Category: Axillary

Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split-area comparative trial.

Lasers Surg Med. 2019 Feb 27;:

Authors: Kaminaka C, Mikita N, Inaba Y, Kunimoto K, Okuhira H, Jinnin M, Kao B, Tanino R, Tanioka K, Shimokawa T, Yamamoto Y

Abstract
BACKGROUND AND OBJECTIVES: Microwave treatment is an effective non-invasive treatment option for primary axillary hyperhidrosis (PAH), but the treatment parameters vary and no histopathological studies have been performed to validate clinical outcomes. This study investigated its efficacy and safety and histopathological changes after a single microwave treatment at the maximum energy level for PAH in Asians.
MATERIALS AND METHODS: A prospective, clinical, and histological split-area randomized controlled trial (RCT) was performed in Japan. Twenty-six subjects underwent a single microwave treatment at the maximum energy level 5 (5.8 GHz/axilla) on the randomized side of axillae. The primary outcome was the mean difference between both sides in the improvement of modified single-underarm Hyperhidrosis Disease Severity Scale (msHDSS) scores over the course of the 12-month study period from baseline. The secondary outcomes were; the percentage of responders with at least a 2-point drop in the msHDSS score of 3 or 4 group or with a 1-point drop in the msHDSS score of 2 group; the percentage of responders with at least a 75% reduction in sweat weight over 12 months; recurrence rate; and adverse effects. We also performed a histological assessment for 13 selected subjects.
RESULTS: Twenty-four subjects completed the study. There were statistically significant differences in improvement of msHDSS scores between the microwave-treated and control sides (P < 0.05) from baseline at 0.5, 1, 3, 6, and 12 months. In the msHDSS score of 3 or 4 group, the percentage of responders with at least a 2-point drop on the microwave-treated side versus control side was 72.2 versus 11.1% (P < 0.05) at 1 month, 83.3 versus 5.6% (P < 0.05) at 3 months, 61.1 versus 38.9% (P = 0.317) at 6 months and 38.9 versus 16.7% (P = 0.264) at 12 months. The percentage of responders with at least a 75% reduction in sweat weight on the microwave-treated side versus control side was 75.0 versus 37.5% at 1 month, 75.0 versus 29.2% at 3 months, 83.3 versus 50.0% at 6 months and 70.8 versus 33.3% at 12 months (all P < 0.05). Recurrence on the microwave-treated side was observed in 4.2% and 12.5% of 24 subjects at 3 and 12 months, respectively. No serious side-effects were noted. Histology showed the diameter and density of secretory eccrine glands and nerve fiber lengths around eccrine glands were significantly decreased after treatment compared to baseline (P = 0.002, 0.027, 0.003, respectively).
CONCLUSIONS: A single-session microwave treatment at the maximum energy level significantly improved the PAH of Japanese patients and had minimal side effects. This technique demonstrates that diminished size of secretory eccrine glands and nerve fiber degeneration could be useful markers for predicting the efficacy of the treatment. Lasers Surg. Med. 9999:1-8, 2019. © 2019 Wiley Periodicals, Inc.

PMID: 30811620 [PubMed – as supplied by publisher]

Bilateral brachial plexus injury after MiraDry® procedure for axillary hyperhidrosis: a case report.

World Neurosurg. 2019 Jan 28;:

Authors: Puffer RC, Bishop AT, Spinner RJ, Shin AY

Abstract
Multiple treatments are available for primary axillary hyperhidrosis, including non-invasive, microwave based thermal treatments designed to destroy sweat glands in the axilla. Often these procedures involve local anesthetic injection to the axilla, followed by placement of the microwave emitter onto the skin and applying the heat treatment to varying depths of the subcutaneous tissues. CASE REPORT: A 49-year old, thin and active woman (BMI 19.6) underwent microwave based treatment to the bilateral axillary regions. She experienced an electric sensation into the ulnar digits of the right hand during anesthetic injection, and then underwent the microwave thermal treatment. She suffered a bilateral brachial plexus injury with imaging evidence of severe, subcutaneous edema surrounding the nerves of the plexus in the axilla, as well as denervation atrophy of the arm and forearm muscles bilaterally. At the time of evaluation and EMG, 8 months after treatment, she had recovered significant strength in the left upper extremity, but continued to have evidence of a severe radial nerve injury on the right. EMG demonstrated some recovery and observation was recommended followed by secondary reconstruction if required. It is likely that the patient sustained thermal injury to the nerves in the axilla bilaterally, given the close proximity to the skin surface in a patient with a low BMI. CONCLUSION: In thin patients undergoing treatment of primary axillary hyperhidrosis, consideration should be given to the distal brachial plexus which may be at risk of damage with high powered microwave-based therapy.

PMID: 30703585 [PubMed – as supplied by publisher]