Brachial plexus injury after microwave-based treatment for axillary hyperhidrosis and osmidrosis

Chang, Chun‐Kai; Chen, Chun-Yu; Hsu, Kuo-Feng; Chiu, Han-Ting; Chu, Tzi-Shiang; Liu, Hung-Hui; Goh, Meng-Xun; Chen, Shyi-Gen

doi:10.1080/14764172.2017.1342039

Cited by 23 publications

(26 citation statements)

References 7 publications

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“…Although the maximum energy setting was selected, the treatment did not produce severe adverse effects with high volume fluid anesthesia, to create a space between skin and nerves. Chang et al reported on a severely underweight female treated at energy level 5 who did not fully recover after 6 months . In our study, one underweight female sustained moderate altered sensation in the treatment limb and recovered within 6 months.…”

Section: Discussionmentioning

confidence: 41%

“…In both this and another study, four of 81 subjects (4.9%) and one of 31 (3.2%) achieved full sweat reduction with one session using low energy level 1 or 3, respectively [10,11]. Two sessions are usually scheduled 3 months apart with severe PAH using a low energy level [10,11,[13][14][15][16][17][18]. In these previous studies, the percentage of responders with a 2-point drop in HDSS score were stable from 1 month (67%) to 12 months (38-55%) [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Microwave treatment for PAH was approved by the United States Food and Drug Administration (FDA) in 2011. It is noninvasive and effective with less scarring and longer acting than other treatments [9][10][11][12][13][14][15][16][17][18]. Microwave devices focus heat at the interface between skin and subcutaneous tissue and have been shown to cause thermolysis of sweat glands in an experiment using apocrine glands of a porcine skin model [9].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split‐area comparative trial

et al. 2019

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Background and Objectives Microwave treatment is an effective non‐invasive treatment option for primary axillary hyperhidrosis (PAH), but the treatment parameters vary and no histopathological studies have been performed to validate clinical outcomes. This study investigated its efficacy and safety and histopathological changes after a single microwave treatment at the maximum energy level for PAH in Asians. Materials and Methods A prospective, clinical, and histological split‐area randomized controlled trial (RCT) was performed in Japan. Twenty‐six subjects underwent a single microwave treatment at the maximum energy level 5 (5.8 GHz/axilla) on the randomized side of axillae. The primary outcome was the mean difference between both sides in the improvement of modified single‐underarm Hyperhidrosis Disease Severity Scale (msHDSS) scores over the course of the 12‐month study period from baseline. The secondary outcomes were; the percentage of responders with at least a 2‐point drop in the msHDSS score of 3 or 4 group or with a 1‐point drop in the msHDSS score of 2 group; the percentage of responders with at least a 75% reduction in sweat weight over 12 months; recurrence rate; and adverse effects. We also performed a histological assessment for 13 selected subjects. Results Twenty‐four subjects completed the study. There were statistically significant differences in improvement of msHDSS scores between the microwave‐treated and control sides (P < 0.05) from baseline at 0.5, 1, 3, 6, and 12 months. In the msHDSS score of 3 or 4 group, the percentage of responders with at least a 2‐point drop on the microwave‐treated side versus control side was 72.2 versus 11.1% (P < 0.05) at 1 month, 83.3 versus 5.6% (P < 0.05) at 3 months, 61.1 versus 38.9% (P = 0.317) at 6 months and 38.9 versus 16.7% (P = 0.264) at 12 months. The percentage of responders with at least a 75% reduction in sweat weight on the microwave‐treated side versus control side was 75.0 versus 37.5% at 1 month, 75.0 versus 29.2% at 3 months, 83.3 versus 50.0% at 6 months and 70.8 versus 33.3% at 12 months (all P < 0.05). Recurrence on the microwave‐treated side was observed in 4.2% and 12.5% of 24 subjects at 3 and 12 months, respectively. No serious side‐effects were noted. Histology showed the diameter and density of secretory eccrine glands and nerve fiber lengths around eccrine glands were significantly decreased after treatment compared to baseline (P = 0.002, 0.027, 0.003, respectively). Conclusions A single‐session microwave treatment at the maximum energy level significantly improved the PAH of Japanese patients and had minimal side effects. This technique demonstrates that diminished size of secretory eccrine glands and nerve fiber degeneration could be useful markers for predicting the efficacy of the treatment. Lasers Surg. Med. 9999:1–8, 2019. © 2019 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split‐area comparative trial

