Clinical Evaluation and Quantitative Analysis of Axillary Hyperhidrosis Treated With a Unique Targeted Laser Energy Delivery Method With 1-Year Follow Up
April 2014 | Volume 13 | Issue 4 | Original Article | 449 | Copyright © April 2014
David Caplin MD FACSa and Jordan Austin BSb
aParkcrest Plastic Surgery, St. Louis, MO bUniversity of Missouri Department of Pathology and Anatomical Sciences, Columbia, MO
BACKGROUND: Primary Focal Axillary Hyperhidrosis (PHH) is a chronic disorder of excessive underarm sweat that causes significant impairment of an individual's daily activities. Multiple studies have established the psychosocial burden of PHH and its negative impact on quality of life. Current first-line therapies include the use of topical aluminum chloride with limited efficacy. Second line therapy includes the use of Botulinum toxin, which is effective, but duration is limited to 6-7 months. Objective: The purpose was to evaluate the long term efficacy and safety of the Nd:YAG 1440nm wavelength with a unique delivery fiber (SideLaze) and the Smartlipo TriPlex device (Cynosure Inc).
METHODS: Fifteen subjects were recruited to an approved Institutional Review Board study. Outcome measures were comprised of clinical and quantitative evaluation of functional impairment. This included HDSS scale, physician and subject evaluation, and digital photography of before and after starch iodine tests utilizing image processing and analysis software. Subjects received a single treatment and were evaluated at 1 week and at 3, 6, and 12 months post treatment. Responders were defined as those that scored an HDSS score of 1 or 2 post-treatment. Those that were non-responsive at 6 months received a second treatment.
RESULTS: All patients responded to treatment with 72% reporting a two-point HDSS score improvement and 28% reporting a 1-point improvement at 1-year follow-up. The average HDSS score improvement was 1.9/3.0. Three of the 15 patients at 6 months received a second treatment. The HDSS average score for all patients remained statistically stable at 1-year follow-up.
CONCLUSIONS: Treatment of axillary hyperhidrosis with the 1440nm Nd:YAG-pulsed laser combined with a targeted fiber and temperature-sensing device provides a safe and minimally invasive approach to the treatment of axillary hyperhidrosis with minimal side effects and long-term efficacy. J Drugs Dermatol.
Primary focal axillary hyperhidrosis is a chronic disorder presenting as excessive underarm sweating. Multiple studies have established the psychosocial burden of primary hyperhidrosis and its negative impact on quality of life. The condition causes significant impairment of an individual’s quality of life and emotional well-being as it often interferes with a patient’s daily activities with occupational, emotional, social, and physical implications. In addition, the risk of cutaneous infections caused by bacterial, fungal, and viral pathogens is substantially increased at affected body sites.1-4 Severe hyperhidrosis affects 2.8% of the overall United States population (7.8 million individuals) and axillary hyperhidrosis affects over 1.4% of the population representing over 4 million individuals.5
Eccrine glands are the major sweat glands of the human body. They start to form in the fourth month of gestation, as a down growth of the epidermis. The glands are distributed throughout the body with the highest density seen on the palms and soles in addition to the axillae.6 The eccrine glands are innervated by the cholinergic fibers of the sympathetic nervous system which may become overly active in axillary hyperhidrosis leading to their hyperstimulation.2 In cases of excessive sweating no change in size or number has been demonstrated. A genetic predisposition may exist as up to two thirds of patients report a family history of the disorder.2 The primary function of the eccrine unit is thermoregulation, which is accomplished through the cooling effects of the evaporation of sweat on the skin’s surface. Eccrine sweat is primarily water as hypotonic saline and other components; sodium, chloride, potassium, calcium, magnesium, lactate, ammonia, amino acids, urea and bicarbonate.6 When sweating occurs in amounts greater than physiologically needed for thermoregulation, the condition is known as hyperhidrosis.3
Treatments abound. Current first-line therapies include prescription antiperspirants, which contain 10% to 20% aluminum chloride hexahydrate. However, these types of antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing.7 Anticholinergics