Primary Focal Axillary

The general recommendation is to try more-conservative therapy before resorting to invasive treatment. Each of the anatomic areas with excessive sweating is more or less susceptible to the various approaches available.[9]

Topical aluminum chloride antiperspirants have long been, and continue to be, the first line of treatment for axillary hyperhidrosis. [9,58] The exception to this is if the patient’s excessive sweating symptoms occur during, or are exacerbated by, known anxiety-provoking situations such as during presentations at work, dramatic performances, etc. In these cases, the patient may be treated prior to such events with an anticholinergic or a short course benzodiazepine. [9,19]

If a patient does not adequately respond to topical antiperspirant therapy or if the side effects of such therapy are intolerable, botulinum toxin A (BTX-A) injections are the next line of treatment. The U.S. Food & Drug Administration (FDA) approved BTX-A for the treatment of severe primary axillary hyperhidrosis in patients unable to obtain relief using antiperspirants on July19, 2004. BTX-A injections offer a minimally invasive treatment option and should be repeated as necessary to control symptoms. [99]

Should a patient not respond BTX-A or require such frequent re-injections as to be impractical surgical measures may be considered. Local sweat gland excision by curettage or liposuction, done on an outpatient basis with tumescent local anesthesia, are less invasive surgical options. [7,99]