SWEATY ARMPITS (AXILLARY HYPERHIDROSIS) 

AXILLARY HYPWEHIDROSIS and OSMIDROSIS

There are two types of sweat glands in our body: the eccrine sweat glands and apocrine sweat glands. Eccrine sweat glands are much smaller than apocrine glands and they are distributed all over the body. Eccrine glands produce a clear and odourless secretion called sweat that mostly consists of water with some trace of salt. Apocrine sweat glands are mostly found in the armpit, areola, and perineum. Hormonal changes during puberty cause the apocrine sweat glands to develop and become active. The secretion from apocrine sweat glands is fatty and more concentrated compared to the watery sweat produced by eccrine glands. Interaction between the apocrine secretion and skin bacteria produces an acrid body odour.

Axillary hyperhidrosis is a condition where the overactive eccrine sweat glands produce excessive watery secretion (sweat) in the armpit. Axillary osmidrosis refers to the offensive body odour originating from the armpits caused by overactive apocrine sweat glands. In some patients, both the axillary hyperhidrosis and axillary osmidrosis can occur together, whereas others are only affected by either axillary hyperhidrosis or axillary osmidrosis alone.

Both axillary hyperhidrosis and axillary osmidrosis cause embarrassment and distress to the patients and interferes with their daily activities and social functions. Most cases of axillary hyperhidrosis and osmidrosis occur in otherwise healthy people, although in some rare cases the condition may be associated with neurologic, endocrine and other medical disorders.

There are many treatment modalities for these conditions. Short term treatments include over-the-counter antiperspirants and botulinum toxin A (BTA) injection. For more effective and long term results, surgical removal of the eccrine glands and apocrine glands is the treatment of choice. There are several surgical treatments available for removal of axillary sweat glands:

1.    The traditional open subdermal trimming technique is considered the mainstream treatment modality. This method is straightforward and very effective even though it is associated with a larger incision and longer recovery time.

2.    Versajet: Versajet is an hydrosurgery system that was initially designed for wound debridement. Recently the system has become a new treatment tool for axillary hyperhidrosis and osmidrosis. Versajet is very effective in removing axillary sweat glands and delivers very good results. Since water is used as the medium, there is no physical friction between the instrument and surrounding tissue and this avoids unintended tissue injury and heating effects. Compared to the other surgical modalities, this technique has the added advantages of being more precise and is gentler to the skin, and is associated with smaller incisions, shorter operation time, faster recovery and lower risk of wound complications.  

3.    Suction-assisted cartilage shaver (rotating blade): a technique in which an arthroscopic cartilage shaver is used for the removal of axillary sweat glands.

4.    Liposuction: liposuction is associated with short recovery time but there could be an increased incidence of recurrence due to incomplete removal of apocrine glands.

Preparation

1.    Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

2.    Stop smoking at least one week before surgery. Smoking is harmful to wound healing and increases the risks of other post-operation complications. 

3.    Stop taking the following medications and supplements one week before surgery:

a.    Medicine that increases bleeding during surgery such as aspirin, NSAIDs and warfarin. However, you may need to consult your physician who prescribed the medicine before you stop them. 

b.    All supplements that contain vitamin E, ginseng, ginkgo, garlic, fish oil and other ingredients that increase bleeding during surgery. Other supplements, traditional medicine and herbs in which ingredients are unknown have to be stopped as well.

4.    On the day of surgery, wear simple and comfortable clothing and do not wear any makeup. Do not wear any jewelry and metal objects on the face and body.

Surgery

Duration: 1 to 2 hours

Anaesthesia: Local anaesthesia

Hospitalization: Not required

Recovery: Back to work in 3 to 5 days, light exercise after 2 weeks, heavy exercise after at least one month.

* The actual speed of recovery depends on the types of procedure performed  and may vary from person to person.

Technique:

1.    Open subdermal trimming technique. A 3 to 4cm incision is made following one of the skin creases on the axilla. The skin is separated from the underlying tissues and sweat glands are removed under direct vision.

2.    Versajet: 1-3 small incisions (0.5 to 1cm) are made on the affected area. The skin is undermined and the Versajet is used to shave the dermis and remove the sweat glands.

3.    Suction-assisted cartilage shaver: One or two incisions are made on the affected area. The skin is undermined and the cartilage shaver is inserted to trim the dermis and remove the sweat glands.

Post-operative Care**

1.    What to expect: Swelling usually peaks on the second to third day after surgery and will gradually subside thereafter.

2.    Drains may be inserted for the first few days to remove fluid and blood from the wound.

3.    General care:

a.    Avoid smoking for at least one month. Smoking increases the risk of wound complications.

b.    Good rest and adequate sleep are helpful for a speedy recovery.

c.     Sleep on the back and avoid sleeping on one side.

d.    Be relaxed and calm. Contact the clinic if there are any queries.

4.    Medicine: Finish the oral antibiotics as prescribed. Take the painkiller as prescribed when necessary.

5.    Wound care: After the dressing is removed, clean the wound with a clean cotton tip soaked with sterile water/saline. Apply antibiotic ointment.

6.    Physical activity: Avoid heavy physical activity and exercise for at least one month.

7.    Follow-up: Come back one week after surgery for review and suture removal. .

8.    Emergency: If there is heavy bleeding, rapid increase in swelling or severe pain, immediately contact the clinic/doctor for advice.

** The instructions in this list are only for general guidance and the list is not meant to be exhaustive. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.