INTRODUCTION
High intensity focused fractional radiofrequency (HIFRF) microneedling is FDA cleared for the treatment of facial wrinkles. The system is designed with a unique technology that is safe for use on patients presenting with all skin types. Based on its unique design and the clinical trial experience reported in the literature by Kim, et al1 and others,2,5 we offer it to our patients as a beneficial treatment option for primary axillary hyperhidrosis (PAH). We present here a clinical experience summary from three US centers providing hyperhidrosis treatments using the high-intensity radio-frequency device, including treatment parameters, clinical outcomes, and pre- and post-treatment images.
Overview of Hyperhidrosis
Hyperhidrosis is a medical condition that causes uncontrollable excessive sweating of the axilla, palms, feet, or head. Secondary hyperhidrosis is caused by another medical condition or a side effect of a medication. Primary hyperhidrosis is an idiopathic condition not caused by another medical condition or a side effect of a medication. Primary axillary hyperhidrosis (PAH), or excessive sweating limited to the axillary area, is a debilitating disease that severely and negatively impacts social and psychological well-being. Several treatment options are available for PAH including antiperspirants, systemic anticholinergic medications, laser devices, and surgical options to remove the sweat glands, eg, via excision, liposuction, curettage, and laser surgery; however, these options have been shown to provide varying effectiveness. The use of neuromodulator injections, eg botulinum toxin A, is a widely used minimally invasive treatment option for PAH; however, limitations of this treatment option include injection discomfort, cost, and temporary treatment effect (3-6 months) necessitating periodic re-treatments. In addition, long-term results (12-14 months) have been reported with use of a device delivering electromagnetic energy for thermolysis of the sweat glands.1-3,5-7Recent studies have suggested HIFRF energy may offer an effective PAH treatment option and long-term results have been reported.1-2,5-7 When used for treating other dermatologic conditions, HIFRF has also been shown to have a more positive safety profile over conventional RF.1,2,5
Overview of the High-intensity Radio-frequency Device
The high-intensity radio-frequency device has a unique insulating design not found in other RF devices that precisely controls the location of the energy delivery within the skin. The high-intensity radio-frequency device consists of a hand piece with a single-use disposable tip containing forty-nine microneedles in a 7x7 arrangement and covering a 10 mm2 area. The microneedles function as alternating positive and negative electrodes. Made of surgical stainless steel and covered with gold to
