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  Table of Contents     
LETTERS
Year : 2015  |  Volume : 61  |  Issue : 2  |  Page : 141-143

A novel option for treatment of primary axillary hyperhidrosis: Fractionated microneedle radiofrequency


1 Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of medical sciences, Isfahan, Iran
2 Students' Research Committee, Semnan University of Medical Sciences, Semnan, Iran
3 Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of medical sciences, Isfahan; Students' Research Committee, Cardiovascular Research Institute, Isfahan University of medical sciences, Isfahan, Iran
4 Department of Dermatology, Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Cardiology, Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of medical sciences, Isfahan, Iran

Date of Web Publication13-Mar-2015

Correspondence Address:
B Abtahi-Naeini
Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of medical sciences, Isfahan; Students' Research Committee, Cardiovascular Research Institute, Isfahan University of medical sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.153111

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How to cite this article:
Naeini F F, Pourazizi M, Abtahi-Naeini B, Nilforoushzadeh M A, Najafian J. A novel option for treatment of primary axillary hyperhidrosis: Fractionated microneedle radiofrequency. J Postgrad Med 2015;61:141-3

How to cite this URL:
Naeini F F, Pourazizi M, Abtahi-Naeini B, Nilforoushzadeh M A, Najafian J. A novel option for treatment of primary axillary hyperhidrosis: Fractionated microneedle radiofrequency. J Postgrad Med [serial online] 2015 [cited 2019 Nov 17];61:141-3. Available from: http://www.jpgmonline.com/text.asp?2015/61/2/141/153111


Sir

Hyperhidrosis is a common ailment which greatly affects quality of life. There are several treatment options, but there is a lack of consensus and clear guidelines for treatment of these patients. [1],[2] Medical (e.g., Botulinum toxin type A) and surgical treatments have been used to control or reduce excessive sweating with variable success. [3],[4],[5] Only surgical modalities have been capable of conferring a permanent solution. [4] Recently, few studies have been done for clinical evaluation of radiofrequency (RF) energy in the treatment of primary axillary hyperhidrosis(PAH). [6],[7] But there is limited published evidence. We report in this paper, successful treatment of refractory PAH with fractionated microneedle radiofrequency (FMR) in a 29-year-old female patient, confirmed with routine histopathological staining.

A 29-year-old female patient had severe recalcitrant bilateral axillary hyperhidrosis since puberty (grade 4 in Hyperhidrosis Disease Severity Scale). Personal history was otherwise uneventful. The patient identified many triggers such as emotion, temperature, or physical effort for the hyperhidrosis that occurred in more than ten attacks per day. Topical treatment with aluminium chloride had produced an unsatisfactory response and she stopped the use of this agent 6 months prior to meeting us for treatment. Systemic therapy using an anticholinergic preparation had to be stopped because of adverse effects. Botulinum toxin type A was used in the affected area in frequent sessions with limited results. We then started the patient on four treatment sessions of FMR (INFINI; Lutronic, Goyang, Korea) at 2-week intervals [Figure 1]. Results of the Iodine starch test (Minor sweat test) are shown in [Figure 2]. The INFINI procedure is performed in foursteps [Figure 3]. After marking the area to be treated, a topical eutectic mixture of 2.5% lidocaine hydrochloric acid and 2.5% prilocaine (EMLA; Astra- Zeneca, Sodertalje, Sweden) was applied to the axilla under occlusion 30 minutes before therapy. The treatment settings were 2.5-to 3-mm Microneedle penetrating depth, 6 to 9 level intensity, and 140- to 180-ms RF time. Multiple placements with the hand piece are required to deliver Microneedle RF [Figure 3]. Immediately after treatment minimal undesirable effects such as mild skin irritation and erythema and pin point bleeding were noted [Figure 3] but none were so severe as to cause termination of treatment. Results of the Iodine starch test after treatment are shown in [Figure 4]. During the 6 month follow-up, the patient had no complaints of hyperhidrosis. The FMR is a minimally invasive method for delivering thermal energy to the target tissue without destroying the epidermis, by using rapid penetration with microneedle. This treatment has demonstrated excellent efficacy for skin rejuvenation, face lifting, large pores and acne scars. [8],[9] The novel bipolar radiofrequency device can destroy eccrine glands which are considered as a thermolysis at the interface of the deep dermis and subcutis, minimizing damage to surrounding tissue. The results demonstrate that microwave technology is well suited for targeting sweat glands while allowing for protection of both the upper skin layers and the structures beneath the subcutaneous fat. [10] The mechanism of reduced hyperhidrosis by way of the radiofrequency device is that the sweat glands are destroyed by heating the interface where they are located, that is, the hypodermal interface. Therefore, the device works by heating and cooling at the same time. [7],[10],[11] The radiofrequency from the tips of the microneedles causes direct thermal injury which decreases the size and density of the apocrine glands. [12] In our patient, a clear reduction of viable sweat gland structures was seen when her before treatment ("baseline") sample was compared with the follow-up time samples. There was no significant histopathologic evidence of adverse effects on other cutaneous structures in this study. Thus, FMR can be considered as a safe, effective and non-invasive technique for treatment of primary axillary hyperhidrosis but more studies are needed to confirm the persistent effect and histopathological alternation during treatment with FMR.
Figure 1: The INFINI console, headpiece. (INFINI; Lutronic, Goyang, Korea)

