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No sweat

Article-No sweat

Key iconKey Points

  • Two new minimally invasive procedures show promise for treating axillary hyperhidrosis, researchers say
  • But experts add that it's too soon to tell if the procedures will succeed long-term
  • Based on a study of 71 patients, this modified technique is shown to be both a safe and effective option

Falk G. Bechara, M.D.
INTERNATIONAL REPORT — An arthroscopic shaver technique and another surgical method that combines liposuction and curettage appear safe and effective for treating primary axillary hyperhidrosis, according to researchers. But experts tell Cosmetic Surgery Times that it's too early to tell how successful these techniques will be long term.

SC ENHANCES LIFE QUALITY In one recent study involving 51 patients with primary focal axillary hyperhidrosis (FAH), the suction-curettage (SC) method largely reversed disabilities caused by excessive axillary sweating. "For the first time, we investigated quality of life in our patients with a standardized questionnaire," the Dermatology Life Quality Index (DLQI), says Falk G. Bechara, M.D., senior consultant, Department of Dermatology and Dermatologic Surgery, and chief of hyperhidrosis research, University of Bochum, Germany. Researchers have employed this questionnaire with endoscopic thoracic sympathectomy (ETS), a procedure used primarily for palmar hyperhidrosis, but never before with a minimally invasive procedure such as SC, he says. With the DLQI, adds Dr. Bechara, "We showed that we could significantly enhance patients' quality of life after surgery." To prepare patients for surgery, physicians first identified hyperhidrotic areas with Minor's iodine starch test. They then applied tumescent local anesthesia before performing SC with a cannula designed to perform both liposuction and curettage, explains Dr. Bechara.

Michael H. Gold, M.D.
Physicians started using superficial liposuction to treat hyperhidrosis around 1990, "But results were not so good because liposuction with a blunt cannula can't really eradicate all the sweat glands," Dr. Bechara notes. Therefore, he says he and his colleagues created a sharp cannula that features a flat tip plus three holes for suctioning. "After one has done the liposuction," Dr. Bechara explains, "one simply puts some pressure on the axillary skin, which forces it into the cannula. It has sharpened rasps between the holes" that enable curettage. Post-surgical administration of the DLQI at several in-person visits found that median DLQI scores fell from 12 at baseline to four at nine months post-surgery. At the same interval, 35 patients estimated their sweat reductions at 75 percent. (Gravimetry performed in other studies consistently shows reductions of 70 to 75 percent, adds Dr. Bechara.) However, Michael H. Gold, M.D., says, "My understanding has always been that patients treated with liposuction techniques tend to do really well for awhile," but nine months' follow-up isn't enough to gauge the procedure's long-term performance. Dr. Gold is medical director at Gold Skin Care Center, Tennessee Clinical Research Center, The Laser and Rejuvenation Center and the Advanced Aesthetics Medi Spa, and clinical assistant professor, Division of Dermatology, Vanderbilt University School of Medicine and School of Nursing, Nashville.

But Dr. Bechara says that in the last 400 patients he's treated with SC, "It's successful in 85 to 90 percent of cases," which holds true for five to six years post-treatment (publication pending). Only about 10 percent of patients experience recurrence after seven to eight months, he adds.

ARTHROSCOPIC SHAVER DEBRIDES, ASPIRATES The arthroscopic shaver technique, on the other hand, achieved a 96 percent satisfaction rate, a six percent recurrence rate and a subjectively measured 75 percent sweat reduction in a recent fiveyear review. "No one else has described using an arthroscopic shaver to treat axillary hyperhidrosis," says Jugpal S. Arneja, M.D., attending plastic surgeon, Children's Hospital of Michigan and assistant professor of surgery, Wayne State University, Detroit. While other techniques involve debridement and sometimes gross excision or scraping from underneath the sweat glands, he adds, "Our technique debrides and aspirates at the same time, because that's the nature of the arthroscopic shaver."

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