Treatment Of Axillary Hyperhidrosis Research Articles

Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating

Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the results were compared statistically. No statistically significant difference was observed between the groups based on age (P=0.56), gender (P=0.81), duration of the surgery (P=0.35) or postoperative satisfaction levels (P=0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3-T4 group at the 1-year follow-up (P=0.008). T3 sympathectomy was as effective as T3-T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients' reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up.

Ramicotomy in Association With Endoscopic Sympathetic Blockade in the Treatment of Axillary Hyperhidrosis

The use of endoscopic sympathetic blockade (ESB) to treat axillary hyperhidrosis (AH) has become more widespread recently. ESB of the T3 and T4 ganglia is more effective, although it results in a higher incidence of compensatory sweating (CS) than ESB of T4 alone. To reduce CS and improve the level of satisfaction and therapeutic success of ESB, we performed T3 ramicotomy in association with T4 ESB. Ninety patients with axillary hyperhidrosis were randomized into 3 groups of 30 patients-group A (T3 and T4 ESB), group B (T4 ESB), and group C (T4 ESB in association with T3 ramicotomy)--and evaluated for CS, therapeutic success and degree of satisfaction 7 days, 6 months, and 1 year after the procedure. CS was observed in 72 patients (80%) and classified as minor in 63 (70%), moderate in 7 (7.8%), and severe in 2 (2.2%). These results were not statistically significant. There was a higher proportion of remission of symptoms and therapeutic success in group B (100%, P=0.008). Forty-seven patients (52.2%) considered themselves very satisfied, 41 (43.3%) satisfied, and only 2 (2.2%) dissatisfied with their surgery. ESB of T4 alone was more effective than ESB of T3 and T4 together and ESB of T4 in association with T3 ramicotomy. No significant difference was found between the techniques in terms of patient satisfaction or the occurrence and degree of CS; however, in group C, CS was more intense in the thighs, whereas in group A it was more intense in other areas.

Randomized, double-blind, controlled pilot study of the efficacy and safety of microfocused ultrasound for the treatment of axillary hyperhidrosis

Randomized, double-blind, controlled pilot study of the efficacy and safety of microfocused ultrasound for the treatment of axillary hyperhidrosis

Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Single Surgeon's Experience With 53 Consecutive Patients

Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Single Surgeon's Experience With 53 Consecutive Patients

Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders

To assess the results of palmar and axillary hyperhidrosis treatment in males and females using low doses of oxybutynin. A retrospective analysis was conducted in 395 women and 170 men followed up in our service with complaint of palmar and axillary hyperhidrosis. A total of 70% of patients in both groups presented partial or great improvement in the level of hyperhidrosis after treatment. The best results were obtained in the female group, in which 40% classified their improvement as "great". Approximately 70% of the patients in both groups improved their quality of life after medical therapy and 30% presented no change in condition. Gender is not a factor that significantly interferes in oxybutynin treatment results. Quality of life indices and clinical improvement level were similar in men and women.

A Comparative Study of Thoracoscopic Sympathicotomy Versus Local Surgical Treatment for Axillary Hyperhidrosis

Axillary hyperhidrosis affects approximately 1.4% of the population. Medical management is often frustrating, and the response generally transient. Surgical methods include thoracoscopic sympathectomy or sympathicotomy and local axillary surgery such as suction-curettage or en-bloc skin resection. Many case series with retrospective follow-up are available in the literature, but no comparative studies between surgical techniques have been published. During a 9-year period, two groups of consecutive patients with isolated axillary hyperhidrosis underwent thoracoscopic sympathicotomy (n = 49) or local axillary surgery (n = 47) at the same university hospital, depending on referral or preference. Patients received identical questionnaires to investigate local effect and side effects after surgery. Questionnaires were returned by 92% after a median of 26 months, with no significant difference between the two groups. Local effect was significantly better after axillary surgery compared with sympathicotomy (p < 0.001), but mild recurrent axillary symptoms were significantly more frequent after axillary surgery (51% versus 5%, p < 0.001). Compensatory and gustatory sweating were significantly more frequent after sympathicotomy (84% versus 25%, p < 0.001; and 54% versus 26%, p = 0.01, respectively). Outcome after surgery for isolated axillary hyperhidrosis was significantly better after local surgical treatment compared with sympathicotomy. Local effect was better and side effects fewer, but milder recurrent symptoms were more frequent. Compensatory sweating also occurs after local axillary surgery and has not been reported before. Our results suggest that local axillary surgery is preferable for isolated axillary hyperhidrosis and that R2-R3 or R2-R4 sympathicotomy should be discouraged. Sympathicotomy should only be considered for patients who have additional palmar hyperhidrosis.