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Figure 2: Starch-iodine tests. Starch-iodine photographs of the left axilla of subject at baseline (blue-black sedimentation)

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Figure 3: Procedure description.The INFINI procedure is performed in foursteps. (a) Step 1 -sizing the area to be treated and marking that area after starch-iodine test. (b) Step 2 -Topical anaesthesia under occlusion. (c) Step 3 -place hand piece on designated areas to deliver the therapy. (d) Step 4 -dressing with sterile vaseline gauzes

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Figure 4: Starch-iodine test. Normal results of starch-iodine testafter foursessions of fractionated microneedle radiofrequency. (Wight sedimentation)

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 :: References Top

1.
Amini M, Harmsze AM, Tupker RA. Patient's estimation of efficacy of various hyperhidrosis treatments in a dermatological clinic. Acta Derm Venereol 2008;88:356-62.  Back to cited text no. 1
    
2.
Yadalla HK, Ambika H, Chawla S. A case of idiopathic unilateral circumscribed hyperhidrosis. Indian J Dermatol 2013;58:163.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Doft MA, Hardy KL, Ascherman JA. Treatment of hyperhidrosis with botulinum toxin. Aesthet Surg J 2012;32:238-44.  Back to cited text no. 3
    
4.
Solish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupin M, et al.; Canadian Hyperhidrosis Advisory Committee. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007;33:908-23.  Back to cited text no. 4
    
5.
Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol 2010;55:8-14.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Hong HC, Lupin M, O'Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg 2012;38:728-35.  Back to cited text no. 6
    
7.
Kim M, Shin JY, Lee J, Kim JY, Oh SH. Efficacy of fractional microneedle radiofrequency device in the treatment of primary axillary hyperhidrosis: A pilot study. Dermatology 2013;227:243-9.  Back to cited text no. 7
    
8.
Lolis MS, Goldberg DJ. Radiofrequency in cosmetic dermatology: A review. Dermatol Surg 2012;38:1765-76.  Back to cited text no. 8
    
9.
Cho SI, Chung BY, Choi MG, Baek JH, Cho HJ, Park CW, et al. Evaluation of the clinical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores. Dermatol Surg 2012;38:1017-24.  Back to cited text no. 9
    
10.
Johnson JE, O'Shaughnessy KF, Kim S. Microwave thermolysis of sweat glands. Lasers Surg Med 2012;44:20-5.  Back to cited text no. 10
    
11.
Lee SJ, Chang KY, Suh DH, Song KY, Ryu HJ. The efficacy of a microwave device for treating axillary hyperhidrosis and osmidrosis in Asians: A preliminary study. J Cosmet Laser Ther 2013;15:255-9.  Back to cited text no. 11
    
12.
Grice K, Sattar H, Baker H. The effect of ambient humidity on transepidermal water loss. J Invest Dermatol 1972;58:343-6.  Back to cited text no. 12
    


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