eMedicine Specialties > Plastic Surgery > Skin

Surgical Treatment of Axillary Hyperhidrosis: Follow-up

Author: Richard H S Karpinski, MD, FACS, Assistant Clinical Professor, Department of Surgery, Columbia University College of Physicians and Surgeons; Senior Attending, Department of Surgery, St Luke's/Roosevelt Hospital
Contributor Information and Disclosures

Updated: Jul 17, 2009

Outcome and Prognosis

Endoscopic sympathectomy

Herbst et al studied 323 patients nearly 15 years after endoscopic thoracic sympathectomy and summarized their results as follows:

There was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1%) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's triad in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).12

Sympathetic regeneration has been documented in animals and humans and may result in late recurrence of hyperhidrotic symptoms. In animals, sympathetic fibers have remarkable regenerative ability, with regrowth and reinnervation through muscle and scar over time.

To achieve axillary anhidrosis, more extensive and/or more caudal resection of the sympathetic chain has been advocated, but this also seems to increase the chances of compensatory sweating and cardiovascular dysautonomia.

Skoog procedure

Every dissected (thus denervated) axilla is dry, even if no sweat glands are resected. Therefore, long-term outcome of sweat gland resection can only be judged after 6 months, when reinnervation should already have taken place. Most patients have a dry axilla for the few months following surgery, then develop some sweating, which the patients characterize as "normal." With meticulous dissection, long-term relief of hyperhidrosis approaches 95%. In a study of use of a mechanical gland-shaving device, Park et al reported an overall satisfaction rate of 94.7% with a complication rate of 13.2%.13

Surgical treatment of axillary hyperhidrosis. Mod...

Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Resulting scar at 2 months after surgery. Note the normal texture and appearance of axillary skin and the normal hair pattern. The pink coloration usually is gone at 4-5 months. Image courtesy of Richard H S Karpinski, MD.

[ CLOSE WINDOW ]
Surgical treatment of axillary hyperhidrosis. Mod...

Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Resulting scar at 2 months after surgery. Note the normal texture and appearance of axillary skin and the normal hair pattern. The pink coloration usually is gone at 4-5 months. Image courtesy of Richard H S Karpinski, MD.

Future and Controversies

Axillary hyperhidrosis is a condition that is little recognized by patients and physicians outside Scandinavia and Great Britain. Patients who suffer from this condition often are misdiagnosed or dismissed as having psychosomatic complaints. Worse, various ineffective therapies are often recommended by "experts."

In Britain and Sweden, treatment of axillary hyperhidrosis is generally covered under the respective National Health Service. In the United States, most insurers deny coverage because surgery is not considered "medically necessary" or because the insurer is either unaware of the procedures or considers them "experimental." No CPT code is defined for the Skoog procedure, but hyperhidrosis has ICD-9 codes as follows:

  • 705.21 - Primary focal hyperhidrosis (axilla, face, palms, soles)
  • 705.22 - Secondary focal hyperhidrosis
Increased popularity and promotion by the manufacturer of BOTOX ® treatments for hyperhidrosis have raised the profile of the condition and made some insurers a more aware of the diagnosis. However, coverage of this treatment for hyperhidrosis remains inconsistent and uncommon.

 


More on Surgical Treatment of Axillary Hyperhidrosis

Overview: Surgical Treatment of Axillary Hyperhidrosis
Workup: Surgical Treatment of Axillary Hyperhidrosis
Treatment: Surgical Treatment of Axillary Hyperhidrosis
Follow-up: Surgical Treatment of Axillary Hyperhidrosis
Multimedia: Surgical Treatment of Axillary Hyperhidrosis
References
[ CLOSE WINDOW ]

References

  1. Adar R. Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg Suppl. 1994;(572):9-11. [Medline].

  2. Bisbal J, del Cacho C, Casalots J. Surgical treatment of axillary hyperhidrosis. Ann Plast Surg. May 1987;18(5):429-36. [Medline].

  3. Morgan WP, Hughes LE. The distribution, size and density of the apocrine glands in hidradenitis suppuritiva. Br J Surg. Dec 1979;66(12):853-6. [Medline].

  4. Heckmann M, Ceballos-Baumann AO, Plewig G, et al. Botulinum toxin A for axillary hyperhidrosis (excessive sweating). N Engl J Med. Feb 15 2001;344(7):488-93. [Medline].

  5. Minor V. Ein neues Verfahren zu der klinischen Untersuchung der Schweissabsonderung. Dtsch Z Nervenheilkd. 1928;101302-7.

  6. Shelley WB, Hurley HJ Jr. Studies on topical antiperspirant control of axillary hyperhidrosis. Acta Derm Venereol. 1975;55(4):241-60. [Medline].

  7. Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. Jul 1990;8(3):479-82. [Medline].

  8. Shenaq SM, Spira M, Christ J. Treatment of bilateral axillary hyperhidrosis by suction-assisted lipolysis technique. Ann Plast Surg. Dec 1987;19(6):548-51. [Medline].

