The body contains millions of sweat glands, categorized into eccrine and apocrine types. Eccrine glands are distributed across most of the skin surface, releasing an odorless, watery fluid that acts as the body’s primary coolant through evaporative heat loss. Apocrine glands are concentrated in areas like the armpits and groin, producing a thicker fluid that causes body odor when it interacts with skin bacteria. For individuals diagnosed with hyperhidrosis—a condition of excessive sweating that exceeds the body’s need for temperature regulation—the prospect of sweat gland removal may seem appealing. This decision requires careful consideration of the potential dangers and long-term physiological consequences.
Methods of Sweat Gland Removal
Procedures designed to eliminate or disable sweat glands are divided into surgical and non-surgical approaches. Surgical methods aim to physically remove the glands from the underarm area. Excision is the oldest technique, involving the surgical removal of the entire sweat-gland-bearing skin, but this method is less common today due to the resulting large wound and potential for extensive scarring. More minimally invasive surgical options include curettage, where a scraping tool is used, and liposuction, which uses suction to extract the glands from the subcutaneous fat layer. Often, a combination of suction and curettage is employed to increase effectiveness.
Non-surgical approaches utilize energy to destroy the glands without deep incisions. Microwave energy, delivered by a specialized handheld device, heats the underarm tissue to cause thermolysis and permanent destruction of the sweat glands. Ultrasound and laser ablation techniques also use concentrated energy to destroy the targeted glands beneath the skin surface.
Immediate Procedural Risks
Any procedure that involves physically altering the tissue carries immediate risks. Localized infection at the surgical site is a common risk following any invasive procedure, sometimes requiring antibiotic treatment. Bruising, swelling, and pain in the treated area are expected side effects, but excessive bleeding or the formation of a hematoma can complicate recovery.
Specific to the armpit area, there is a risk of temporary or permanent nerve damage. Sensory nerve irritation or injury can lead to numbness or a change in sensation on the inner upper arm, which typically resolves within a few weeks. More serious, though rare, is the risk of skin necrosis (skin death), which occurs if the procedure compromises the blood supply to the skin flap. While this can cause delayed healing and scarring, the risk is low when performed by an experienced surgeon.
Long-Term Physiological Consequences
The most significant long-term consequence of sweat gland removal or nerve-interrupting surgery is compensatory sweating. This involves the body producing excessive sweat in other areas, such as the back, torso, groin, or legs. Compensatory sweating is reported by a high percentage of patients who undergo surgical nerve interruption (sympathectomy), with many reporting it as severe.
The mechanism is thought to be the body’s attempt to maintain thermoregulation, forcing the remaining active sweat glands to work harder to dissipate heat. The body’s total evaporative cooling surface area is effectively reduced, requiring a higher sweat rate from the remaining areas. The inability to sweat from the treated area can also affect overall heat tolerance, increasing the risk of heat-related illness during strenuous activity or in hot environments. This permanent alteration can sometimes be more distressing than the original condition.
Non-Removal Treatment Options
Before considering permanent gland removal, several less invasive alternatives exist for managing hyperhidrosis:
- Prescription-strength topical antiperspirants contain a high concentration of aluminum chloride, which temporarily obstructs the sweat gland pores. These are used for mild to moderate cases and are applied nightly to dry skin.
- Botulinum toxin injections (Botox) temporarily block the nerve signals that trigger sweat production. Results last between three to ten months, and injections are routinely used for the underarms, hands, and feet.
- Iontophoresis is a non-invasive procedure that uses a mild electrical current passed through water to temporarily block the sweat glands, suitable particularly for the hands and feet.
- Oral anticholinergic medications can reduce overall sweating by blocking the nerve impulses to the sweat glands throughout the body.