Axillary Hyperhidrosis

Sweat is a solution of water and salts produced by glands immediately under the skin and cools the body by evaporation during exercise and in warm surroundings. The activity of these glands is normally controlled by the nervous system. In a small number of people (less than 1.0% of the population), this control mechanism fails to function normally causing excessive sweating, even when body temperature is normal. This condition is known as hyperhidrosis.

Occasionally, hyperhidrosis occurs as a result of abnormal hormone levels and these will be measured as part of the assessment of people with this condition. In most cases, no reason for the excessive sweating will be identified by these tests. 

Excess sweating may occur anywhere but usually affects the hands, armpits, scalp, face, and/or feet. Although some people may find this excess sweating embarrassing, it is not a dangerous or life threatening condition.

The principle means of treating this condition are the use of potent antiperspirants, surgery and Botulinum toxin injection.

The most effective antiperspirant is Aluminum Chloride - typically Anhydrol Forte(TM) - which may be prescribed for you. This is applied in the evening 2-3 times per week and washed off the following morning. In some cases, it causes skin irritation. The treatment must be repeated regularly for life. This agent cannot be used on the face or scalp.

Botulinum toxin injection 
This treatment is suitable for people who find the topical antiperspirants ineffective or develop skin problems. This procedure is performed using local anaesthesia in the day ward or outpatient department. The evening before your procedure you should carefully shave your underarm area. Do not apply antiperspirants or deodorants.

On the morning of your procedure you will be asked to attend the day ward. When you arrive, local anaesthetic cream (Ametop) will be applied to the area and covered with an occlusive dressing. (If you have had the treatment before, you can apply this local anaesthetic at home before you come to the hospital which is even more effective). The procedure only takes a few minutes and consists of a number (10-12) of tiny injections into the skin under each arm. These injections may cause minimal discomfort. The botulinum toxin binds to the nerve endings and prevents their effects on the sweat glands. 

The injections may take several days to work. During this time you should not shave but may use antiperspirants or deodorants. The nerve endings begin to regrow six to nine months after the injections and you may notice recurrence of the sweating. Please contact the Vascular Surgery office (in writing or by email, preferably) if you wish to have the injections repeated at this time.

Complications: While allergic reactions can occur, these are not common. There is a theoretical risk of developing botulism which is a very serious illness that can be life threatening but this has never been described with the preparation that we use in our clinic (Dysport, Ipsen, UK)  

Surgery (Endoscopic sympathectomy also called ETS - endoscopic thoracic sympathectomy and TTEC - trans thoracic electrocoagulation )
For those who find the botulinum toxin treatment ineffective, surgery may sometimes be of benefit. While this procedure is very effective in treating hand (or plamer) hyperhidrosis, it is not as sucessful for axillary sweating because more nerves must be divided to make the axillary skin dry which increase the risk of compensatory hyperhidrosis 

During the procedure, the nerves that supply the sweat glands in the hands and axilla (armpit) are permanently divided within the chest cavity. This procedure is performed as a Day case.

The nerves are divided using a keyhole surgery technique under general anaesthesia. Two or three small incisions (5-10mm) are made in the skin under each arm. In order to see the nerves, the lung is collapsed. The nerves are divided and then sealed using cautery to prevent them regrowing.

Complications: Although this is a safe procedure, complications can occur in a small number of people. Some people notice an increase in sweating from other parts of the body (compensatory hyperhidrosis) which may be quite troublesome. When a more extensive nerve dissection is performed to make the axilaae dry, this occurs in up to 50% of patients and is troublesome in up to 20%.

In addition, if the branches of the nerves that supply the face are damaged during the operation, this may cause visible drooping of the eyelid (Horner’s syndrome). 

Occasionally, the lung may fail to reinflate and it may be necessary to place a small drainage tube into the chest for a short time after the surgery. As with any surgery, bleeding or infection may occur but this is not common.  

The heart and major vessels are close by and if these are injured, which occurs rarely, your life may be at risk.

Postoperative instructions 
After the procedure, you may have some mild discomfort. Some people may have pain (or altered sensation - numbness or tenderness) along the line of one or more ribs due to bruising of the nerves. While this will usually settle, it may persist for months in some cases. Dissolving stitches are usually used to close the wounds so there are no stitches to be removed. You may need to take some simple pain killers following the procedure which will be prescribed for you before you leave.