Surgery To Remove Sweat Glands In Hands – Surgical treatment of axillary hyperhidrosis by suction-curettage of the sweat glands * * Study conducted at the Hospital Antonio Pedro University – Federal Fluminense University (HUAP-UFF) – Niterói (RJ), Brazil.
Suction curettage is an increasingly popular dermatological surgical technique for the treatment of axillary hyperhidrosis. Purpose: The purpose of this study is to describe the modern technique of axillary sweat gland removal and to evaluate its efficacy and safety. Conclusion: Suction-curettage of sweat glands is a minimally invasive surgical procedure that is easy to perform, safe, with high success rates and relatively few side effects. It is generally well tolerated by patients and requires more time off daily activities than other surgical methods.
Contents
Surgery To Remove Sweat Glands In Hands
Hyperhidrosis is a common, underdiagnosed and undertreated disease. It is characterized by sweat secretion that exceeds the normal physiological needs of the body to regulate body temperature and can significantly impair the quality of life of affected patients. 11 Connolly M, de Berker D. Management of primary hyperhidrosis: a summary of different approaches. Am J Clin Dermatol. 2003;4:681-97. 2 Gelbard CM, Epstein H, Hebert A. Primary pediatric hyperhidrosis: a review of current treatments. Pediatric Dermatol. 2008;25:591-8. 3 Mahendiran S, Burkhart CN, Burkhart CG. Hyperhidrosis: a review of the medical condition. Open Dermatol J. 2009;3:195-7.
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44 Ramos R, Moya J, Turon V, Perez J, Villalonga R, Morera R, et al. Primary hyperhidrosis and anxiety: a preoperative survey of 158 patients. Arch Bronconeumol. 2005;41:88-92. Quality of life studies show that the adverse effects of hyperhidrosis are comparable to conditions such as severe psoriasis, end-stage renal disease, rheumatoid arthritis, and multiple sclerosis.55 Cinà CS, Clase CM. The Disease Intrusiveness Rating Scale: a measure of severity in individuals with hyperhidrosis. Qual Life Res. 1999;8:693-8.
Hyperhidrosis can be classified as primary (idiopathic) or secondary; generalized (involving the whole body) or focal (involving specific areas of the body).66 Felini R, Demarchi AR, Fistarol ED, Matiello M, Delorenze LM. Prevalence of hyperhidrosis in the adult population of Blumenau-SC, Brazil. Bras Dermatol. 2009;84:361-6.
Primary hyperhidrosis is idiopathic and focal. Areas of excessive sweat production include the armpits, hands, feet, and face. Affected individuals experience limitations in work, social interaction, physical activity, and leisure time. The condition also causes psychological and relational disturbances that significantly endanger the patient’s life. 66 Felini R, Demarchi AR, Fistarol ED, Matiello M, Delorenze LM. Prevalence of hyperhidrosis in the adult population of Blumenau-SC, Brazil. Bras Dermatol. 2009;84:361-6. It can also lead to many secondary medical conditions such as bacterial or fungal overgrowth, muscle cramps, eczematous dermatitis, etc.77 Gontijo GT, Gualberto GV, Madureira NAB. There is no treatment for axillary hyperhidrosis. Surg Cosmet Dermatol. 2011;3147-51. About two-thirds of patients report a positive family history, suggesting a genetic predisposition.88 Solish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupine M, et al. A comprehensive approach to recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg. 2007;33:908-23.
Secondary hyperhidrosis can be generalized or focal and results from an underlying condition such as endocrine, neurological, or infectious diseases. 22 Gelbard CM, Epstein H, Hebert A. Primary pediatric hyperhidrosis: a review of current treatment options. Pediatric Dermatol. 2008;25:591-8.
Hyperhidrosis (excessive Sweating)
Some criteria are recommended for the diagnosis of primary focal hyperhidrosis. In addition, visible and focal sweat secretion, lasting at least six months and without a clear reason, must be accompanied by at least two of the following characteristics: relatively symmetrical and bilateral; significant enough to disrupt daily activities; at least one episode per week; started before the age of twenty-five; positive family history; and interruption of focal sweating during sleep.99 Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Identification, diagnosis and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51:274-86.
Currently, there are several (subjective and objective) methods for assessing the degree of disease impairment. The Dermatology Life Quality Index (DLQI) and the Hyperhidrosis Severity Scale are two commonly used questionnaires to assess the impact of the disease on patients’ quality of life.
Minor’s starch-iodine test is an objective method of assessing the prevalence and distribution of disease, as well as an indirect iodine-starch test. However, these tests do not indicate the severity of the condition. 88 Solish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupine M, et al. A comprehensive approach to recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg. 2007;33:908-23.
