Axillary Hyperhidrosis: The Old is New Again

The standard treatment for increased sweating of the armpits (axillary hyperhidrosis) has been the use of aluminum hexahydrate in either prescription or nonprescription strengths. If that fails the next step has generally been the injection of Botox, although other methods such as iontophoresis (the patient uses a battery powered device to deliver an electric current to the skin while the skin is immersed in water) have sometimes been used. All of these methods have disadvantages. Botox is expensive and lasts 4 months to a year. Topical antiperspirants can be irritating and can loose their effectiveness. Iontophoresis can be painful, time consuming and of limited effectiveness.
In a recent letter to the editor of the journal Dermatologic Surgery, Dr. James Swinhart, of Denver Colorado, reminds of a technique that he described in 2000.

Dr. Swinehart described the use of superficial tumescent liposuction to remove many of the sweat glands in the armpit skin. His technique has many advantages. It is permanent, and only 3 patients in the 21 years he has been doing it have required a touch up procedure. It has a relatively low risk of side effects, while the other surgical procedure for this problem, cutting the nerves that activate the sweat glands, has a 50% risk of increased sweating in other parts of the body (compensatory hyperhidrosis). Liposuction of the armpit sweat glands can result in a complete cessation of sweating in some. In others the result is sweating that can now be controlled with antiperspirants. Clearly this is an approach that has been underused.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA