Axillary hyperhidrosis is a medical condition characterized by excessive sweating localized primarily to the underarm (axillary) region. Unlike normal sweating, which is a physiological response to regulate body temperature, hyperhidrosis leads to sweat production far exceeding what is necessary for thermoregulation, often without apparent triggers. This excessive sweating can interfere with daily activities, cause significant emotional distress, and affect the quality of life for millions worldwide.

The condition is typically classified into two categories: primary (idiopathic) hyperhidrosis, where excessive sweating occurs without an identifiable underlying cause, and secondary hyperhidrosis, where sweating results from systemic conditions or external factors. Axillary hyperhidrosis specifically impacts the underarms but may occur alongside sweating in other areas such as the palms, soles, or face.

Recent advancements in diagnosis and treatment provide patients with effective options ranging from topical therapies to minimally invasive procedures and surgery, allowing better symptom control and improved lifestyle.

Primary axillary hyperhidrosis has no identifiable underlying medical cause and is believed to result from hyperactivity of the sympathetic nervous system, specifically overactive eccrine sweat glands in the axillae. Genetic factors play a significant role, with many patients reporting a family history of excessive sweating. The exact mechanism remains unclear but is thought to involve abnormal stimulation of sweat glands by the sympathetic nerves.

Primary Axillary Hyperhidrosis
Primary hyperhidrosis is believed to stem from hyperactivity of the sympathetic nervous system, specifically affecting eccrine sweat glands. Although the exact pathophysiology remains unclear, the following factors are recognized:

• Genetic Predisposition: A family history of hyperhidrosis is common, suggesting a hereditary component.
• Autonomic Nervous System Dysfunction: Overstimulation leads to excessive sweat gland activation even in the absence of heat or exercise.
• Age of Onset: Typically begins in childhood or adolescence and may persist lifelong.

Secondary Axillary Hyperhidrosis
Secondary hyperhidrosis is caused by underlying health issues or external factors, including:

• Endocrine Disorders: Hyperthyroidism, diabetes mellitus, pheochromocytoma, menopause.
• Infections: Tuberculosis, HIV/AIDS, or systemic infections can provoke sweating.
• Neurological Disorders: Parkinson’s disease, spinal cord injuries, stroke.
• Medications: Certain antidepressants, antipyretics, steroids, and hypoglycemics.
• Malignancies: Lymphoma or other cancers causing systemic symptoms.
• Obesity: Associated with increased metabolic activity and sweat production.

Risk Factors

• Family History: Increases likelihood of developing primary hyperhidrosis.
• Emotional Stress: Can exacerbate sweating episodes.
• Environmental Factors: Heat and humidity trigger sweat production.
• Lifestyle: Smoking and alcohol consumption may aggravate symptoms.

The hallmark symptom is excessive sweating localized to the underarms that is disproportionate to ambient temperature or exercise level.

Common Signs and Symptoms

• Visible, profuse sweating often soaking through clothing within minutes.
• Persistent moisture causing discomfort and skin maceration.
• Frequent need to change clothes or use absorbent pads.
• Strong or unpleasant odor due to bacterial growth.
• Skin irritation or rash in the axillary region.
• Psychological distress including embarrassment, social withdrawal, and reduced self-esteem.

Impact on Quality of Life
Patients may experience limitations in social interactions, work productivity, and leisure activities. Emotional symptoms such as anxiety and depression are common and exacerbate sweating.

Diagnosis involves a combination of clinical evaluation and specialized tests.

Clinical History

• Duration of symptoms (>6 months).
• Symmetry and focal nature of sweating.
• Triggers and exacerbating factors.
• Family history and impact on daily life.
• Review of medical history to rule out secondary causes.

Physical Examination

• Observation of sweat distribution.
• Assess for signs of systemic disease.
• Skin examination for infection or dermatitis.

Diagnostic Tests

• Starch-Iodine Test: Reveals sweat patterns by color change when iodine and starch are applied.
• Gravimetric Test: Measures sweat volume over time by weighing absorbent materials.
• Minor’s Test: Highlights hyperactive sweat glands using indicator dyes.

Laboratory and Imaging
Indicated if secondary causes are suspected: thyroid function tests, blood glucose, infection screening, imaging for tumors.

Treatment strategies are progressive, ranging from conservative to surgical interventions.

Topical Therapies

• Aluminum Chloride Hexahydrate: Standard first-line antiperspirant that blocks sweat ducts.
• Glycopyrrolate Topical: Anticholinergic to reduce sweat production.

