Axillary Hyperhidrosis After Sympathectomy: Treatment Options - Neurosurgery

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Axillary hyperhidrosis, or excessive sweating in the underarm area, can be a challenging condition to manage, especially after undergoing sympathectomy for palmar hyperhidrosis (sweaty palms). Your experience highlights a common issue faced by many patients who have had this type of surgery: the development of compensatory sweating in other areas, such as the axillae (armpits). Let’s address your questions and explore treatment options.

1. Surgical Focus: During your initial sympathectomy, the surgeon likely targeted the sympathetic nerves responsible for sweating in the hands. The procedure typically involves cutting or clamping these nerves to reduce sweating in the palms. However, if you did not mention your axillary sweating at that time, it is possible that the surgeon did not address this area. The sympathetic nervous system is complex, and different regions control sweating in different parts of the body. Therefore, it is not uncommon for patients to experience persistent or new areas of sweating after surgery.

2. Reoperation Considerations: If you are considering a second sympathectomy specifically for axillary hyperhidrosis, it is essential to consult with a surgeon who specializes in this field. While some patients have undergone multiple procedures, there are risks associated with reoperation, including increased chances of complications and the potential for further compensatory sweating in other areas. The decision to proceed with another surgery should be made after a thorough evaluation of your specific case and a discussion of the potential risks and benefits.

3. Alternative Treatments: If reoperation is not advisable or if you prefer to explore other options, there are several non-surgical treatments available for axillary hyperhidrosis:
- Botulinum Toxin Injections: This is one of the most effective treatments for axillary hyperhidrosis. Botulinum toxin (commonly known as Botox) can temporarily block the nerves that cause sweating. The effects can last for several months, and repeat treatments are necessary to maintain results.

- Antiperspirants: Prescription-strength antiperspirants containing aluminum chloride can be effective for managing axillary sweating. These products work by blocking the sweat glands and can be used in conjunction with other treatments.

- Iontophoresis: This treatment involves using a device that passes a mild electrical current through water and into the skin's surface, which can help reduce sweating in various areas, including the hands and feet. While it is less commonly used for axillary hyperhidrosis, it may be worth discussing with your healthcare provider.

- Microwave Therapy: This is a newer treatment option that uses microwave energy to destroy sweat glands in the underarm area. It is a minimally invasive procedure and can provide long-lasting results.

- Lifestyle Modifications: While not a cure, certain lifestyle changes can help manage symptoms. Wearing breathable fabrics, using absorbent pads, and maintaining a cool environment can help reduce discomfort associated with excessive sweating.

In conclusion, your situation is not uncommon, and there are various avenues to explore for managing axillary hyperhidrosis after sympathectomy. It is crucial to have an open dialogue with a healthcare provider who specializes in hyperhidrosis to discuss your symptoms, treatment history, and the best options moving forward. Each treatment has its pros and cons, and a tailored approach will help you find the most effective solution for your condition.