  9. Ellis H. Axillary hyperhidrosis: failure of subcutaneous curettage. Br Med J. Jul 30 1977;2(6082):301-2. [Medline].

  10. Skoog T. Excision of the axillary sweat glands. In: Plastic Surgery, New Methods and Refinements. Philadelphia, Pa: WB Saunders Co; 1974.

  11. Arneja JS, Hayakawa TE, Singh GB, et al. Axillary hyperhidrosis: a 5-year review of treatment efficacy and recurrence rates using a new arthroscopic shaver technique. Plast Reconstr Surg. Feb 2007;119(2):562-7. [Medline].

  12. Herbst F, Plas EG, Fugger R, Fritsch A. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. Ann Surg. Jul 1994;220(1):86-90. [Medline].

  13. Park DH, Kim TM, Han DG, Ahn KY. A comparative study of the surgical treatment of axillary osmidrosis by instrument, manual, and combined subcutaneous shaving procedures. Ann Plast Surg. Nov 1998;41(5):488-97. [Medline].

  14. Atkins JL, Butler PE. Hyperhidrosis: a review of current management. Plast Reconstr Surg. Jul 2002;110(1):222-8. [Medline].

  15. Atkins JL, Butler PE. Treating hyperhidrosis. Excision of axillary tissue may be more effective. BMJ. Sep 16 2000;321(7262):702; author reply 703. [Medline].

  16. Chiou TS, Chen SC. Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Br J Surg. Jan 1999;86(1):45-7. [Medline].

  17. Freeman R, Waldorf HA, Dover JS. Autonomic neurodermatology (Part II): Disorders of sweating and flushing. Semin Neurol. Dec 1992;12(4):394-407. [Medline].

  18. Goldwyn RM. Editorial: The treatment of axillary hyperhidrosis. Arch Surg. Jan 1976;111(1):13. [Medline].

  19. Gossot D, Galetta D, Pascal A. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg. Apr 2003;75(4):1075-9. [Medline].

  20. Guttmann L. A demonstration of the study of sweat secretion by the quinazarin method. Proc R Soc Med. 1941;35:77-8.

  21. Hamm H, Naumann MK, Kowalski JW, Kutt S, Kozma C, Teale C. Primary focal hyperhidrosis: disease characteristics and functional impairment. Dermatology. 2006;212(4):343-53. [Medline].

  22. Heckmann M. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. Jun 1998;42(6):1403-4. [Medline].

  23. Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. Aug 2004;51(2):274-86. [Medline].

  24. Hund M, Kinkelin I, Naumann M, Hamm H. Definition of axillary hyperhidrosis by gravimetric assessment. Arch Dermatol. Apr 2002;138(4):539-41. [Medline].

  25. Karpinski RHS. Axillary hyperhidrosis: treatment by excision or by suction adenectomy. Abstract presented at: Northeastern Society of Plastic Surgeons Annual Meeting; Sep 1990.

  26. Lawrence CM, Lonsdale Eccles AA. Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients. Br J Dermatol. Jul 2006;155(1):115-8. [Medline].

  27. Mack GW, Shannon LM, Nadel ER. Influence of beta-adrenergic blockade on the control of sweating in humans. J Appl Physiol. Nov 1986;61(5):1701-5. [Medline].

  28. Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ. Sep 16 2000;321(7262):702-3. [Medline].

  29. Odia S, Vocks E, Rakoski J, Ring J. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol. Nov 1996;76(6):472-4. [Medline].

  30. Reinauer S, Neusser A, Schauf G, Holzle E. Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. Br J Dermatol. Aug 1993;129(2):166-9. [Medline].

  31. Skoog T, Thyresson N. Hyperhidrosis of the axillae, a method of surgical treatment. Acta Chir Scand. 1962;124:531-8.

  32. Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. Aug 2004;51(2):241-8. [Medline].

  33. Wang HJ, Cheng TY, Chen TM. Surgical management of axillary bromidrosis--a modified skoog procedure by an axillary bipedicle flap approach. Plast Reconstr Surg. Sep 1996;98(3):524-9. [Medline].

  34. Wu WH, Ma S, Lin JT, et al. Surgical treatment of axillary osmidrosis: an analysis of 343 cases. Plast Reconstr Surg. Aug 1994;94(2):288-94. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

excessive underarm sweating, bromidrosis, osmidrosis, idiopathic hyperhidrosis, essential hyperhidrosis, primary hyperhidrosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Richard H S Karpinski, MD, FACS, Assistant Clinical Professor, Department of Surgery, Columbia University College of Physicians and Surgeons; Senior Attending, Department of Surgery, St Luke's/Roosevelt Hospital
Richard H S Karpinski, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Shahin Javaheri, MD, Chief, Department of Plastic Surgery, Martinez Veterans Affairs Outpatient Clinic; Consulting Staff, Advanced Aesthetic Plastic & Reconstructive Surgery
Shahin Javaheri, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Gregory Caputy, MD, PhD, FICS, Chief Surgeon, Aesthetica Plastic and Laser Surgery Center, Inc
Gregory Caputy, MD, PhD, FICS is a member of the following medical societies: American Medical Association, American Society for Laser Medicine and Surgery, Canadian Medical Association, Hawaii Medical Association, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association, and Wound Healing Society
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.