A Novel, Non-Invasive Microwave-Based Device for the Treatment of Axillary Hyperhidrosis

INTRODUCTION: A new non-invasive microwave device was developed to treat axillary hyperhidrosis. This study reports a large, multicenter, randomized, sham-controlled clinical trial investigating efficacy and safety. METHODS: 120 adult subjects were randomized to treatment group (n=81) or sham group (n=39) and were treated in two sessions spaced two weeks apart. Each axilla was marked using a template, anesthetized using local anesthesia, and treated using a device handpiece that delivers microwave energy through the skin. Follow-up was 6 months for the sham group and 12 months for the treatment group. RESULTS: The mean age of subjects was 32.8 years; 58% of the subjects were female. The primary efficacy measure was the percentage that had HDSS scores reduced to 1 or 2 (from 3 or 4 at baseline), implying sweat that was not noticeable or was tolerable. Results for the treatment group were 89% at 30-days post-treatment, 67% at 6-months, and 69% at 12-months. Sham group results were 54% at 30-days and 44% at 6-months (p<0.001 at 30 days and p=0.019 at 6 months). Additionally, 91% of treated subjects showed at least a one point decrease in HDSS score at 30 days, and 81% at 12-months. Treatment-related adverse events were generally mild and all but one completely resolved. The most common adverse events were transient patches of altered sensation in the skin of the treated arm (n=9, 9.9%). Most subjects experienced transient post-treatment local sequelae in the axilla including edema, tenderness, and bruising. CONCLUSION: A new microwave-based device and procedure has been developed with a very high efficacy for treating axillary hyperhidrosis, with results that show promising stability for long-term relief. DISCLOSURES: Research was supported by Miramar Labs. Larry K. Fan, MD is a consultant and has received research funding from Miramar Labs. William P. Coleman, MD is a consultant and shareholder and has received research funding from Miramar Labs. Dee Anna Glaser, MD is a consultant and shareholder and has received research funding from Miramar Labs. Michael S. Kaminer, MD is a consultant and shareholder and has received research funding from Miramar Labs. Suzanne L. Kilmer, MD is a consultant and has received research funding from Miramar Labs. Robert Nossa, MD has received research funding from Miramar Labs. Stacy R. Smith, MD is a consultant and has received research funding from Miramar Labs.

Efficacy and safety of methantheline bromide (Vagantin®) in axillary and palmar hyperhidrosis: results from a multicenter, randomized, placebo‐controlled trial

Focal hyperhidrosis can severely affect quality of life. So far, knowledge on the effect of systemic therapy of focal hyperhidrosis is limited. To assess the efficacy and safety of methantheline bromide (MB) in the treatment of axillary and palmar-axillary hyperhidrosis. A multicenter controlled randomized double-blind clinical trial was conducted in patients with axillary or palmar-axillary hyperhidrosis defined by a sweat production >50 mg/5 min. Patients received 3 × 50 mg MB daily or placebo over a period of 28 ± 1 days. Main outcome criterion was the reduction of sweat as measured by gravimetry on day 28 ± 1. Quality of life was assessed by Dermatology Life Quality Index (DLQI) and Hyperhidrosis Disease Severity Score (HDSS). A total of 339 patients were randomly assigned to receive MB or placebo. On day 28 ± 1, the mean axillary sweat production was 99 mg for MB and 130 mg for placebo compared with 168 mg and 161 mg respectively at baseline (P = 0.004). Patient's HDSS score decreased in the MB group from 3.2 to 2.4 compared with 3.2 to 2.7 for placebo (P = 0.002). Similar results could be obtained for the DLQI with 9.7 for MB and 12.2 for placebo, which decreased from 16.4 or 17 respectively (P = 0.003). Tolerability was good for both groups. The most frequent adverse event was dry mouth. Fifty milligrams methantheline bromide three times a day is an effective and safe treatment of axillary hyperhidrosis.