et al. 2019

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“…Clinically, there was improvement in the HDSS but no difference in gravimetry. Because of the non‐selective thermal component, this form of treatment may also damage other structures such as nerves .…”

Section: Treatment Of Primary Hyperhidrosismentioning

confidence: 99%

Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis

Rzany

Bechara

Feise³

et al. 2018

J Deutsche Derma Gesell

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Focal hyperhidrosis can have a considerable impact on social and occupational activities and be associated with significant impairment in quality of life. Primary (idiopathic) hyperhidrosis is neither caused by systemic disorders nor by external factors. It usually occurs in areas characterized by a high density of sweat glands such as the axillae and hands. The diagnosis of focal hyperhidrosis is based on history and clinical findings. Supplementary diagnostic tests include gravimetry (measurement of the amount of sweat) and the iodine starch test (which shows the area of sweating). Treatment options consist of topical agents, botulinum toxin A injections, iontophoresis, treatment with radiofrequency, microwaves, or ultrasound as well as surgical procedures (axillary suction curettage, sympathectomy). Systemic agents such as anticholinergics may also be used. Selection of the most appropriate therapeutic approach depends on the site affected, prior treatment as well as the patient's requests.

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“…Klinisch zeigte sich eine Besserung des HDSS, jedoch keine Unterschiede der Gravimetrie. Auch bei dieser Therapie kann es durch die ungerichtete thermische Komponente zur Schädigung zum Beispiel von Nerven kommen .…”

Section: Therapie Der Primären Hyperhidroseunclassified

Aktualisierung der S1‐Leitlinie zur Definition und Therapie der primären Hyperhidrose

Rzany

Bechara

Feise³

et al. 2018

J Deutsche Derma Gesell

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Zusammenfassung Die fokale Hyperhidrose kann zu erheblichen sozialen und beruflichen Einschränkungen und damit zu einer ausgeprägten Verminderung der Lebensqualität führen. Der primären Hyperhidrose liegen keine internistischen Erkrankungen oder externen Ursachen zugrunde. Sie tritt vor allem im Bereich von Arealen mit einer großen Schweißdrüsendichte wie den Achseln und den Händen auf. Die Diagnose der Hyperhidrose basiert auf der Anamnese und der Klinik. Unterstützt wird die Diagnostik durch Gravimetrie (die Schweißmengenmessung) und den Iod‐Stärke‐Test (der das vom Schwitzen betroffene Areal definiert). Zur Behandlung der primären Hyperhidrose stehen eine Reihe von Verfahren wie die topische Therapie, die Injektionstherapie mit Botulinumtoxin A, die Leitungswasser‐Iontophorese, die Therapie mit Radiofrequenz, Mikrowellen oder Ultraschall bis hin zu den operativen Interventionen wie der axillären Saugkürettage oder der Sympathektomie zur Verfügung. Auch systemische Therapeutika (vor allem Anticholinergika) kommen zur Anwendung. Die Auswahl der geeigneten Behandlungsmaßnahmen sollte individuell auf die Lokalisation, die vorangegangen Behandlungen und die Wünsche des Patienten abgestimmt werden.

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Brachial plexus injury after microwave-based treatment for axillary hyperhidrosis and osmidrosis

Cited by 23 publications

References 7 publications

Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split‐area comparative trial

Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split‐area comparative trial

Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis

Aktualisierung der S1‐Leitlinie zur Definition und Therapie der primären Hyperhidrose

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