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 (PrecisionTxâ„¢) and the Smartlipo Triplexâ„¢ 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.

Conclusion

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.

Disclosure

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

References

  1. Solish N, Murray C. Skin Therapy Letter.com, 2005;last modified Feb. 20, 2014.
  2. Jacob C. Treatment of hyperhidrosis with microwave technology. Semin Cutan Med Surg. 2013;32:2-8.
  3. 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.
  4. 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.
  5. Doft MA, Hardy KL, Ascherman JA. Treatment of hyperhidrosis with botulinum toxin. Aesthet Surg J. 2012;32:238-244.
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  7. Praharaj SK, Arora M. Paroxetine useful for palmar-plantar hyperhidrosis. Ann Pharmacother. 2006;40:1884-1886.
  8. 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.
  9. Bretteville-Jensen G, Mossing N, Albrechtsen R. Surgical treatment of axillary hyperhidrosis in 123 patients. Acta Derm Venereol. 1975;55:73-77.
  10. Shenaq SM, Spira M, Christ J. Treatment of bilateral axillary hyperhidrosis by suction assisted lipolysis technique. Am Plast Surg. 1987;19:548-551.
  11. Coleman WP III. Noncosmetic applications of liposuction. J Dermatol Surg Oncol. 1988;14:1085-1090.
  12. Lillis PJ, Coleman WP III. Liposuction treatment of axillary hypohidrosis. Dermatol Clin. 1990;8:479-482
  13. Bogokowsky H, Slutzki S, Bacalu L, et al. Surgical treatment of primary hyperhidrosis. A report of 42 cases. Arch Surg. 1983;118:1065-1067.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. Hong HC, Lupin M, O’Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg. 2012;38:728-735.
  19. Lupin M, Hong HC-H, O’Shaughnessey KF> Long-term evaluation of microwave treatment for axillary hyperhidrosis. Lasers Surg Med. 2012;44:6.

AUTHOR CORRESPONDENCE

Deborah S. Sarnoff MD FAAD FACPAndrew.Sarnoff@gmail.com
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