Hyperhidrosis Surgical Treatments Include Botox Injections and the Excicsion of Axillary Tissue:

The following article is presented as educational material for those considering surgical alternatives;

Author/s: J L Atkins Issue: Sept 16, 2000 Excision of axillary tissue may be more effective EDITOR--We read with interest the editorial on hyperhidrosis by Collin and Whatling.[1]

They suggest that botulinum toxin (Botox) should be the surgical treatment of choice for axillary hyperhidrosis. Early studies have shown that intradermal injection of botulinum toxin produces an effective but temporary inhibition of sweating.[2] The therapeutic effects of botulinum toxin have been reported to last three to eight months in healthy volunteers.[3] There is some evidence to suggest that higher doses of botulinum toxin may produce a satisfactory reduction in sweating for as long as one year in some patients.[4] Continued treatment is inevitable in order to maintain anhidrosis. Repeated injections and hospital visits may be unpleasant and inconvenient for the patient and expensive for the NHS. Collin and

Whatling fail to mention the role of surgical excision of axillary tissue for the treatment of hyperhidrosis. Breach described a simple method of surgical excision of subcutaneous axillary tissue that produced a high satisfaction rate among the reported case group of 25 patients (50 axillae) at follow up after one year.[5] The method described uses three parallel transverse incisions to the axilla, through which the subcutaneous axillary tissue is removed. This technique carries a low complication rate and produces aesthetic scars with negligible functional deficit. Many of the patients attend after thorascopic sympathectomy which resolved their palmar, but not axillary, hyperhidrosis. Surgical excision of axillary tissue remains an important treatment modality for a large proportion of hyperhidrotic patients. It has the ability to provide a permanent and satisfactory solution to a frustrating problem. It is not as yet a redundant method of treatment.

J L Atkins senior house officer, plastic surgery P E M Butler consultant plastic surgeon Royal Free Hospital, London NW3 2QG

[1] Collin J, Whatling E Treating hyperhidrosis. BMJ 2000;320:1221-2. (6 May.)

[2] Schnider P, Binder M, Auff E, Kittler H, Berger T, Walsh TN. Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol 1997;136:548-52.

[3] Naumann M, Flachenecker P, Brocker EB. Botolinum toxin for palmar hyperhidrosis. Lancet 1997;349:252.

[4] Heckmann M. Follow up of patients with axillary hyperhidrosis alter botulinum toxin injection. Arch Dermatol 1998;134:1298-9. [5] Breach NM. Axillary hyperhidrosis: surgical cure with aesthetic scars. Ann R Coll Surg Engl 1979;61:295-7.

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