Axillary hyperhidrosis is a disorder affecting the eccrine sweat glands of the skin of the axillary areas, which is manifested by excessive sweating, intense unpleasant odor. The amount of sweat released does not correspond to the level of physical activity, significantly exceeds the physiological norm of dehumidification to maintain normal body temperature. The diagnosis is made on the basis of anamnesis, the clinical picture of the disease, the results of diagnostic tests. Treatment involves the use of medical antiperspirants, the appointment of physiotherapy, botulinum toxin injections. In the absence of the effect of conservative therapy, an operation is performed.
To denote the disease in the medical literature, the term “axillary hyperhidrosis” is used. According to statistics, only in 1% of cases a local sweating disorder develops for no apparent reason based on an existing genetic predisposition. The remaining 99% is a consequence of pathological processes occurring in the body. Idiopathic localized hyperhidrosis affects 3% of the world’s population. At the same time, axillary hyperhidrosis accounts for 51% of all cases. According to various data, from 30 to 65% of patients with increased sweating in the armpits have blood relatives suffering from the same problem.
Persistent disruption of the functioning of the sweat glands can result from a number of external influences and internal disorders. The diagnosis of primary hyperhidrosis is made only after the exclusion of all possible causes of the development of secondary pathology of sweating. In the genesis of the disease , the most important are:
- Genetic predisposition. An increase in the total number of glands per square centimeter of the skin, their sensitivity to nervous stimulation leads to excessive release of moisture. At the same time, the existing hereditary predisposition is realized only in some patients under the influence of stress, damaging environmental influences and other factors.
- Neurological disorders. Increased sweating may develop due to dysfunction of the nerve centers responsible for thermoregulation. Psychoemotional tension, stress, neuroses can provoke the onset of the disease or aggravate its course. To exclude organic brain damage with increased sweating, a neurologist’s consultation is prescribed.
- Thyroidopathy. Local increased sweating of the armpits against the background of existing thyroid diseases is more often diagnosed in women. It is accompanied by a number of symptoms and complaints that have an asthenovegetative character: unstable heart rate, fatigue, sleep disorders, memory, attention. Simultaneously with the axillary, with thyroid pathology, palmar or plantar hyperhidrosis may develop.
Eccrine and apocrine sweat glands are located in the skin of the armpits. The first ones lie on the surface, function since birth, are intended primarily for thermoregulation. The latter are located deep in the dermis and subcutaneous tissue, sometimes at a depth of 6-8 mm, begin to secrete sweat during puberty. The secret of the apocrine sweat glands has the appearance of a whitish liquid that contains a large amount of protein, ammonia, lipids, carbohydrates. The active reproduction of bacteria on this nutrient substrate leads to the release of a large number of metabolic products, which is manifested by the appearance of a characteristic smell of sweat.
In the genesis of axillary hyperhidrosis, the leading role is assigned to the hyperfunction of the eccrine sweat glands. More than the required amount of sweat is released in conditions of insufficient mechanisms of regulation of sweating on the part of the peripheral sympathetic nervous system. Apocrine glands can contribute to the development of symptoms in adolescence, causing an intense unpleasant odor to attach to the constant humidity of the axillary areas.
Axillary hyperhidrosis belongs to the group of local chronic sweating disorders. This group of diseases is characterized by the involvement of one anatomical region in the pathological process. Depending on the conditions of pathology development, there are two main forms of the disease, different in clinical manifestations and approaches to treatment:
- Primary (essential). It develops as an independent disease from the first months of life against the background of a genetic predisposition. A feature of the idiopathic form of the disease is a decrease in sweating to normal values at night.
- Secondary. It is a consequence of a number of endocrine and neurological diseases. It can develop at any age. The increase in the severity of hyperhidrosis correlates with the exacerbation of the “causal” pathological process. When going into remission for the underlying disease, the sweating of the axillary areas decreases to normal. Secondary localized sweating of the axillary arches is characterized by a constant level of moisture release during the day.
