Questions & Answers

Stashak AB, Brewer JD. Management of hyperhidrosis. Clin Cosmet Investig Dermatol. 2014. 7:285-99. [Medline]. [Full Text].
Adar R. Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg Suppl. 1994. (572):9-11. [Medline].
Bisbal J, del Cacho C, Casalots J. Surgical treatment of axillary hyperhidrosis. Ann Plast Surg. 1987 May. 18(5):429-36. [Medline].
Morgan WP, Hughes LE. The distribution, size and density of the apocrine glands in hidradenitis suppuritiva. Br J Surg. 1979 Dec. 66(12):853-6. [Medline].
Thorlacius L, Gyldenlove M, Zachariae C, Carlsen BC. Distinguishing hyperhidrosis and normal physiological sweat production: new data and review of hyperhidrosis data for 1980-2013. Int J Dermatol. 2015 Oct. 54 (10):e409-15. [Medline].
Heckmann M, Ceballos-Baumann AO, Plewig G, et al. Botulinum toxin A for axillary hyperhidrosis (excessive sweating). N Engl J Med. 2001 Feb 15. 344(7):488-93. [Medline].
Minor V. Ein neues Verfahren zu der klinischen Untersuchung der Schweissabsonderung. Dtsch Z Nervenheilkd. 1928. 101302-7:
Shelley WB, Hurley HJ Jr. Studies on topical antiperspirant control of axillary hyperhidrosis. Acta Derm Venereol. 1975. 55(4):241-60. [Medline].
Glaser DA, Hebert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. J Am Acad Dermatol. 2019 Jan. 80 (1):128-38.e2. [Medline]. [Full Text].
Brooks M. FDA OKs New Topical Treatment for Excessive Underarm Sweating. Medscape Medical News. 2018 Jun 29. [Full Text].
Brehmer F, Lockmann A, Gronemeyer LL, Kretschmer L, Schon MP, Thoms KM. Repetitive injections of botulinum toxin A continuously increase the duration of efficacy in primary axillary hyperhidrosis: a retrospective analysis in 101 patients. J Dtsch Dermatol Ges. 2015 Aug. 13 (8):799-805. [Medline].
Fibla Alfara JJ, Molins Lopez-Rodo L, Hernandez Ferrandez J, Guirao Montes A. Effectiveness of bilateral clipping of the thoracic sympathetic chain for the treatment of severe palmar and/or axillary hyperhidrosis and facial flushing. Cir Esp. 2019 Jan 23. [Medline].
Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. 1990 Jul. 8(3):479-82. [Medline].
Shenaq SM, Spira M, Christ J. Treatment of bilateral axillary hyperhidrosis by suction-assisted lipolysis technique. Ann Plast Surg. 1987 Dec. 19(6):548-51. [Medline].
Ellis H. Axillary hyperhidrosis: failure of subcutaneous curettage. Br Med J. 1977 Jul 30. 2(6082):301-2. [Medline].
Skoog T. Excision of the axillary sweat glands. Plastic Surgery, New Methods and Refinements. Philadelphia, Pa: WB Saunders Co; 1974.
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. 2007 Feb. 119(2):562-7. [Medline].
Smidfelt K, Drott C. Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. Br J Surg. 2011 Dec. 98(12):1719-24. [Medline].
Kim JB, Park CK, Kum DY. The effect of thoracoscopic sympathicotomy at the fourth rib (r4) for the treatment of palmar and axillary hyperhidrosis. Korean J Thorac Cardiovasc Surg. 2011 Apr. 44(2):154-8. [Medline]. [Full Text].
Chou SH. Sympathetic ablative surgery for palmar and axillary hyperhidrosis. Semin Thorac Cardiovasc Surg. 2011 Autumn. 23(3):250-2. [Medline].
Gunn TM, Davis DM, Speicher JE, et al. Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy. J Thorac Cardiovasc Surg. 2014 Jul 22. [Medline].
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. 1994 Jul. 220(1):86-90. [Medline].
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. 1998 Nov. 41(5):488-97. [Medline].

Media Gallery

Surgical treatment of axillary hyperhidrosis. Staggered-cross incision of a classic Skoog procedure. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Karpinski modification of the classic Skoog procedure incision. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Iodine tincture or Betadine applied and air dried. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Cornstarch powdered onto dried iodine. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Iodine/starch test: As sweating begins, iodine and starch react wherever dampened to produce a blue color. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Further color development (see Image 6). Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Iodine/starch test: An indelible marker outlines the area positive for hyperhidrosis. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Preoperative axilla in a healthy young writer with axillary hyperhidrosis. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Outline of the operative site as estimated by the hair pattern (not by mapping). Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Anesthesia is attained by infiltration of local anesthetic. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: The transverse incision is made, here exposing the subcutaneous sweat glands. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Through the rather limited incision, dissection is carried to the entire outlined area. The dissection is deep to the glands but superficial to axillary fascia. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: In the recess of the incision, the shiny and somewhat striated axillary fascia is visible. In conducting the operation, no part of the dissection should violate this fascia. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Once the flaps are elevated and hemostasis is achieved, the flaps are everted and the layer of the glands snipped off the undersurface of the dermis. Here, the upper portion of the flap has been cleared of sweat glands, while the gland lobules are still visible on the lower portion of the flap. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. The carpet of glandular tissue is seen intact on the left side of the skin flap, while the glands have been resected on the right side of the flap, revealing the underside of the dermis. The axillary fascia is visible as a glistening sheet above the skin flap. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: Once the skin flaps are cleared of sweat glands, the dermis should be visible along with the bulbs of many hair follicles. Although not seen clearly in this photo, the fine vessels of the subdermal plexus should be visible under magnification as a network of red vessels. The posture of everting the flap over the surgeon's finger to facilitate gland dissection is demonstrated. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: At the completion of gland resection, vascularity of the flaps should show no compromise. Hemostasis should be meticulous. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: A drain has been led out through a small incision at the most proximal area dissected. This spot will be the most dependent when the patient is up and about. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: The incision has been closed in two layers, and the drain secured with a single suture. The needle end of the drain can be inserted into a Vacutainer red top tube to supply gentle suction once the incision is closed. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Incision is closed and drain is in place. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: The bandage should be padded and should overlie the entire dissected area. The distal portion can be held in place by wrapping the arm, and the proximal portion needs to be attached to the chest so that the dressing acts like a hinge when the arm is abducted. Image courtesy of Richard H S Karpinski, MD.
Surgical treatment of axillary hyperhidrosis. Modified Skoog procedure: The completed dressing, in this case using a self-adherent stretchy flexible bandage on top of surgical paper tape and Tegaderm. Image courtesy of Richard H S Karpinski, MD.
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.
Surgical treatment of axillary hyperhidrosis. Professor Tord Skoog (1915-1977).

of 24

Sections Surgical Treatment of Axillary Hyperhidrosis
Overview
Workup
Treatment
Questions & Answers
Media Gallery
References

Surgical Treatment of Axillary Hyperhidrosis Questions & Answers

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Surgical Treatment of Axillary Hyperhidrosis Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Related Conditions and Diseases

Medscape Consult

News & Perspective

Tools

Most Popular Articles

Recommended