Leitungswasseriontophorese

Since 1968, tap water iontophoresis has been employed as the method of choice for treating palmoplantar hyperhidrosis. Special electrodes also allow treatment of axillary hyperhidrosis. Tap water iontophoresis also can extend symptom -free intervals in dyshidrotic palmar eczema. The mechanism action is most likely a functional disturbance of the secretory mechanism of eccrine acini. During the induction phase, treatments are carried out once daily. Current direction may be switched before each treatment or, even better, kept constant until one side, preferably the dominant hand on the anode, is sweating normally. Then polarity is switched until both hands are adequately treated. During the weekly maintenance therapy, current direction is switched before each treatment. The most comfortable means of iontophoretic treatment employs pulsed direct current of high frequency (5-10kHz) which is better tolerated than continuous direct current and also suitable for children. Side effects are minimal and transient. Only slight skin irritation or sensations of discomfort may occur during treatment. Electric burns and shocks can be avoided by following routine precautions. Contraindications for tap water iontophoresis are metallic implants, such as cardiac pacemakers, or orthopaedic joint or bone implants, if they are within the electric circuit. Defects in the skin barrier, which can not be protected by petrolatum or insulating tape, also represent a temporary contraindication. Treatment in pregnancy is contraindicated, since experience is lacking.

Clinical Evaluation of a Microwave Device for Treating Axillary Hyperhidrosis

BackgroundA third-generation microwave-based device has been developed to treat axillary hyperhidrosis by selectively heating the interface between the skin and underlying fat where the sweat glands reside.Materials and MethodsThirty-one (31) adults with primary axillary hyperhidrosis were enrolled. All subjects had one to three procedure sessions over a 6-month period to treat both axillae fully. Efficacy was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), gravimetric weight of sweat, and the Dermatologic Life Quality Index (DLQI), a dermatology-specific quality-of-life scale. Subject safety was assessed at each visit. Subjects were followed for 12 months after all procedure sessions were complete.ResultsAt the 12-month follow-up visit, 90.3% had HDSS scores of 1 or 2, 90.3% had at least a 50% reduction in axillary sweat from baseline, and 85.2% had a reduction of at least 5 points on the DLQI. All subjects experienced transient effects in the treatment area such as swelling, discomfort, and numbness. The most common adverse event (12 subjects) was the presence of altered sensation in the skin of the arm that resolved in all subjects.ConclusionThe device tested provided efficacious and durable treatment for axillary hyperhidrosis.

A Randomized, Blinded Clinical Evaluation of a Novel Microwave Device for Treating Axillary Hyperhidrosis: The Dermatologic Reduction in Underarm Perspiration Study

Duration of effect and effectiveness limit current options for treating axillary hyperhidrosis. A new microwave procedure for treatment of axillary hyperhidrosis has been tested. Adults with primary axillary hyperhidrosis were enrolled in a randomized, sham-controlled, blinded study. Subjects were required to have a Hyperhidrosis Disease Severity Scale (HDSS) score of 3 or 4 and baseline sweat production greater than 50 mg/5 min. Procedures were administered using a proprietary microwave energy device that isolates and heats target tissue. Responders were defined as subjects reporting a HDSS score of 1 or 2. Subjects were followed for 6 months (sham group) or 12 months (active group). Thirty days after treatment, the active group had a responder rate of 89% (72/81), and the sham group had a responder rate of 54% (21/39) (P < .001). Treatment efficacy was stable from 3 months (74%) to 12 months (69%), when follow-up ended. Adverse events were generally mild, and all but one resolved over time. The procedure demonstrated statistically significant, long-term efficacy in sweat reduction. As with any new procedure, findings from this first investigational device study identified optimization strategies for the future.

Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Single Surgeon’s Experience With 53 Consecutive Patients

Axillary hyperhidrosis is a debilitating disease that affects the social and occupational lives of many Americans. It can be treated with subdermal injections of botulinum toxin. This study aimed to determine the interval between injections during which patients are symptom free and whether that interval varies depending on the number of treatments a patient has received. The study enrolled all the patients treated with botulinum toxin for axillary hyperhidrosis by the senior author between 2004 and 2010. Patient responses to the treatment with regard to both satisfaction and length of the symptom-free interval were collected prospectively and analyzed. An in-depth PubMed search was performed through July 2010 to compile the published data on using botulinum toxin injections to treat axillary hyperhidrosis. These data served as a benchmark to which the trends at our institution were compared. The 53 patients included in the study had an average age of 29years, and 64% were women. Of the 53 patients, 23 (43%) underwent multiple injections of botulinum toxin. The average symptom-free interval was 261days. There was no statistically significant difference in symptom-free intervals after multiple treatments. Patient satisfaction rates were very high, similar to the high degrees of satisfaction found in the published data. Botulinum toxin injections provide an effective treatment for axillary hyperhidrosis with a rapid onset and high patient satisfaction. Many patients have a symptom-free interval of 6-9months after each botulinum toxin injection. This interval does not change significantly after multiple treatments.

Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of primary axillary hyperhidrosis: a double‐blind, randomized, comparative preliminary study

Botulinum toxin A (BTX-A) is an effective and safe treatment modality for primary axillary hyperhidrosis. However, some patients experience considerable pain during injections. Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of primary axillary hyperhidrosis: a double-blind, randomized, comparative preliminary study. The aim of this study was to compare the efficacy, safety and pain tolerance of lidocaine-diluted BTX-A vs. saline-diluted BTX-A for the treatment of axillary hyperhidrosis. Eight patients were injected with 50 U of BTX-A diluted in 0.5 mL of saline and 1 mL of 2% lidocaine into one axilla and 50 U of BTX-A diluted in 1.5 mL of saline into the other axilla in a randomized fashion. The pain associated with the injections were self-assessed by the subjects using a 100-mm visual analogue scale (VAS). Lidocaine-diluted BTX-A and saline-diluted BTX-A were similarly effective regarding the reduction in sweat production, the onset of sweat cessation and the duration of hypo/anhidrosis. Nevertheless, the pain VAS score during the injections was significantly lower in the axilla treated with lidocaine-diluted BTX-A than the one treated with saline-diluted toxin. Preliminary study due to relatively small sample size. Botulinum toxin A diluted in lidocaine causes significantly less pain than BTX-A diluted in saline, whereas it is is equally effective and safe as the latter one in treating axillary hyperhidrosis. Therefore, we suggest that lidocaine-diluted BTX-A may be a better treatment option for the patients with primary axillary hyperhidrosis.

Simpatectomia torácica ao nível de 4ª e 5ª costelas para o tratamento de hiper-hidrose axilar

To describe the clinical results and the degree of satisfaction of patients submitted to thoracic sympathectomy at the level of the fourth and fifth ribs (R4-R5) for the treatment of axillary hyperhidrosis. We included 118 patients diagnosed with axillary hyperhidrosis and having undergone axillary sympathectomy at the R4-R5 level between March of 2003 and December of 2007 at the Paraná Federal University Hospital de Clínicas, located in the city of Curitiba, Brazil. All procedures were carried out by the same surgeon. Data regarding the resolution of axillary hyperhidrosis and the degree of patient satisfaction with the surgical outcome, as well as compensatory hyperhidrosis in the early and late postoperative periods (after 7 days and after 12 months, respectively), were collected. Of the 118 patients evaluated, 99 (83.9%) and 81 (68.6%) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5%) in the early postoperative period and in 77 (65.2%) in the late postoperative period. Of those 77, 55 (71.4%) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2%) were satisfied with the surgical results, and 104 (88.1%) remained so in the late postoperative period. Sympathectomy at the R4-R5 level is efficient in the resolution of primary axillary hyperhidrosis. The degree of patient satisfaction with the long-term surgical results is high. Mild compensatory hyperhidrosis is the main side effect associated with this technique.

Thirty-five units of botulinum toxin type A for treatment of axillary hyperhidrosis in female patients

We present a retrospective audit on efficacy and impact of 35 units of botulinum toxin type A per axilla on quality of life in female patients with axillary hyperhidrosis. This audit shows that 35 units of botulinum toxin type A is a reasonable starting dose and could significantly improve patients' quality of life and reduce the cost of treatment.

The Influence of Needle Size on Pain Perception in Patients Treated with Botulinum Toxin A Injections for Axillary Hyperhidrosis

Botulinum toxin A (BTX-A) injections can be an effective treatment for axillary hyperhidrosis, a condition characterized by excessive secretion by the eccrine sweat glands. However, as up to 50 intradermal injections in each axilla are required, the pain experienced by many patients may lead to poor compliance with treatment (1) or to some patients preferring local anesthesia prior to re-treatment (2). No single effective treatment for pain during treatment with BTX-A has been widely accepted. Topical anesthesia with, for example, tetracaine, is among the most commonly applied methods, but is time-consuming, expensive and often difficult to apply to the axillae (3). Cooling of the skin has also been tested, but with limited success (1). Needle size may also be important. Indeed, small needle size has been associated with a lower frequency of pain in healthy volunteers (4) and in a lower intensity of pain in patients with multiple sclerosis (5). However, other studies have shown pain intensity to be either only slightly affected (6) or unaffected by needle size (7, 8). Reportedly, injections of BTX-A are typically performed using 27 G (outer diameter 0.4 mm) or 30 G (outer diameter 0.3 mm) needles (1, 9-12). The aim of the present study was to investigate whether the use of a 30 G versus a 27 G needle influenced pain intensity in patients treated with BTX-A for axillary hyperhidrosis.