Medical Treatments

• Botulinum Toxin Injections: Temporarily block acetylcholine release, reducing sweat gland activation for 6-9 months.
• Oral Anticholinergics: Glycopyrrolate or oxybutynin reduce sweating but have systemic side effects like dry mouth.

Procedural Interventions

• Iontophoresis: Electrical stimulation to decrease sweat production, mostly for palms and soles.
• Microwave Thermolysis (e.g., miraDry): Destroys sweat glands using microwave energy, offering longer-term relief.

Surgical Treatments

• Endoscopic Thoracic Sympathectomy (ETS): Surgical interruption of sympathetic nerves; effective but with risks including compensatory sweating.
• Axillary Sweat Gland Removal: Via curettage, laser, or liposuction techniques to physically remove sweat glands.
• Subcutaneous Tissue Removal: For severe cases with skin excision.

Though primary hyperhidrosis cannot be prevented, management focuses on symptom control:

• Hygiene: Regular washing with antibacterial soap.
• Clothing Choices: Breathable, moisture-wicking fabrics.
• Lifestyle Modifications: Stress reduction, smoking cessation, diet.
• Weight Management: Reduces overall sweating.

Complications from the Condition

• Skin infections and breakdown.
• Emotional and psychological distress including anxiety and depression.

Treatment-Related Complications

• Topical Agents: Skin irritation and allergic reactions.
• Botox: Injection site pain, temporary muscle weakness.
• Surgery: Compensatory sweating, nerve injury, pneumothorax, scars.

Axillary hyperhidrosis impacts emotional, social, and professional life:

• Psychological Effects: Anxiety, social withdrawal, reduced self-esteem.
• Daily Adaptations: Using sweat pads, frequent clothes changes.
• Support: Counseling and support groups may benefit patients.
• Ongoing Treatment: Regular follow-ups and possible combination therapies for sustained relief.

1. What is axillary hyperhidrosis?
Axillary hyperhidrosis is a medical condition characterized by excessive sweating specifically in the underarm (axillary) area, beyond what is necessary to regulate body temperature. It can cause significant discomfort and social embarrassment.

2. What causes axillary hyperhidrosis?
It may be caused by overactive sweat glands triggered by the nervous system. Primary axillary hyperhidrosis has no underlying medical cause and often begins in childhood or adolescence. Secondary hyperhidrosis results from medical conditions like infections, hormonal imbalances, or medications.

3. How common is axillary hyperhidrosis?
It affects about 1-3% of the global population and can impact men and women equally. Many people do not seek treatment due to embarrassment, but effective therapies are available.

4. How is axillary hyperhidrosis diagnosed?
Diagnosis involves a clinical evaluation including medical history and physical exam. Tests such as the iodine-starch test may be used to visualize sweating areas. Doctors also rule out secondary causes through blood tests or imaging.

5. What treatment options are available for axillary hyperhidrosis?
Treatments range from topical antiperspirants and oral medications to advanced options like Botox injections, microwave therapy (miraDry), and surgical procedures such as sympathectomy or sweat gland removal.

6. How effective is Botox for treating axillary hyperhidrosis?
Botox injections block the nerves that stimulate sweat glands, significantly reducing sweating for 6 to 12 months. It is a safe and popular non-surgical treatment with minimal downtime.

7. Are there any side effects or risks of treatments?
Most treatments are safe, but side effects can include skin irritation, temporary muscle weakness (Botox), or compensatory sweating elsewhere on the body. Surgery carries typical surgical risks like infection and scarring.

8. Can lifestyle changes help manage axillary hyperhidrosis?
Yes, wearing breathable clothing, using clinical-strength antiperspirants, managing stress, and avoiding known triggers like spicy food or caffeine can help reduce symptoms but may not eliminate excessive sweating.

9. When should I see a doctor for excessive sweating?
Seek medical advice if sweating interferes with daily life, causes emotional distress, or occurs suddenly or in unusual patterns, as it could indicate an underlying health problem.

10. Is axillary hyperhidrosis curable?
While some treatments provide temporary relief, others such as surgery can offer long-term or permanent reduction of sweating. Management often depends on individual needs and treatment response.

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Few Popular Hospitals for Axillary Hyperhydrosis are:

• Yanhee Hospital
• Bangmod Hospital
• Villa Bella
• Fortis Hospital
• Albert Einstein Jewish Hospital

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