Primary axillary hyperhidrosis typically begins during childhood or adolescence, but can happen at any age. It is usually life-long, although in a few people symptoms can spontaneously improve over time. Severe primary axillary hyperhidrosis can be defined as a score of 3 or 4 on the Hyperhidrosis Disease Severity Scale. Excessive sweating can have a profound effect on quality of life, interfering with daily activities and causing anxiety and embarrassment.
First-line management of primary axillary hyperhidrosis includes lifestyle measures such as avoiding known triggers and tight clothing, and using antiperspirants (including aluminium chloride hexahydrate). Other treatments include iontophoresis, botulinum-toxin A injection, and oral medications such as anticholinergics, antimuscarinics, beta-blockers, antihypertensives and anxiolytics. If these do not work, surgical options include local sweat-gland excision by subcutaneous curettage, tumescent liposuction, or thoracic sympathectomy.