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.
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.
- Solish N, Murray C. Skin Therapy Letter.com, 2005;last modified Feb. 20, 2014.
- Jacob C. Treatment of hyperhidrosis with microwave technology. Semin Cutan
Med Surg. 2013;32:2-8.
- Flanagan KH, Glaser DA. An open-label trial of the efficacy of 15% aluminum
chloride in 2% salicylic acid gel base in the treatment-to-severe primary axillary
hyperhidrosis. J Drugs Dermatol. 2009;8:477-480.
- Newman JL, Seitz JC. Intermittent use of an antimicrobial hand gel for reducing
soap-induced irritation of health care personal. Am J Infect Control. 1990;3:194-200.
- Doft MA, Hardy KL, Ascherman JA. Treatment of hyperhidrosis with botulinum
toxin. Aesthet Surg J. 2012;32:238-244.
- Lee HH, Kim do W, Kim do W, et al. Efficacy of glycopyrrolate in primary
hyperhidrosis patients. Korean J Pain. 2012;25:28-32.
- Praharaj SK, Arora M. Paroxetine useful for palmar-plantar hyperhidrosis. Ann
- Ohshima Y, Shimizu H, Yanagishita T, et al. Changes in Na+, K+ concentrations
in perspiration and perspiration volume with alternating current iontophoresis in
palmoplantar hyperhidrosis patients. Arch Dermatol Res. 2008;300:595-600.
- Bretteville-Jensen G, Mossing N, Albrechtsen R. Surgical treatment of axillary
hyperhidrosis in 123 patients. Acta Derm Venereol. 1975;55:73-77.
- Shenaq SM, Spira M, Christ J. Treatment of bilateral axillary hyperhidrosis by
suction assisted lipolysis technique. Am Plast Surg. 1987;19:548-551.
- Coleman WP III. Noncosmetic applications of liposuction. J Dermatol Surg
- Lillis PJ, Coleman WP III. Liposuction treatment of axillary hypohidrosis. Dermatol
- Bogokowsky H, Slutzki S, Bacalu L, et al. Surgical treatment of primary hyperhidrosis.
A report of 42 cases. Arch Surg. 1983;118:1065-1067.
- Letada PR, Landers JT, Uebelhoer NS, et al. Treatment of focal axillary hyperhidrosis
using a long pulsed Nd:YAG 1064 nm laser at hair reduction settings. J Drugs Dermatol. 2012;11:59-63.
- Bechara FG, Georgas D. Sand M, et al. Effects of a long-pulsed 800-nm
diode laser on axillary hyperhidrosis: A randomized controlled half-side comparison
study. Dermatol Surg. 2012;38:736-740.
- Caplin D., Austin J. Clinical evaluation and quantitative analysis of axillary
hyperhidrosis treated with a unique targeted laser energy delivery method
with 1-year follow up. J Drugs Dermatol. Apr; 13(4):449-56.
- Nestor MS, Park H. Safety and efficacy of micro-focused ultrasound plus
visualization for the treatment of axillary hyperhidrosis. J Clin and Aesth Dermatol. Apr 2013; Vol 7. Number 4.
- Hong HC, Lupin M, O’Shaughnessy KF. Clinical evaluation of a microwave
device for treating axillary hyperhidrosis. Dermatol Surg. 2012;38:728-735.
- Lupin M, Hong HC-H, O’Shaughnessey KF> Long-term evaluation of microwave
treatment for axillary hyperhidrosis. Lasers Surg Med. 2012;44:6.
Deborah S. Sarnoff MD FAAD FACPAndrew.Sarnoff@gmail.com