Hyperhidrosis: Local Removal of Sweat Glands


Hyperhidrosis and Facial Blushing

- Hyperreactivity of the Sympathetic Nervous System -


Local Removal of Sweat Glands

Resection (exeresis) of the axillary sweat glands

The method consists in removal of the skin in the armpits. The procedure must be performed as radically as possible and encompass the area with the highest density of sweat glands; generally, this means removal of all of the hair bearing skin. Depending on the dimension of the resulting skin defect, closure could result difficult and often wound healing will be impaired and delayed. The the edges of the wound can not be sutured without tension, even if Y- or Z-plasty or similar flap transposition principles of plastic surgery are employed. Cosmetically disturbing scars are almost an inevitable consequence. On the other hand, limited excision often leads to persistent hyperhidrosis from the edges, requiring additional measures.
Today, this procedure is almost abandoned.

Example of a removal of the axillary sweat glands, not radical enough; due to residual hyperhidrosis, the patient requires annual botulinum toxin infiltrations:

Fig.1: right armpit

Fig.2: left armpit

Curettage and suction curettage

In order to avoid the disadvantage of a large skin defects, methods have been developed that preserve the skin, trying instead to destroy and aspirate the sweat glands under the skin. Such procedures can be performed on an outpatient basis under local anesthesia (tumescence anesthesia). Thin curettes (sharp scraping devices) or suction curettes are introduced through small skin incisions into the subcutaneous tissue. In the plane between the superficial skin layer (dermis and epidermis) and the subcutaneous fatty tissue, the sweat glands are separated from the dermis and aspirated or, at least, damaged. Eventually, a suction drain is inserted and a compression bandage is applied to prevent bleeding or collection of body fluid into the resulting cavity.

Abb.3: curettage

Abb.4: curette

Abb.5: suction curettage

Abb.6: suction cannula

The result of the subcutaneous suction curettage depends on the surgeon's experience, since too careful a curettage leads to a quick relapse and too radical curettage endangers the blood supply of the central portions of the skin overlying the cavity. Skin necrosis, delayed wound healing and scarring may result. Even correctly performed surgery does not guarantee a permanent result, as regeneration of the glands and re-innervation of the torn nerve endings may ensue. So far reliable reports on long-term results are still lacking. At short and medium term, patient satisfaction in the order of 70-90 % is claimed.

Tumescent suction curettage vs. curettage only for treatment of axillary hyperhidrosis evaluated by subjective and new objective methods.
Tronstad C, Helsing P, Tønseth KA, Grimnes S, Krogstad AL.
Acta Derm Venereol. 2014 Mar;94(2):215-20. doi: 10.2340/00015555-1671.

The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial.
Ibrahim O, Kakar R, Bolotin D, Nodzenski M, Disphanurat W, Pace N, Becker L, West DP, Poon E, Veledar E, Alam M.
J Am Acad Dermatol. 2013 Jul;69(1):88-95. doi: 10.1016/j.jaad.2013.02.013. Epub 2013 Apr 13.