Thu | Oct 29, 2020

Dear Doc | Help! My armpits are sweating excessively

Published:Sunday | April 26, 2020 | 12:00 AM

Q. I have a problem with excessive sweating of the armpits, which causes a bad odour. I was wondering if it’s a good idea to get my sweat glands removed, because this problem is negatively affecting my job performance.

 

A. What you are describing is called axillary hyperhidrosis, which simply means excessive sweating of the arm pits. As you have rightly expressed, it can have serious social, emotional, and professional consequences.

However, there are numerous treatments available for this condition before you get to the point of removing the sweat glands.

The act of sweating is not just to make you feel uncomfortable, but, instead, has numerous functions. Sweating assists with thermoregulation (control of body temperature), skin hydration, and fluid and electrolyte balance.

Humans have three types of sweat glands - eccrine, apocrine, and apoeccrine glands. Eccrine sweat glands are responsible for hyperhidrosis. The primary function of eccrine sweat glands is thermoregulation, with cooling resulting from evaporation of eccrine sweat.

The various treatments available use this knowledge in helping to reduce the amount of sweat produced in your armpit.

The major treatment options for axillary hyperhidrosis includes antiperspirants, botulinum toxin, microwave thermolysis, oral medications, and surgery. I will discuss these so that you know what your other options are, apart from removing your sweat glands.

FIRST-LINE THERAPY

Antiperspirants

Antiperspirants are the preferred initial treatment for axillary hyperhidrosis because they are widely available, inexpensive, and well-tolerated therapies. Most commercially available non-prescription antiperspirants contain aluminium that physically obstructs the opening of sweat gland ducts. These are only successful in treating patients with very mild hyperhidrosis.

Treatment with prescription antiperspirants, with higher percentages of aluminium than commercial preparations, may be required for persons who do not respond to non-prescription antiperspirants.

Prescription antiperspirants are applied nightly to the armpits until improvement is noted. Significant improvement may be noted within one week. The interval between applications is then gradually lengthened. Once-weekly applications are typically needed for maintenance therapy.

You will not need to use additional antiperspirant product during the daytime, but you can use a fragranced product, such as a non-medicated deodorant, in the morning after showering.

SECOND-LINE THERAPY

Patients who do not have sufficient improvement of symptoms with topical antiperspirants may benefit from botulinum toxin (Botox) injections or microwave thermolysis.

Botulinum toxin

Periodic botulinum toxin injection into the affected skin is a safe and effective method for improving axillary hyperhidrosis. However, treatment can be painful and expensive.

Botulinum toxin works by temporarily reducing sweat production.

A response to treatment is usually evident within two to four days, and improvement in sweating typically persists for three to nine months or longer.

Microwave thermolysis

Microwave energy can be used to destroy eccrine glands and relieve hyperhidrosis in the axilla. Limited availability and cost may affect access to this therapy.

Microwave thermolysis is typically administered in two 20- to 30-minute treatment sessions three months apart.

OTHER THERAPIES

Additional therapies that may improve axillary hyperhidrosis, such as medication and surgical interventions, are less favourable options for initial therapy, because of side effects and limited data on how well they work.

 

Suction curettage

This is the treatment option that you asked about. For many years, axillary hyperhidrosis was surgically treated with subcutaneous curettage, or excision (removal) of the skin containing eccrine glands. However, this procedure has a significant failure rate and is associated with permanent scarring and the risk of restricted arm movement. Minimally invasive suction curettage is a newer surgical technique for removing axillary sweat glands that may have better outcomes.

 

Systemic agents

Systemic therapies (anticholinergics, clonidine, beta-blockers, and benzodiazepines) can be effective for treatment of axillary hyperhidrosis. However, the potentially adverse effects of these agents inhibit the routine use of these therapies.

As you can see, surgery is quite a drastic option, and there are many other easier and more effective treatment options available to you. See your doctor and discuss these options, and they will help you make a decision.

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