Laser Assisted Reduction of Axillary Hyperhidrosis (LARAH) – evaluation of success up to 24 months after the treatment

Keywords:laser, treatment, assisted,  Time:04-11-2015

ABSTRACT

The objective of this study was to evaluate the safety and efficacy (reduction of axillary sweating) up to 24 months after subdermal Nd:YAG laser treatment of Axillary Hyperhidrosis.

Method:


A retrospective study was conducted on 32 patients (23 females and 9 males) who received subdermal 1064 nm NdYAG laser treatment of axillary hyperhidrosis on both axillas between May 2008 and November 2010. The majority of patients (27) received only one treatment while 5 patients came back for a second touch-up treatment. Laser energy of approx. 200 J/cm2 was delivered to sweat-producing areas. These areas were detected prior to surgery with an iodine - starch test. Assessment of the axillar sweating reduction was made subjectively by patient self evaluation and objectively by a comparison of sweat-producing surface area as measured by the iodine starch test. Patients were asked about post-op pain, recovery time and potential compensatory sweating, and about their general satisfaction with treatment.

Conclusions:


Laser assisted reduction of axillary hyperhidrosis with NdYAG laser is an effective and safe method for the permanent and significant reduction of axillary sweating.


INTRODUCTION：

Hyperhidrosis in the armpit region is a very unpleasant condition for both men and women at all ages, especially during the summer. Numerous treatment modalities have been used in an attempt to treat axillary hyperhidrosis including topical and systemic medications and surgical methods. The most common method is the use of botulinum toxin to temporarily disable the sweat glands [7,8,9]. All of these methods have their limitations and side effects; for these reasons new methods are constantly being sought. One newer technique involves the use of lasers for the selective thermal destruction of sweat glands. The proponents of this technique claim that it is a permanent solution, with the additional advantages of being minimally invasive and safe. The purpose of this study is to assess the efficacy, safety, and permanence of this treatment.  

MATERIALS AND METHODS

32 patients suffering from moderate-to-severe axillary hyperhidrosis were treated subdermally by Nd:YAG 1064 nm laser under tumescent local anesthesia using the Schavelzon-Blugerman technique [1,2]. All treatments were executed at a single center, Dr. Maletic’s Polyclinc in Daruvar, Croatia in the period between May 2008 and November 2010.  At the baseline consultation visit patients were examined to determine there suitability according to the inclusion and exclusion criteria. All patients submitted to treatment had passed inclusion criteria and had provided written informed consent form.

Treatment procedure

Laser assisted reduction of axillary hyperhidrosis is a surgical procedure executed under local tumescent anesthesia, where the apocrine glands are destroyed with the laser energy and removed from the armpit with suction probe (modified Blugerman-Schavelzon model) [1].  To detect the location of sweat glands and obtain an objective measure of method efficacy an iodine starch test was performed on all patients prior to treatment. Photographs of sweat-producing areas were taken and surface areas were calculated.  

(Fotona XP-2, Slovenia) using a 600 µm fiber and 3 mm cannula. Laser energy was delivered in quasicontinuous mode, with a power of 10 W, a repetition rate of 40 Hz and a pulse-duration of 300 µsec. An average of 211 J/cm2 of laser energy was delivered to the sweat-producing area.(Medfiber provide medical fibers- Disposable Bare Fiber,Diffuser Fiber,Holmium Fiber,Polyimide Fiber,Side Fire Fiber,)

During the treatment the skin surface was cooled with cold air (Cryo6, Zimmer, Germany) to prevent surface skin temperatures from reaching beyond 40 °C. After the treatment patients received bandages and compression garments to wear for 48 hours. Post-op recovery of all patients was checked by telephone interviews on day 2, one week and one month after the treatment. To optimize the results five (15%) patients got secondary touch-up treatment one to two months after the first treatment. Assessment of axillary sweating reduction was performed by comparing the results of iodine - starch tests before and after pictures and the subsequent calculation of residual sweat-producing areas. All patients were additionally interviewed for their  self-assessment of degree of axillar sweating reduction post-op pain, adverse effects, time to full recovery, potential compensatory sweating and general satisfaction with treatment and its outcome. Degree of sweating reduction was graded using a four-point scale: 0 (0-25%), 1 (26-50%), 2 (51-75%) and 3 (76100%. A similar four-point scale was used for evaluation of the level of satisfaction: 0 (not satisfied) 1 (somewhat satisfied), 2 (satisfied) and 3 (very satisfied). Interviews with the patients were held in January 2011. For most of the patients (15/32 or 47%) the interview was done 18 to 24 months after the treatment, for 7 patients (22%) this follow-up was 1218 months after the treatment, 5 patients (16%) were interviewed 6-12 months after and only 5 patients had follow up shorter that 6 months.  

RESULTS

Measurements of sweat-producing areas before and after the treatment were taken on 30 axillas of 15 patients who came for follow-up control visits one to three months after treatment. The average measured sweating reduction was 93%, with results ranging from 73% to 100% as shown on Fig.