Treatment of Focal Axillary Hyperhidrosis Using a Long-Pulsed Nd:YAG 1064 nm Laser at Hair Reduction Settings

January 2012 | Volume 11 | Issue 1 | Original Article | 59 | Copyright © January 2012


Philip R. Letada MD, John T. Landers MD, Nathan S. Uebelhoer DO, Peter R. Shumaker MD

Department of Dermatology, Naval Medical Center San Diego, San Diego, CA

Abstract
Background and Objective: Axillary hyperhidrosis is a rather common idiopathic disorder of the eccrine sweat glands, which can interfere with daily activities and cause significant social distress. The effects of 1064 nm laser hair reduction on sweat production in a pilot study in patients with focal axillary hyperhidrosis are described.
Study Design/Materials and Methods: In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures.
Results: Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology.
Conclusions: Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.

J Drugs Dermatol. 2012;11(1):59-63.

INTRODUCTION

Primary hyperhidrosis is an idiopathic disorder of the eccrine sweat glands resulting mainly from overactivity of the sympathetic nervous system and is often associated with emotional factors (i.e., nervous sweating).1 It is a relatively common disorder affecting 1.4% of the U.S. population.2
Current treatments for axillary hyperhidrosis are frequently unsatisfactory as they may be temporary, have limited efficacy, systemic side effects, or may be associated with significant surgical morbidity. Local treatment modalities include iontophoresis and the use of topical antiperspirants. Systemic medications including tranquilizers, anticholinergics, NSAIDs, and calcium channel blockers have also been utilized with varying degrees of success. Botulinum toxin injections have also been shown to be safe and effective, but the results are temporary and may be associated with significant cumulative expense.3 Various surgical interventions have also been used with differing degrees of efficacy and surgical morbidity. Techniques described include subcutaneous tumescent liposuction, 4 undermining and resection of all exposed sweat glands,5 arthroscopic shaving,6 laser-assisted long-pulsed Nd:YAG liposuction, 7 and sympathectomy.
In the course of performing axillary hair reduction with a long-pulsed Nd:YAG laser in a patient with concurrent axillary hyperhidrosis, significant subjective improvements in axillary sweating were noted. To date, little research has been done on the effect of laser hair reduction (regardless of wavelength utilized) specifically on sweating and/or eccrine gland disruption. In a study by Bencini et al., long-pulsed Nd:YAG laser hair reduction produced complete long-term epilation in 208 patients with minimal side effects. Histologic specimens revealed extensive necrosis of the hair follicle and surrounding sebaceous gland epithelium six hours after treatment.8 Similar long-term clinical and histologic results were seen in darker pigmented individuals in a related study by Alster et al. in 2001.9 However, neither of these studies commented on the effect of hair reduction on the eccrine gland or its secretions. Recently a pilot study using a long-pulsed Nd:YAG laser applied with a subdermal fiberoptic needle demonstrated subjective and objective improvement in axillary sweating up to three years after treatment.10
In this pilot study, we examined the clinical and histologic effects of 1064 nm Nd:YAG laser hair removal at laser hair reduction setting in patients with axillary hyperhidrosis.
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