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Axillary HyperhidrosisEdit

Axillary hyperhidrosis is a form of hyperhidrosis characterized by excessive sweating in the underarm region that exceeds what is necessary for temperature control. This condition can be focal, affecting the axillae predominantly, and may persist despite normal ambient conditions. It often first becomes noticeable in adolescence or early adulthood and can have a substantial impact on daily life, including clothing dampness, odor management, and social interactions. For many individuals, axillary sweating occurs alongside sweating in other regions, but the armpit focus remains the primary concern Hyperhidrosis.

The underlying biology involves the eccrine sweat glands, which are innervated by the sympathetic nervous system. In primary axillary hyperhidrosis, the nerves that stimulate these glands appear to be overactive, producing more sweat than is needed for thermoregulation. There is evidence for a genetic predisposition in some families, though the exact mechanisms are not fully understood. In most cases, axillary hyperhidrosis is a localized, primary condition rather than a symptom of a broader systemic illness; secondary causes—such as endocrine disorders, infections, medications, or other medical conditions—should be considered if the presentation is atypical or accompanied by other symptoms eccrine gland sympathetic nervous system.

Diagnosis and assessment typically involve a combination of clinical history, physical examination, and objective measurements when needed. A common clinical tool is the Hyperhidrosis Disease Severity Scale Hyperhidrosis Disease Severity Scale, which helps gauge the impact on daily living. Objective tests include gravimetry (measuring the quantity of sweat) and the iodine-starch test (Minor's test), which maps sweating areas. Clinicians also distinguish primary focal hyperhidrosis from secondary forms caused by other conditions or drugs, guiding treatment decisions gravimetry iodine-starch test.

Causes and pathophysiology

  • Primary focal axillary hyperhidrosis: excessive activity of axillary eccrine glands due to dysregulated sympathetic signaling, often with a genetic component. The condition is typically limited to the underarms but can be associated with sweating in nearby regions.
  • Secondary hyperhidrosis: sweating due to another medical problem or medication. In these cases, evaluation for thyroid disease, diabetes, infection, menopause, certain psychiatric conditions, or drugs is important to exclude underlying contributors. See Hyperhidrosis for broader context and differential diagnosis.

Diagnosis

  • Clinical assessment: history of persistent underarm sweating that impairs daily life.
  • Objective measures: gravimetry and the Minor’s iodine-starch test help quantify sweating and delineate affected areas.
  • Classification: distinguishing primary axillary hyperhidrosis from secondary causes informs treatment sequencing and prognosis. See Hyperhidrosis for related criteria.

Treatments

Management is individualized and often begins with conservative measures, progressing to more advanced interventions based on response, tolerance, and patient preferences. Throughout, clinicians consider cost, durability, potential side effects, and impact on quality of life.

  • Topical antiperspirants: aluminum-based formulations applied nightly or daily can reduce axillary sweating for many patients. They are noninvasive and widely accessible, though skin irritation or local sensitivity can occur. See antiperspirant and aluminum chloride for related topics.
  • Botulinum toxin injections: injections of Botulinum toxin type A into the underarm area temporarily block acetylcholine signaling to eccrine glands, reducing sweat for several months. Treatment is effective for many patients but requires periodic repeat procedures and may cause transient pain or localized weakness in nearby muscles. See Botulinum toxin.
  • Oral anticholinergic medications: agents such as glycopyrrolate or oxybutynin can reduce sweating systemically but carry risks of dry mouth, constipation, blurred vision, and cognitive effects, particularly in older adults. These are often reserved for more widespread or refractory cases. See glycopyrrolate and oxybutynin.
  • Iontophoresis: electrical current applied to the underarms can reduce gland activity in some patients, though devices and protocols vary, and skin irritation can occur. This approach is more commonly used for hands and feet but is available in adapted forms for axillary treatment. See Iontophoresis.
  • Microwave or radiofrequency-based gland destruction: devices that deliver targeted energy to reduce or destroy sweat glands under the skin can provide durable relief for many patients. These approaches balance efficacy with potential transient pain, swelling, or numbness. See miraDry (brand-name references) or more general discussions of microwave therapy for sweat glands.
  • Surgical and energy-based procedures:
    • Endoscopic techniques targeting nerve pathways (for example, selective reductions in sympathetic signaling) are options in some centers, with risks including compensatory sweating in other body regions and, rarely, neural injury. See Endoscopic thoracic sympathectomy.
    • Endoscopic thoracic sympathectomy (ETS) is a more permanent intervention that can markedly reduce axillary sweating but carries a notable risk of compensatory sweating elsewhere on the body, sometimes more troubling than the original symptoms. See Endoscopic thoracic sympathectomy.
  • Behavioral and lifestyle strategies: wearing breathable fabrics, using absorbent undershirts, and avoiding triggers (like excessive heat or stress) can complement medical treatments and improve comfort. See Lifestyle change discussions in the context of hyperhidrosis.

Controversies and debates

  • Durability versus invasiveness: less invasive treatments (topical agents, injections) offer reversible or temporary relief, whereas surgical or energy-based approaches promise longer-lasting results but carry higher upfront risk and potential for compensatory sweating. Clinicians and patients weigh the trade-offs between durability, safety, and quality of life.
  • Access and cost: advanced therapies (Botulinum toxin, energy-based devices, or surgical options) can be expensive and vary in insurance coverage. Debates focus on how to allocate resources efficiently while ensuring patients with significant impairment can access effective treatment.
  • Individual variation in response: not all patients respond equally to a given therapy, and side effects (e.g., dry mouth with anticholinergics, local irritation with topical agents, or compensatory sweating after sympathetic interventions) influence treatment choice and sequencing.
  • Timing of intervention: some clinicians advocate early, proactive treatment for severe cases to prevent psychosocial impact, while others prefer a stepped approach starting with minimal-risk options and escalating as needed. The optimal strategy often depends on patient priorities, occupational considerations, and tolerance for risk.
  • Regulatory and clinical standards: ongoing evaluation of the efficacy and safety of new devices and pharmacologic regimens shapes guidelines. Interdisciplinary care involving dermatology, surgery, and primary care helps address coexisting conditions and patient preferences.

See also