Why Laser Sweat Ablation is required for Underarm Sweating (Axillary Hyperhidrosis)

Excessive sweating, also known as hyperhidrosis, is an embarrassing condition that can have dramatic negative effects on peoples' lives.

Hyperhidrosis can affect most areas of the body - but it is usually a major problem in one or two main areas. Common areas to be affected by excessive sweating are:

● Head - scalp and face (often associated with facial flushing)

● Hands - called Palmar Hyperhidrosis)

● Under-arms or armpits - called axillary hyperhidrosis

● Feet - called Plantar Hyperhidrosis

● and occasionally groins, backs, chests

Hyperhidrosis is the excessive production of the watery sweat. This sweat causes the damp patches on clothes, and in severe cases, beads of sweat form and can drip down the body from the affected area. This sweat is produced by the Eccrine glands. It's main purpose is to cool the body.

This condition is not to be confused with smelly sweat - properly called Bromhidrosis - which is a more greasy sweat of low volume that has a distinctive - and often nasty - smell. Bromhidrosis is formed by the Apocrine glands. These produce a greasy substance called sebum that is discharged into hair follicles.

Hyperhidrosis is controlled by the sympathetic nervous system, although many other factors also influence it - such as heat or local heat, psychological effects (embarrassment or fear), some hormones, some drugs, some sorts of food. For more information about the causes of hyperhidrosis and other treatments for excessive sweating, please see www.sweating.co.uk.

Axillary Hyperhidrosis - Why Laser Sweat Ablation (LSA)?

People who sweat excessively from their armpits have several options of treatment.

Minor cases can be treated with loose clothing, natural fibres especially cotton and normal shop bought anti-perspirants.

In those people with worse axillary hyperhidrosis, these simple methods are not effective. Such people often resort to strong anti-perspirants (especially those containing Aluminium, pads that stick under the arms or to the clothes in this region, hypnotherapy or cognitive behavioural therapy.

Although there are people in whom these measures work, a great many people find these to be unacceptable. The strong antiperspirants often lead to irritation of the skin and white marks on the clothes. The pads can be bulky and restrict the sorts of clothes that can be worn - those sticking to the skin can leave marks on the skin that are hard to remove. Both hypnotherapy and cognitive behavioural therapy require many sessions to have any effect, and even in those who get results, they often only reduce the problem but don't get rid of the underlying hyperhidrosis.

Therefore a great many people seek out a medical cure for their axillary hyperhidrosis.

There are many medical treatments for axillary hyperhidrosis - but most have unacceptable features for many patients, resulting in the need for Laser Sweat Ablation. Such treatments include:

● "Botox®" - Botulinum Toxin A - a series of injections into the skin of the armpits dramatically reduces the sweating for 6 weeks to 9 months - depending both on what dose is given, and how the patient responds to it. Many clinics give very low doses so that patients return regularly for further treatments. Even with large doses, it is a once or twice a year treatment. Although one UK company has tried to make out this is a "new treatment", we have been using Botulinum Toxin A for axillary hyperhidrosis since 1998 - following research from Oxford University in 1997/8.

● Iontophoresis - This is a technique of passing a small electric current through the skin which stops the sweat glands from working. It needs to be repeated regularly. Although a reasonable treatment for hands and feet (which can be put in water to help the current flow) it is hard to get the same effect in the arm-pit. Therefore this really hasn't taken off as a viable treatment for most people.

● ETS - Endoscopic Transthoracic Sypathectomy - This is a "keyhole" operation under a genearl anaesthetic where each lung is deflated in turn, a surgical "telescope" (called and "endoscope") is passed across the chest between the ribs, and the main nerve, called the sympathetic chain, is cut. The problems with this operation for axillary hyperhidrosis are many - it is a major operation with infrequent but significant risks (see www.sweating.co.uk for full explanation), it stops sweating from the head, face, hands, arms and upper chest - about one quarter of the body! Hence the risk of compensatory sweating - excessive sweating elsewhere to get rid of the extra sweat - is much increased. Therefore, although excellent for head, face and hand sweating, it is not a good alternative for isolated axillary hyperhidrosis.

● Drugs / Tablets - Especially Glycopyrolate (Robinul) - Drugs or tablets can be used to reduce the total sweating from a body. However, they need to be taken for life, they affect the whole of the body - not just the area needing treatment - and there are always risks of side-effects and allergies.

● Axillary skin excision +/- skin grafting - Cutting away the skin of the armpit, with or without a skin graft, should never be done unless there is a malignancy (cancer) or if there is severe infection of the glands in the skin with severe scarring and pus formation (called hydradenitis suppritiva). The pain, scarring and lack of mobility afterwards make this a barbaric operation that is out of date EXCEPT in the above conditions.

● Retrodermal currettage / axillary liposuction / Vaser - these techniques, and some similar ones called different things, are aiming to remove the sweat glands (the Eccrine Glands) from under the skin using "keyhole surgery" - just like laser sweat ablation (LSA). However they all have quite a substantial failure rate. Laser Sweat Ablation uses the same suction currettage principlle that each of these use - but also adds Laser treatment of the sweat glands before the suction currettage. As the laser used in LSA has been proven to destroy the Eccrine sweat glands, it seems obvious that lasering as many of the glands as possible followed by suction curettage is bound to be more effective than suction currettage alone. Our early results seem to support this logical view.

● Open surgery and the Skoog Procedure - Some doctors offer open surgery (open surgery means where the skin is cut open to operate through the incision) such as the Skoog procedure. Although this does work for some patients, it leaves a large scar (or scars) across the armpit compared with the minimally invasive operations such as LSA, which reduce the chances of successful LSA if the Skoog fails. We have had several patients ask for LSA but who have had previous open surgery which failed to give the results that they wanted - and the resulting scar tissue as precented us from attempting LSA.
As LSA not only removes the sweat glands but also lasers them, it is sensible to have LSA first and only consider open surgery such as the Skoog procedure, if it hasn't worked (which hasn't happened to any of our patients so far).

This brief look at what is currently available shows why Laser Sweat Ablation (LSA) is needed for the treatment of axillary hyperhidrosis.

It is a local anaesthetic treatment that takes about 2 hours to perform. Using the technique that we have developed, early results suggest it is highly effective and looking at the results from Buenos Aries (where the principle was invented by Dr Blugerman) it is likely to be permanent. As it only affects the area operated on the armpit or axillary skin, it seems to fulfil all of the requirements that are needed -

- local anaesthetic walk-in walk-out surgery, very small scars, permanent results, high chance of satisfactory reduction in sweating, high patient satisfaction.