The severity of the course of the disease is determined taking into account the amount of fluid released, the patient’s subjective attitude to the problem, the presence of difficulties in everyday life associated with excessive sweating of the axillary region. The Hyperhidrosis Disease Severity Scale (HDSS) includes 4 degrees of severity of the manifestations of the disease:
- First. The sweating of the armpit area does not exceed the physiological norm. Daily hygienic care is enough for a person to feel comfortable. His activity does not suffer.
- The second. The degree of sweating is regarded as acceptable, but a person needs to pay more attention to hygiene procedures. There may be discomfort associated with increased humidity of the armpit area when performing daily chores.
- Third. The amount of sweat secreted by the skin of the armpits is regarded by the patient as barely tolerable. Physical activity, housework, and work activities are significantly limited.
- Fourth. Constant copious local sweating becomes unbearable for the patient, interferes with work and life, makes certain types of activities inaccessible, leads to social maladaptation.
Symptoms of axillary hyperhidrosis
Patients note the constant humidity of the axillary arches. Sweat permeates the clothes. At the same time, wet spots appear not only on a thin shirt, but also on the dense fabric of a jacket or jacket. Hygienic procedures do not allow you to cope with an unpleasant body odor, even if the patient takes a shower every few hours.
Excessive sweating limits the ability of patients to play sports, perform hard physical work, and in severe cases – habitual housework. Patients begin to fixate on their constantly wet armpits, their uncomfortable sensations, which affects concentration, memory, and emotional state. People are embarrassed by their defect, which negatively affects interpersonal communication.
According to the American Academy of Dermatology, 80% of patients with axillary hyperhidrosis experience significant difficulties in establishing and maintaining contact with people. Against this background, half of the patients develop depression of varying severity. Despite the fact that excessive sweating is not a life-threatening disease, the psychological state of people with constantly wet armpits is much worse than in patients with severe psoriasis and other serious dermatological diseases. Localized sweating can cause the development of hydradenitis, as high humidity promotes the reproduction of microorganisms, maceration of the skin.
The main difficulty in making a correct diagnosis with armpits hyperhidrosis is to identify the cause of the disease. Without this, in the case of secondary hyperhidrosis, the patient will have to struggle with the symptom throughout his life, and not with the disease. In addition to a dermatologist, an endocrinologist and a neurologist can be involved in the examination of the patient. Mandatory items of a comprehensive survey are:
- Lodine-starch test (Minor test). A simple diagnostic method that allows you to get a qualitative assessment of sweating in a particular area of the body. According to the degree of intensity of starch staining with iodine per unit of time, it is possible to establish the fact that the patient has hyperhidrosis, to determine the boundaries of the problem area.
- Gravimetric test. The method is based on the determination of the amount of sweat secreted, which is expressed in mg/min. The diagnosis of hyperhidrosis is established in men at 20 mg/min., in women – 10 mg/min. The test is mainly used in clinical trials to evaluate the effectiveness of certain treatment methods.
- Evapometry. An instrumental method for investigating the functioning and condition of the skin, which, in addition to the rate of transepidermal moisture loss, evaluates a number of other indicators. The use of evapometry is limited by the high cost of devices, so the method is mainly used in scientific research.
Treatment of axillary hyperhidrosis
Treatment of armpits hyperhidrosis may include hygiene measures, physiotherapy, injection and surgical techniques. Their use is justified in patients with essential hyperhidrosis. In secondary axillary hyperhidrosis, it is advisable to identify and eliminate the cause of excessive sweating, but symptomatic treatment techniques can be successfully used in this category of patients.
