Microwave-based therapy for axillary hyperhidrosis
Editorial

Microwave-based therapy for axillary hyperhidrosis

Sujoy Roychowdhury1, Salvatore Scuderi2

1Royal Perth Hospital, Perth, WA, Australia; 2Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

Correspondence to: Sujoy Roychowdhury. Royal Perth Hospital, Perth, WA, Australia. Email: sujoyr@gmail.com.

Received: 02 January 2019; Accepted: 14 January 2019; Published: 21 March 2019.

doi: 10.21037/shc.2019.03.04


Microwave treatment for axillary hyperhidrosis is an effective treatment modality with high rates of patient satisfaction (1). It has a rapid response time and effectively allows the patient to return to work or normal physical activity in a short period of time. The procedure is performed under local anaesthesia and each armpit takes around thirty minutes for the microwave application to occur. Each armpit needs two treatments, around 3 months apart. The most common side effects of this modality include swelling, pain, numbness and hair loss. The side effects are minor and short lived.

Being a permanent treatment modality, it should be compared with the other permanent options reported in the literature which include radical surgical excision, excision with liposuction and endoscopic thoracic sympathectomy (2). There are also newly developed physical therapies that are currently being explored including the recently described Nd-YAG laser used both on the skin surface and subdermally (3-5). Studies have demonstrated that both modalities are effective in axillary hyperhidrosis. Laser treatments are effective but are often associated with long recovery times and can leave scarring and retraction. Surgically, endoscopic thoracic sympathectomy is very effective but compensatory hyperhidrosis has been as high as 94% (6). It is however a very effective and satisfying with satisfaction rates high at 88.7% at three years of follow up (7). Medical management with anticholinergic agents has declined in recent years with the use of these newer modalities. While effective, three quarters of patients report dry mouth (8). Other anticholinergic side effects including headache, constipation, and urinary retention limit their use in some patients (9).

Microwave ablation is effective and, most importantly, the side effects are fewer and less significant in comparison to other modalities (10-12). It has followed up data for 12 months which showed a statistically significant improvement [responders defined as those reaching Hyperhidrosis Disease Severity Score (HDSS) of 2 or less] (12,13). Hong et al.’s un-blinded study of 31 patients showed that over 90 per cent of patients achieved a HDSS score of 2 or less with a follow up time of 12 months (11). From a patient focused perspective, microwave treatment is highly effective and patients report a high level of satisfaction (14). Lupin et al. reported a significant reduction in the above Dermatology Life Quality Index (DLQI) points (14). In their systematic review, Nasr et al. reported better short-term and longer lasting results than Botox or liposuction-curettage (9,14,15). Most of the literature focuses on axillary hyperhidrosis so studies on other body parts is welcome. Pace and Kentosh reported on the emerging usage of microwave ablation on residual limbs to combat dermatoses driven by the prosthetic liner covering limb prosthesis in young amputee patients (16).


Conclusions

Axillary hyperhidrosis is common and intrusive. Patients present with debilitating effects on their confidence and interaction with other people. It can severely impact quality of life.

Surgical intervention does provide long-term management of axillary hyperhidrosis but it is more invasive and associated with compensatory hyperhidrosis. Alternatively, long-term oral medications and injections have side effects, are expensive and only work for short periods of time relative to the permanent modalities. The microwave device treatment offers a long-term solution to axillary hyperhidrosis, is non-invasive, has little downtime, minimal side effects and high patient satisfaction.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Scuderi S, Manoharan P, Lim D, et al. A survey of patient satisfaction with use of microwave device for axillary hyperhidrosis. Australas J Dermatol 2017;58:126-9. [Crossref] [PubMed]
  2. Ou LF, Yan RS, Chen IC, et al. Treatment of axillary bromhidrosis with superficial liposuction. Plast Reconstr Surg 1998;102:1479-85. [Crossref] [PubMed]
  3. 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. [PubMed]
  4. Goldman A, Wollina U. Subdermal Nd-YAG laser for axillary hyperhidrosis. Dermatol Surg 2008;34:756-62. [PubMed]
  5. Jacob C. Treatment of hyperhidrosis with microwave technology. Semin Cutan Med Surg 2013;32:2-8. [PubMed]
  6. Chwajol M, Barrenechea IJ, Chakraborty S, et al. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery 2009;64:511-8; discussion 518. [Crossref] [PubMed]
  7. Karamustafaoglu YA, Kuzucuoglu M, Yanik F, et al. 3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects. J Laparoendosc Adv Surg Tech A 2014;24:782-5. [Crossref] [PubMed]
  8. Wolosker N, de Campos JR, Kauffman P, et al. The use of oxybutynin for treating axillary hyperhidrosis. Ann Vasc Surg 2011;25:1057-62. [Crossref] [PubMed]
  9. Nasr MW, Jabbour SF, Haber RN, et al. Comparison of microwave ablation, botulinum toxin injection, and liposuction-curettage in the treatment of axillary hyperhidrosis: A systematic review. J Cosmet Laser Ther 2017;19:36-42. [Crossref] [PubMed]
  10. Johnson JE, O'Shaughnessy KF, Kim S. Microwave thermolysis of sweat glands. Lasers Surg Med 2012;44:20-5. [Crossref] [PubMed]
  11. Hong HC, Lupin M, O'Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg 2012;38:728-35. [Crossref] [PubMed]
  12. Lee SJ, Chang KY, Suh DH, et al. The efficacy of a microwave device for treating axillary hyperhidrosis and osmidrosis in Asians: a preliminary study. J Cosmet Laser Ther 2013;15:255-9. [Crossref] [PubMed]
  13. Hamm H. Impact of hyperhidrosis on quality of life and its assessment. Dermatol Clin 2014;32:467-76. [Crossref] [PubMed]
  14. Lupin M, Hong HC. OʼShaughnessy KF. Long-term efficacy and quality of life assessment for treatment of axillary hyperhidrosis with a microwave device. Dermatol Surg 2014;40:805-7. [PubMed]
  15. Doft MA, Hardy KL, Ascherman JA. Treatment of hyperhidrosis with botulinum toxin. Aesthet Surg J 2012;32:238-44. [Crossref] [PubMed]
  16. Pace S, Kentosh J. Managing residual limb hyperhidrosis in wounded warriors. Cutis 2016;97:401-3. [PubMed]
doi: 10.21037/shc.2019.03.04
Cite this article as: Roychowdhury S, Scuderi S. Microwave-based therapy for axillary hyperhidrosis. Shanghai Chest 2019;3:19.