What is the pathophysiology of axillary hyperhidrosis?

Updated: Feb 12, 2019
  • Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Bisbal et al have determined that eccrine and apocrine sweat glands are mixed in the axilla, with a proportion of 1:1. [3]

In patients with axillary hyperhidrosis, Morgan and Hughes demonstrated that the apocrine glands are significantly larger and more numerous than those in axillary hidradenitis and in healthy control subjects. [4]

Following a thorough resection of the subcutaneous axillary sweat glands (Skoog procedure), a few eccrine glands remain, and practically no apocrine glands can be found.

Thus it seems that a Skoog adenectomy is essentially an apocrinectomy. This is at odds with the observation that the profuse sweat produced in axillary hyperhidrosis (and stopped by Skoog resection) is clear and odorless; classically, apocrine sweat is described as cloudy and odoriferous, while eccrine sweat is labeled clear and without odor. No one has reconciled these seeming inconsistencies, but the inference is that the clear, odorless, profuse sweating observed in axillary hyperhidrosis comes from the hypertrophied and overactive apocrine glands.

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