Use of a transparent dressing in the treatment of axillary hyperhidrosis with botulinum toxin type A

Use of a transparent dressing in the treatment of axillary hyperhidrosis with botulinum toxin type A

Diode laser hair removal does not interfere with botulinum toxin A treatment against axillary hyperhidrosis

The possible interference of combined laser hair removal and Botulinum toxin A (BoNT/A) injections in the treatment of axillary hyperhidrosis has not previously been explored. In order to examine this potential interference, we assessed the effect of BoNT/A on axillary hyperhidrosis with and without concomitant diode laser axillary hair removal. In a prospective, double blind, randomized cross over trial, nine patients suffering from primary axillary hyperhidrosis were laser-treated on one randomly assigned axilla. One week later, both axillas were injected intradermally with BoNT/A (100 MU per axilla). During the same session, the previously untreated axilla was lasered. Axillary sweat rates (in g/5 minutes.) were determined by gravimetry and compared at rest, during mental exercise, and during physical exercise. Additionally, subjective outcome measures were assessed by a visual analogue scale, Dermatology Life Quality Index, and Global Clinical Impression score. No differences were found regarding the effect of BoNT/A on previously laser-treated and laser co-treated sides over time course for any of the outcome parameters. Sweat production was reduced 3 weeks after BoNT/A treatment by 93.5% at rest, 96.5% during mental exercise, and 67% during physical exercise. Concomitant laser hair removal does not interfere with BoNT/A treatment on axillary hyperhidrosis.

T3T4 Endoscopic Sympathetic Blockade Versus T3T4 Video Thoracoscopic Sympathectomy in the Treatment of Axillary Hyperhidrosis

The use of endoscopic sympathetic blockade (ESB) in the treatment of axillary hyperhidrosis has grown because of its potential reversibility. But it is still not clear whether the rates of success, compensatory sweating, and satisfaction are better than those accomplished with video thoracoscopic sympathectomy (VTS). Eighty-four patients were studied to compare the rates of success, satisfaction, and compensatory sweating in patients undergoing either ESB or VTS of the T3T4 ganglion after 2 years' follow-up. Thirty-five patients (83.3%) undergoing ESB and 39 patients (92.8%) undergoing VTS had remission of axillary hyperhidrosis (p = 0.315). Improvement was seen in 7 patients (16.7%) in the ESB group and 1 patient (2.4%) in the VTS group. Two patients (4.8%) had bad results in the VTS group. Absence of or minor compensatory sweating was observed in 25 patients (59.5%) in the ESB group and 28 patients (66.7%) in the VTS group, and moderate compensatory sweating occurred in 13 patients (31.0%) in the ESB group and 10 patients (23.8%) in the VTS group. Severe compensatory sweating was observed in 4 patients (9.5%) in the ESB group versus 4 patients (9.5%) in the VTS group (p = 0.905). In the ESB group, 28 patients (66.7%) were very satisfied, 11 patients (26.2%) were satisfied, and 3 patients (7.1%) were unsatisfied with treatment. In the VTS group, 35 patients (83.3%) were very satisfied, 6 patients (14.3%) were satisfied, and 1 patient (2.4%) was unsatisfied with VTS. Endoscopic sympathetic blockade and VTS of T3T4 ganglion are efficient in axillary hyperhidrosis treatment. We found no differences regarding therapeutic success, satisfaction rate, and incidence, severity, and location of compensatory sweating.

Treatment of axillary hyperhidrosis and bromidrosis with botulinum toxin (BTX)-A injection

Objective To probe the advantages of BTX-A for the treatment of axillary hyper-hidrosis. Methods 42 cases were treated by BTX-A injection, 50 units per axillae, 25 sites with 2 u-nits each, 1.5 cm apart. They consisted of 24 cases of axillary hyperhidrosis, 10 cases of axillary hy-perhidrosis combined bromidrosis, and 8 cases of bromidrosis. Results All hyperhidrosis patients a-chieved good effects. Among patients with axillary hyperhidrosis combined bromidrosis, it had effects on hyperhidrosis, but only one case effected on bromidrosis. Among patients with bromidrosis, only one case had effect. Conclusions In the treatment of hyperhidrosis, BTX-A is very useful, and side effect is temporary and slight. But for bromidrosis, BTX-A is not very useful. Key words: Botulinum toxin-A(BTX-A); Axillary hyperhidrosis; Bromidrosis