Histological and clinical findings in different surgical strategies for focal axillary hyperhidrosis.
BACKGROUND
Although a variety of different surgical strategies for focal axillary hyperhidrosis (FAH) have proven effective, little is known of intraoperative and postoperative histologies of different surgical methods.


OBJECTIVE
The objective was to use pre-, intra-, and postoperative histologic findings to evaluate different surgical procedures for FAH in establishing a possible correlation between the interventions and clinical outcome.


METHODS
A total of 40 patients underwent surgery with 15 undergoing liposuction-curettage (LC), 14 radical skin excision (RSE) with Y-plasty closure, and 11 a skin-sparing technique (SST). Before surgery, density and ratio of eccrine and apocrine sweat glands were evaluated with routine histology. Further biopsies were taken directly after surgery in the RSE and SST groups and 1 year postoperatively in all patients. Additionally, gravimetry was performed, side effects were documented, and patients were asked to evaluate the aesthetic outcome of the surgical method by using an analogue scale.


RESULTS
Preoperatively, the mean density of eccrine glands was 11.1/cm(2) compared to 16.9/cm(2) apocrine glands (apocrine/eccrine ratio, 1.6). Biopsy specimen directly after surgery showed remaining sweat glands in 7/15 (46.7%) LC patients and in 4/11 (36.4%) of the SST patients. One year after surgery, sweat gland density was significantly reduced in the LC (79.1%) and the SST (74.9%) groups. In the RSE group, only scar formation was present. Gravimetry showed significantly reduced sweat rates 12 months after surgery in all groups (LC, 66.4%; SST, 62.9%; RSE, 65.3% [p<.05]). Most frequent side effects were hematoma (LC, n=3; SST, n=2; RSE, n=3), subcutaneous fibrotic bridles (LC, n=8; SST, n=3; RSE, n=0), skin erosion (LC, n=3; SST, n=4; RSE, n=0), focal hair loss (LC, n=9; SST, n=11; RSE, n=14), and paresthesia (LC, n=4; SST, n=3; RSE, n=5).


CONCLUSIONS
Histologic distribution and density of sweat glands were comparable to previous studies. All three surgical procedures evaluated are effective in the treatment of FAH. RSE and SST techniques are associated with a higher risk of side effects and cause more extensive scarring. However, one LC patient (n=1; 6.7%) did not respond to treatment.
Bechara
Falk G
FG
Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany. f.bechara@derma.de
Sand
Michael
M
Hoffmann
Klaus
K
Boorboor
Pejman
P
Altmeyer
Peter
P
Stuecker
Markus
M
D000328:Adult; D001050:Apocrine Glands / Q000473:pathology; D001365:Axilla; D001706:Biopsy; D002921:Cicatrix / Q000473:pathology; D004439:Eccrine Glands / Q000473:pathology; D004954:Esthetics; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000473:pathology* / Q000601:surgery*; D007150:Immunohistochemistry; D007432:Intraoperative Period; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D013546:Sweating / Q000502:physiology; D016896:Treatment Outcome; D014619:Vacuum Curettage