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Treatments

EXCESSIVE SWEATING OF THE ARMPITS (AXILLARY HYPERHIDROSIS)

1. Aluminum compounds (aluminum chloride hexahydrate) have been used for many years with success to treat this unwelcome condition. These salts, of course, are employed in concentrations much higher than one might find in an over-the-counter antiperspirant. 20% aluminum chloride hexahydrate in alcohol (Drysol ®) can be applied to dry armpits at bedtime.  

It is utilized for 2-7 consecutive nights and then as needed. Irritation can be a problem but can be diminished by use of over the counter hydrocortisone cream. Sweating may decrease approximately 50% within 4 weeks.

Another form of this medication is available as Certain-Dri ® pads, applied also in the evening to the armpits. This medication does not provide a cure, but only a control, and must be used continuously every night or every other night. Aluminum salts also seem to act by physical blockage of the sweat ducts and possibly, with long term use, via a gradual decrease in size and function of the secretory cells in the sweat glands themselves.

2. Topical scopolamine hydrobromide and topical tannic acid have been also utilized in the past. Scopolamine can potentially be absorbed into the blood stream, producing unwanted side effects, and tannic acid (such as from tea) can cause staining of the skin areas treated.

3. In the past, excision (surgical removal) of the sweat glands was a permanent solution to this problem. However, the older techniques left a long, and sometimes thick, scar in each armpit.

4. Tumescent liposuction: The sweat glands in the arm pit reside in the upper levels of the subcutaneous fat. They, therefore, are quite amenable to removal by superficial liposuction (suctioning of the fat right under the skin in the armpit).

These sweat glands can be identified by the starch-iodine test. 10% aqueous iodine is first applied to the armpit, producing a brown color. After cornstarch is sprinkled on the armpits, each sweat gland is delineated by a black dot as the starch darkens in this area (see accompanying photographs).

Once the glands have been delineated, they can be removed under local anesthesia by superficial liposuction techniques by Dr. Swinehart, who is skilled and experienced with this technique. A reduction of up to 90% in the sweating in the armpit (which is generally permanent) can be obtained with 1-2 treatments. The cost is approximately $1,500 per axilla, or $2,900 for both axillae,  plus additional costs (approximately $950.00) for preoperative laboratory work, supplies, and the infusion of the local anesthesia.

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HYPERHIDROSIS OF THE PALMS AND SOLES:

1. Glutaraldehyde, also used to sterilize medical instruments, has been utilized in the past for this condition on the palms and soles. It can cause a temporary brownish discoloration to appear in these areas but may diminish sweating. However, glutaldehyde is a frequent cause of contact allergy (contact dermatitis) with continued usage.

2. Methenamine, when applied to the skin, breaks down into ammonia and formaldehyde. Formaldehyde is also a frequent cause of contact allergy on the skin.

3. Iontophoresis is a technique by which a stepped down low amperage current is passed through tap water in which the palms and/or soles are immersed for a treatment lasting anywhere from 5 to 30 minutes. This procedure seems to act by producing a blockage of sweat ducts at the top level of the skin (stratum corneum). Treatments are necessary approximately three to four times per week, for about three weeks to achieve the desired effect. The effect is not permanent: maintenance therapy with iontophoresis must be continued in order to continue to inhibit sweating.

A battery powered iontophoresis unit (the Drionic unit) from General Medical Corporation in Los Angeles, is available for sale for home use. This is most affective on the palms, but also works in approximately one-third of cases for the soles and arm pits. If used for 20 days continuously, the percent response can range between 75% to 100%.

Iontophoresis can also be performed with a Fischer Galvanic Unit, (from Fischer Scientific, cost approximately $600). Both palms, or both soles, are immersed into large plastic pans through which current is passed. Approximately 3 treatments per week, for 3 weeks, are necessary to determine the efficacy of this treatment; maintenance therapy is also required. Office treatments are approximately $75 in some offices, for each of eight to nine outpatient treatments.

4. Botulinum toxin (Botox ®, Allergan Corp). Botulinum inhibits the release of acetylcholine, a neurotransmitter, from the nerves that stimulate the sweat glands. If acetylcholine is blocked from working in the palms and soles, sweating does not occur in these areas.

Botulinum toxin is injected with a tiny needle (after application of ice to temporarily numb the skin) at intervals of  approximately 1/2 inch in the areas in which sweating occurs. This treatment lasts 4-6 months. Its use is presently limited by the cost of the medication, and the fact that Botox therapy is not covered by insurance.

5.
Thoracic Sympathectomy --a surgical procedure in which a nerve in the chest is cut in order to attempt to decrease sweating. This procedure is not performed at the Colorado Dermatology Center.

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Photos:
1
Materials necessary for the starch-iodine test include cornstarch and 10% aqueous (water) iodine solution


2
After application of the iodine to the skin with a Q-tip, the sweat glands turn black after application of the cornstarch on a cotton ball.


3
Starch-iodine test delineating large and extensive array of sweat glands in the patient's left axillae.


4
Diminution of sweating by approximately 90% after tumescent liposuction in this same area


5
Tumescent liposuction has been performed in the left axilla but not on the patient's right. Note presence of sweat glands in the right armpit but absence in the left


6
After liposuction of the sweat glands in the right axilla, both armpits are now clear of sweating.


7
In another patient, the sweat glands have been delineated to a silver dollar sized area in the right armpit.


89
Following tumescent liposuction, sweating has nearly completely vanished in this area

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