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ARTICLE | HYPERHIDROSIS |


treatments at longer intervals. A potential mechanism


of action is hyperkeratosis, which physically limits sweat secretion, although studies have shown normal skin and gland structure after treatment5


. Home systems are


commercially available for self-administration. There can be technical challenges in treating the axillae as compared with the palms and soles, which can more easily be submerged in water baths lined with electrode plates.


The benefits of


iontophoresis are temporary and require continuous treatments. Botulinum toxin type A has been extensively used for the management of primary hyperhidrosis6


presynaptic acetylcholine release.


Figure 1 Subermal 1320 nm Nd:YAG laser treatment for axillary hyperhidrosis


treatment include the discomfort associated with injections in an area of heightened sensitivity. Topical and local anaesthetics can mitigate injection pain. Suction curettage is a surgical option for axillary


hyperhidrosis that relies on direct mechanical trauma and destruction of the sweat glands7


Suction curettage is a surgical option for axillary


owing to its potent inhibition of Typically,


hyperhidrosis that relies on direct mechanical trauma


30–100 units of BOTOX Cosmetic (Allergan Inc., CA) or equivalent, are injected intradermally in small aliquots across the affected area for each axilla. Significant sweat reduction is expected for approximately 4–6 months. The drawbacks of this


Table 1 Hyperhidrosis Disease Severity Scale (HDSS)


1


Never noticeable and never interferes with my daily activites


2 3 4


40


Tolerable but sometimes interferes with my daily activities


Barely tolerable and frequently interferes with my daily activities


Intolerable and always interferes with my daily activities


❚ June 2012 | prime-journal.com


and destruction of the sweat glands.


. A liposuction


technique allows for small incisions to access the subdermal space with the use of tumescent anaesthesia for haemostasis and patient comfort. A suction cannula is placed in the subcutaneous level with a port facing the dermis. Negative pressure pulls the skin and associated structures into the cannula while movement creates a rasping force. A range of cannulae have been specifically designed to enhance the sharp subdermal shearing. Sweat reduction after curettage can last for more than a year and the


procedure is repeatable. Laser and ultrasound-assisted liposuction8, 9


have been used in a similar fashion to


achieve axillary sweat gland injury. Localised heat is transferred from an energy source introduced to the subdermis such as a 1064 nm laser, a 1320 nm laser, or ultrasound diathermy device, theoretically minimising the mechanical trauma associated with traditional suction curettage. A microwave device called miraDry (Miramar Labs


Inc., CA) uses non-invasive, transcutaneously applied heat focused in the deep dermis and shallow subcutaneous levels10


. It employs a cooling mechanism


that protects the axillary skin from burns during heat delivery. The procedure is repeatable and significant axillary sweat reduction has been reported for longer than a year11


. For patient comfort, local anaesthetic is


necessary before administering the miraDry treatment, which takes approximately 1 hour for both axillae.


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