Surgical Treatment of Axillary Hyperhidrosis Workup
- Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS more...
Diagnosis of axillary hyperhidrosis is essentially from patient history (see Clinical) and from visible signs of excessive sweating. No useful formal staging or severity scale exists, but the terms mild, moderate, and severe are used in some clinical descriptions. Hund et al have proposed a quantitative definition of axillary hyperhidrosis, but the requirement of a gravimetric assay makes this approach practical only in the research setting.
Laboratory testing may play a vital role in excluding secondary hyperhidrosis from causes such as hyperthyroidism, pheochromocytoma, carcinoid or other malignancy, tuberculosis, or adrenal pathology, especially in patients with asymmetric, late, or atypical onset of symptoms.
Heckmann et al have described a gravimetric method for quantitating sweat production in which filter paper is weighed dry on a high-precision laboratory scale, then placed in contact with a hyperhidrotic area of patient skin for 60 seconds, then weighed again. They found the rate of sweat production in hyperhidrotic areas to be near 200 mg/min.
Minor's iodine starch test has been used for many years to map the areas of axillary hypersecretion.
The axilla is dried thoroughly, painted with an iodine tincture, then air-dried. See the image below.
The dried area is then dusted with cornstarch or potato flour. See the image below.
As the patient begins to sweat, moistened starch combines with the iodine to produce a vivid blue color. See the images below.
The hyperhidrotic areas then can be mapped and outlined with an indelible felt-tip marker. See the image below.
A variation of this test uses ninhydrin solution sprayed on an air-dried axilla, relying on color reaction with proteinaceous sweat to produce a visible pattern.
In practice, gravimetric measurement of sweat production is seldom used. Iodine mapping is also of limited usefulness as a prelude to surgery, since the hyperhidrotic area usually corresponds quite closely to the hair-bearing area of the axilla; however, mapping may be extremely helpful in pinpointing an area of recurrence (or failed gland resection) in patients who require reoperation. See the image below.
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