Therapeutic Update on Hyperhidrosis

August 2014 | Volume 13 | Issue 8 | Features | 896 | Copyright © August 2014

Deborah S. Sarnoff MD FAAD FACP

table 2
with the Nd:YAG 1440 nm wavelength with a unique delivery fiber (PrecisionTx™) and the Smartlipo Triplex™ device (Cynosure). In a minimally invasive approach, the targeted fiber is inserted under the skin with a temperature-sensing device to safely heat the underlying sweat glands. 72% reported a two-point HDSS score improvement and 28% reported a onepoint improvement at one-year follow-up.16 Additional large, multi-center studies with long-term follow-up are warranted to further evaluate laser treatment of hyperhidrosis.
2. Microfocused Ultrasound
A microfocused ultrasound device that has been cleared by the FDA for noninvasive eyebrow lifting and lifting of the submental area, has been recently used in two randomized, double-blinded, sham-controlled pilot studies (14 patients and 20 patients respectively, to treat axillary hyperhidrosis).17 High intensity microfocused ultrasound plus visualization was used to deliver energy to the sweat glands. The pilot studies revealed a 50-60% positive treatment response at 1 year. Further studies are warranted to explore the merits of ultrasound in the treatment of hyperhidrosis.

3. Microwave

Microwaves, preferentially absorbed by high water-content tissue, lead to heating of the dermal adipose interface where the sweat glands reside. The targeted heating results in thermolysis of the eccrine glands. The miraDry® (Miramar Labs) is the first FDA-cleared (January 2011) microwave device for lasting treatment of underarm sweat. A vacuum pump is used to lift the skin away from underlying structures such as nerves; active cooling is used to protect overlying epidermis and dermis. Usually, a second treatment is given 3 months after the first for lasting results.2 A study of 31 patients showed 90% efficacy and 90 % patient satisfaction after 1 year. Efficacy was defined as a drop in HDSS from 3 or 4 to 1 or 2. The average patients’ sweat was reduced by 82%.18 Histology revealed sweat gland necrosis at 11 days post treatment and reduction of sweat glands 6 months post treatment.2 All subjects experienced transient effects in the treatment area, such as swelling, discomfort or numbness; the most common adverse event was altered sensation in the skin of the upper arm, which resolved in all cases.19
Theoretically, since sweat glands do not regenerate, complete destruction of sweat glands should result in a permanent solution.


There are many treatment options today for patients with axillary or palmoplantar hyperhidrosis. Further research and development of drugs and devices, and fine tuning of treatment protocols will undoubtedly improve safety, efficacy, and longevity of results.


Dr. Sarnoff has no relevant conflicts of interest to disclose.


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Deborah S. Sarnoff MD FAAD