1010. Vorkamp T, Foo FJ, Khan S, Schmitto JD, Wilson P. Hyperhidrosis: Emerging concepts and a comprehensive review. Surgeon. 2010;8:287-92.
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1111 Bechara FG, Tomi NS, Boorboor P, Sand M, Altmeyer P, Hoffmann K. Liposuction curettage for axillary hyperhidrosis: improving the success rate and determining its effectiveness. Dermatology. 2007;215:268-9. To perform these tests, the armpit must be clean, dry and free of hair. In the infant starch-iodine test, an alcohol solution of iodine is applied to the axillary skin. After the solution dries, the place is dusted with a thin layer of starch powder. When sweat is formed, it comes into contact with the two substances and forms a black-blue-purple precipitate, and therefore the test gives a positive result. Vorkamp et al (2010) 1010 Vorkamp T, Foo FJ, Khan S, Schmitto JD, Wilson P. Hyperhidrosis: Emerging concepts and a comprehensive review. Surgeon. 2010;8:287-92. suggests using a 3.5% alcohol solution of iodine, as well as Swinehart (2000).1212 Swinehart JM. Treatment of axillary hyperhidrosis: combining the starch-iodine test with the swollen liposuction technique. Dermatol Surg. 2000;26:392-6. For an indirect test, a standard sheet of A4 paper is pre-mixed with unground crystals of iodine and kept in a closed vial for 5 days (1 g of pure iodine per 50 sheets of paper). Then the sheet is placed under the armpit for 1 minute. Hyperdrotic areas mark the sheet with a blue-violet color. In most cases, the axillary sweat glands are concentrated in a central, round or oval area of about 4 to 5 centimeters. However, peripheral glands may also be found.1212 Swinehart JM. Treatment of axillary hyperhidrosis: combining the starch-iodine test with the swollen liposuction technique. Dermatol Surg. 2000;26:392-6.
Gravimetric test, ninhydrin test and VapoMeter can be used for quantitative evaluation.1313 Larson DL. Definite diagnosis and treatment of axillary hyperhidrosis: arthroscopic shaving with vapometer and suction. Aesthet Surg J. 2011;31:552-9. However, the objective methods of seeing or weighing sweat can ultimately lead to disappointment, because the rate of sweat changes over time and even in untreated patients can be completely absent at the time of consultation. 1414 Swartling C, Naver H. , Lindberg M. Botulinum toxin A improves quality of life in severe primary focal hyperhidrosis. Eur J Neurol. 2001;8:247-52.
Although a standard definition of excessive sweating has yet to be established, Cohen et al1515 Cohen JL, Cohen G, Solish N, Murray CA. Diagnosis, treatment and management of focal hyperhidrosis, including botulinum toxin therapy. Facial Plast Surg Clin North Am. 2007;15:17-30, v-vi. (2007) and Solish et al1616 Solish N, Wang R, Murray CA. Evaluation of the patient with hyperhidrosis. Thorac Surg Clin. 2008;18:133-140. (2008), in practice, believe that any sweating that significantly interferes with the daily life of patients (physically or psychologically, socially or professionally) should be considered abnormal.
Before making a diagnosis of primary hyperhidrosis, it is important to exclude secondary causes (infections, malignant tumors, drugs, neurological, metabolic and endocrine disorders). This disorder can appear at any stage of life. However, the average age of onset of the disease varies by location. Axillary onset usually occurs during adolescence.99 Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Identification, diagnosis and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51:274-86.
Sweaty Hands And Feet: Is It Hyperhidrosis Or Something Else?
Although the etiopathogenesis of hyperhidrosis is not well understood, its mode of action is well known. As shown in Table 1, different treatments affect different points in this pathway.
There are several therapeutic options for treating axillary hyperhidrosis: topical medications, systemic medications, iontophoresis, botulinum toxin, and various surgical procedures. Each case must be evaluated individually, taking into account the severity and extent of the clinical condition, as well as the advantages and disadvantages of each method. We must always remember that the treatment of axillary hyperhidrosis should always follow a step-by-step strategy, starting with the use of conservative methods.
Atkins et al (2002) believe that the goal of treatment should be to reduce sweating to a level acceptable to the patient.1717 Atkins JL, Butler PEM. Hyperhidrosis: a review of current management. Plast Reconstruction Surg. 2002;110:222-8. The authors emphasize the importance of understanding patients’ motivations and expectations before choosing a treatment plan. They should be informed about possible complications and aware of the limitations of all therapeutic options (clinical or surgical).
Coelho et al (2002) suggest that although psychological and psychotherapeutic treatment is palliative in nature, it can be helpful. Therefore, they should be used in patients with an increased emotional component or with psychological or psychiatric disorders.1818 Coelho MS, Lira EJT, Zanin AS, Gonçalves JL, Neto NB, Pagnano PMG, et al. video-thoracoscopic sympathectomy for
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