(Axillary and palmoplantar hyperhidrosis)
Hyperhidrosis means excess production of sweat. Seating is a vital function of the human organism. It regulates the body’s temperature and does not only cool the skin, but also the inside of the body. Approx. 1-2% of the general population are affected by hyperhidrosis, in which the body produces excessive and uncontrollable amounts of sweat independent of ambient temperature, time of day or season.
Human sweat consists of 99% water and also contains various electrolytes (sodium, chloride, potassium), proteins and carbohydrates. Histologically, the sweat glands are located in the area of transition between the cutis (dermis) and the subcutaneous adipose tissue (tela subcutanea). Locally limited hyperhidrosis occurs primarily, at 60%, on the palms (sweaty hands) or soles of the feet, and at 40% in the armpits.
Three different stages of severity of hyperhidrosis are distinguished, with approximately one percent of the general population of Switzerland affected by severe hyperhidrosis (level III).
“Plate-sized” wet spots on the clothes caused by sweating can be a major stress factor for professionals working in public, such as teachers or pilots, but also for social interaction. Strong body odour is not at all caused by sweat itself, but by bacteria and fungi. Many bacteria are found particularly under the armpits, where they turn sweat with a neutral odour into strong, unpleasant body odour by means of a bacterial decomposition process.
The first therapeutic option is local injection with botulinum toxin A, colloquially referred to as “Botox”. In the process, very fine needles are used to inject Botox into the skin of the armpits, soles of the feet or palms. Botox blocks the neural stimulation of the sweat glands by inhibiting a neurotransmitter (acetylcholine). With only a few localized injections, this method is very gentle and reduces sweating for a period of 5 to 6 months, which means it only needs to be repeated twice a year. The procedure can be performed in an outpatient setting, takes an average of 20 minutes and does not leave any scars. If applied properly, no major complications are to be expected. The effect will be noticeable after approx. one week. Since the active ingredient for this indication is not included in the list of essential medicines, the cost is not covered by health insurance in most cases, meaning the patients cover the cost themselves.
Only five percent of the populace do not respond to the treatment with Botox, as they possess antibodies against the toxin, which means that removing the sweat glands (by means of liposuction and curettage) should be considered as a secondary therapeutic option. In the armpits, the sweat glands are removed using a fine tube and, in a second step, scraped off from under the skin using a type of sharp spoon. In the process, the nerve ends running to the sweat glands are also separated. This procedure will remove approx. 60 to 90% of the sweat glands. In some cases, the sweat glands which could not be removed may respond with hyperactivity. A recurrence rate of up to 25% has also been described in the literature. Since this outpatient procedure involves only very small incisions under local or general anaesthesia, there will be no disfiguring scars. Wound healing will be complete after two weeks. The surgical risks of this method of treatment are slightly higher than with Botox injection. Conversely, the chances that health insurance will cover the costs are somewhat higher here.
Local sweat gland excision involves removing the affected skin region including the sweat glands. Besides the higher risk of bleeding and infection, impaired wound healing often occurs and scar formation may limit the mobility of the affected body sites, with larger, visible scars resulting. In addition, excision of the entire sweat-producing area is often impossible. For these reasons, this therapeutic option should be considered only as a last resort and should only be performed in case of recurring infections or if explicitly demanded by the patient.
In summary, the therapeutic options with little adverse effects, such as local injection of botulinum toxin A, should always be tried first before the patient is exposed to a more substantial surgical procedure and consequently to the associated greater risks.
Since individual case history and scope may vary, we always recommend comprehensive personal consultation. Please arrange an appointment with us.