Patients with 1 and 2 degrees of severity according to HDSS can cope with the problem by making small adjustments to their daily body care. At 3 and 4 degrees of severity, the means controlling sweating are of auxiliary importance, are used simultaneously with methods of conservative treatment, cosmetological procedures. Help to make life easier for a patient with excessive sweating:
- Medical antiperspirants. The main active component of this group of products is aluminum hexachlorohydrate, less often aluminum chloride with a concentration of 20-40%. It penetrates into the ducts of the sweat glands and clogs them for a while. A prerequisite for the effectiveness of a medical antiperspirant is its application to dry skin. This limits the use of drugs in patients with grade 4 hyperhidrosis severity on the HDSS scale.
- Hygienic liners for armpits. The sticky side of the inserts are fixed on the clothes from the inside out in the armhole area. The absorbent surface prevents the appearance of sweat stains. The active ingredients, which impregnate the material of the inserts, restrain the reproduction of bacteria, relieve a person from an unpleasant smell. Armpit pads can be used simultaneously with hygienic or medical antiperspirants.
Indications and contraindications for conservative treatment are determined during dermatological admission after a comprehensive examination of the patient. Taking into account the age, the presence of concomitant diseases, the technical equipment of the clinic, the patient may be recommended:
- Anticholinergic drugs. Enteral administration of drugs, their local introduction into the skin by means of ionophoresis is possible. Local treatment is preferable, since medications when taken orally can give side effects. Glycopyrolate is used more often than other drugs in this group. The method has limited effectiveness in relation to the correction of sweating.
- Ultra-high frequency therapy (UHF). Under the influence of an electro-magnetic field of a certain frequency, local heating of tissues occurs. An increase in temperature induces thermolysis of sweat glands in certain areas of the body. Treatment involves performing 4 procedures with an interval of 1 week. This allows you to achieve a pronounced reduction in sweating in the armpit areas, eliminating the unpleasant smell of sweat for up to 6 months.
Injectable agents and hardware procedures can be used to combat excessive sweating. The advantage of the methods used in cosmetology is their versatility: several aesthetic problems can be eliminated at once in one procedure. Most often used in the fight against sweating:
- Botox injections. The introduction of botulinum toxin type A drugs normalizes sweating for 4-6 months. It takes from 70 to 150 units of the drug to prick one axillary area. It is enough for most patients to perform injections once a year in the spring so as not to experience discomfort when wearing light open clothing in the warmer months.
- Laser treatment. The destruction of the glands is carried out using a micro-cannula, which is inserted into the dermis through small punctures. One procedure is enough to reduce sweating by 80%. Laser treatment is performed under local anesthesia on an outpatient basis. Compensatory reactions after the procedure, as a rule, are not observed.
In most cases, conservative treatment can reduce the intensity of pathological manifestations to an acceptable level for a long time. Surgical operations are shown to a limited number of people who have failed to achieve improvement in other ways. Currently, two main methods are used:
- Excision of the skin of the axillary area. Removal of the skin of the arch of the armpit is a radical method of treating localized hyperhidrosis, which is resorted to only if there is no effect from conservative methods of treatment. The edges of the wound are tightened and stitched. If it is not possible to bring them together, a skin transplant is performed.
- Curettage and liposuction. The cannula for liposuction during curettage is inserted under the skin to a depth of 3-4 mm, where most of the eccrine glands are located. It is enough to carry out one scraping to significantly reduce the sweating of the armpits. During liposuction of problem areas, nerve endings are injured, which go to the skin in fatty tissue. It also helps to reduce the release of moisture.
Prognosis and prevention
Axillary hyperhidrosis is a chronic disease, the manifestations of which can only slightly decrease in old age. Conservative treatment allows you to control the intensity of the manifestations of the disease, so that most patients can lead a normal lifestyle without resorting to surgical interventions. At the same time, expensive botulinum toxin injections and more affordable UHF procedures give a satisfactory effect.
The intensity of the manifestations of pathology is largely determined by the emotional stress associated with the smell of sweat and wet spots on clothes. Patients with axillary hyperhidrosis may be recommended to work with a psychotherapist, taking sedatives, yoga, meditation, and other practices aimed at harmonizing personality and relaxation.