit area and then the area of the dermis containing sweat glands is scraped, or curetted, and sewn up with sutures. This can be done using local anesthesia. Studies have shown that sweating can be reduced by up to 50% in 90% of patients. Unfortunately, there is a relapse rate of 29%. One study compared the effectiveness of curettage compared to Botox injections and found that both treatments were equally effective in treating axillary sweating 6 months after treatment. Curettage is a fairly safe and long lasting treatment option. There are possible side effects which include hematoma, paresthesia, alopecia (baldness) and hyperpigmentation.
This is a procedure that combines both liposuction and curettage techniques. A special type of local anesthesia is given and both a liposuction cannula and a curate are used to remove sweat glands. This procedure has been used safely for a long period of time and there are several ways a doctor can choose to perform it. It takes several days to remove to fully recover afterwards. There is a 60.4% to 69% reduction in sweating in nearly 90% of patients, so it has a good success rate. Side effects are mild and do not last long. They can include hematoma, paresthesia, seroma formation, and skin infection. It is important to find a surgeon who is familiar with this technique as it can greatly impact the surgical outcome.
Nonsurgical Treatment Options - MiraDry
MiraDry is a relatively new device that is FDA approved to treat axillary hyperhidrosis. It uses microwave energy to destroy sweat glands. Microwave energy is most readily absorbed by tissue that contains high amounts of water and so sweat glands are specifically targeted. The heat created by the microwaves essentially destroys the sweat glands and thus reduces sweating. Before treatment, either the Minor iodine-starch test or a hair bearing test is performed to determine the areas that need to be treated. Lidocaine is usually used prior to performing the procedure. Microwaves are initially targeted superficially and then deeper as the treatment progresses. Afterwards, an ice pack is applied to the treated area and patients are told take an NSAIDs for the first two days after treatment. Results are favorable as 90% of patients experienced a 50% reduction of symptoms. MiraDry is an excellent option for patients with severe axillary sweating and it has been shown to provide permanent results and it also reduces or eliminates body odor.
Patients with axillary hyperhidrosis often struggle with their symptoms, but they can find relief by managing their hyperhidrosis with a doctor. There are many potential treatments, and with the advent of devices like MiraDry there are options that are less invasive and which offer permanent solutions. There are other future treatments for hyperhidrosis that are being developed and offer hope to those struggling with difficult symptoms. Unfortunately, the many of these permanent treatment options are very expensive and not covered by insurance, this issue is what make the cost of treating hyperhidrosis so expensive for many patients.
- Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
- Curettage. 2018. In Merriam-Webster.com. Retrieved August 20, 2018, from http://www.meririam-webster.com/dictionary/curettage
- Budamakuntla, L., Loganathan, E., George, A., Revanth, B., & Sankeerth, V. (2017). Comparative study of efficacy and safety of botulinum toxin a injections and subcutaneous curettage in the treatment of axillary hyperhidrosis. Journal of Cutaneous and Aesthetic Surgery;, 10(1). doi:10.4103/JCAS.JCAS_104_16
- Owen, K. (2016). Excessive Sweating: Are Patients Suffering Unnecessarily? The Journal for Nurse Practitioners, 12(1). doi:10.1016/j.nurpra.2015.09.015