title: Short- and long-term efficacy and mechanism of action of tumescent suction curettage for axillary hyperhidrosis.
abstract: BACKGROUND
  Axillary hyperhidrosis is a common and distressing problem interfering with the life of affected individuals. Currently, local surgery is the treatment of choice once conservative treatment has failed.
  
  
  OBJECTIVE
  To evaluate the clinical efficacy and safety of tumescent suction curettage (TSC) in treating axillary hyperhidrosis and to correlate it with histological markers.
  
  
  METHODS
  Thirty patients (17 females and 13 males, average age 29.9 years) underwent TSC. After tumescent anaesthesia, a suction cannula was inserted in the axilla on each side through two tiny incisions and subcutaneous tissue was removed by suction. We evaluated the clinical efficacy and complications, and in a subset of patients performed biopsies before surgery, as well as 1 month and 1 year after the operation.
  
  
  RESULTS
  In comparison with preoperative values, the sweat rate was diminished by 85% after 1 month, 71% after 6 months, 77% after 12 months and 61% after 24 months. The reduced efficacy with time was histologically correlated with an increase in the innervation, whereas the number of sweat glands continued to diminish. The majority of patients were satisfied with the operation but the satisfaction diminished with time. Patients with the highest preoperative sweat rates were the most satisfied after the intervention.
  
  
  CONCLUSIONS
  TSC is an effective and safe treatment for axillary hyperhidrosis. The long-term recurrence may be due to reinnervation.
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-4858-5525
authors.initials: L
authors.lastname: Feldmeyer
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Bogdan
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Moser
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Specker
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Kamarashev
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: L E
authors.initials: LE
authors.lastname: French
authors.affiliation: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Läuchli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D001365:Axilla; D001706:Biopsy; D003475:Curettage / Q000009:adverse effects; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000294:innervation; D040521:Subcutaneous Tissue / Q000601:surgery; D013396:Suction; D013545:Sweat Glands / Q000473:pathology; D013546:Sweating; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult