Surgical Treatment of Axillary Hyperhidrosis Workup

Updated: Feb 17, 2016
  • Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Workup

Laboratory Studies

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.

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Other Tests

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. [6]

Minor's iodine starch test has been used for many years to map the areas of axillary hypersecretion. [7]

The axilla is dried thoroughly, painted with an iodine tincture, then air-dried. See the image below.

Surgical treatment of axillary hyperhidrosis. Iodi Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Iodine tincture or Betadine applied and air dried. Image courtesy of Richard H S Karpinski, MD.

The dried area is then dusted with cornstarch or potato flour. See the image below.

Surgical treatment of axillary hyperhidrosis. Iodi Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Cornstarch powdered onto dried iodine. Image courtesy of Richard H S Karpinski, MD.

As the patient begins to sweat, moistened starch combines with the iodine to produce a vivid blue color. See the images below.

Surgical treatment of axillary hyperhidrosis. Iodi 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. Iodi Surgical treatment of axillary hyperhidrosis. Iodine/starch test: Further color development (see Image 6). Image courtesy of Richard H S Karpinski, MD.

The hyperhidrotic areas then can be mapped and outlined with an indelible felt-tip marker. See the image below.

Surgical treatment of axillary hyperhidrosis. Iodi 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.

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.

Surgical treatment of axillary hyperhidrosis. Modi 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.
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