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Hyperhidrosis

  • Doris Hexsel
  • Fernanda Oliveira Camozzato
Chapter

Abstract

Hyperhidrosis is defined as sweating amounts larger than necessary to maintain normal body thermoregulation. This condition can affect the patient’s quality of life by way of its psychological and social impact. The central nervous system (cortex, hypothalamus, medulla) and sweat glands, including the eccrine, apocrine, and apoeccrine, are involved in the physiopathology of this condition. Hyperhidrosis can be divided into primary and secondary, and is also associated with a wide variety of conditions. Treatments to alleviate this disorder include topical products (aluminum compounds), iontophoresis, oral treatment with anticholinergic agents (glycopyrrolate, clonidine, oxybutynin), and interventional procedures such as botulinum toxin A, sweat gland removal (suction or curettage), microfocused ultrasound, and sympathectomy. Understanding the clinical features of this disorder and treatment modalities is vital to the optimization of treatment for affected patients.

Keywords

Hyperhidrosis Primary hyperhidrosis Secondary hyperhidrosis Axillar hyperhidrosis Palmar hyperhidrosis Sweat glands Aluminum compounds Botulinum toxin A Iontophoresis Anticholinergic agents Microfocused ultrasound Sympathectomy 

Notes

Glossary

Apocrine sweat glands 

Larger sweat glands that occur in hair follicles. They appear after puberty.

Apoeccrine sweat glands 

Contain morphological features common to the eccrine and apocrine sweat glands.

Eccrine sweat glands 

Small sweat glands that produce a fluid secretion without removing cytoplasm from the secreting cells and that are restricted to the human skin.

Hyperhidrosis 

Sweating greater than necessary for the maintenance of normal body thermoregulation.

Primary hyperhidrosis 

Excessive sweating in specific regions of the body and not caused by other medical conditions or by medications.

Secondary hyperhidrosis 

Excessive sweating caused by medications or medical conditions.

Sympathectomy 

Procedures that break the sympathetic innervation, thereby blocking stimulation of eccrine glands.

References

  1. 1.
    Leung AK, Chan PYH, Choi MCK. Hyperhidrosis. Int J Dermatol. 1999;38:5617.CrossRefGoogle Scholar
  2. 2.
    Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case control study of 387 patients. J Am Acad Dermatol. 2009;61(2):242–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Lasek RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol. 1998;134:454–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Higaki Y, Kawamoto K, Kamo T, Horikawa N, Kawashima M, Chren MM. The Japanese version of Skindex-16: a brief quality-of-life measure for patients with skin diseases. J Dermatol. 2002;29:693–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol. 2011;64(4):690–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004;51:241–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Fujimoto T, Kawahara K, Yokozeki H. Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis. J Dermatol. 2013;40:886–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Augustin M, Radtke MA, Herberger K, Kornek T, Heigel H, Schaefer I. Prevalence and disease burden of hyperhidrosis in the adult population. Dermatology. 2013;227:10–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Stefaniak T, Tomaszewski KA, Proczko-Markuszewska M, Idestal A, Royton A, Abi-Khalil C. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults. J Dermatol. 2013;40:819–23.PubMedGoogle Scholar
  10. 10.
    Lear W, Kessler E, Solish N, Glaser DA. An epidemiological study of hyperhidrosis. Dermatol Surg. 2007;33:S69–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg. 2002;35(2):382–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Quinton PM, Elder HY, Jenkinson DME, et al. Structure and function of human sweat glands. In: Laden K, editor. Antiperspirants and deodorants. New York: Marcel Dekker; 1999. p. 17–57.Google Scholar
  13. 13.
    Bovell DL, Clunes MT, Elder HY, Milsom J, Jenkinson DM. Ultrastructure of the hyperhidrotic eccrine gland. Br J Dermatol. 2001;145:298–301.PubMedCrossRefGoogle Scholar
  14. 14.
    Dobson RL. The human eccrine gland. Arch Environ Health. 1965;2:423–9.CrossRefGoogle Scholar
  15. 15.
    Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. I. Normal sweat glands function. J Am Acad Dermatol. 1989;20:537–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Hurley HJ, Witkowski JA. The dynamics of the eccrine sweating in man. I. Sweat delivery through myoepithelial contraction. J Invest Dermatol. 1962;39:329–38.PubMedCrossRefGoogle Scholar
  17. 17.
    Lonsdale-Eccles A, Leonard N, Lawrence C. Axillary hyperhidrosis: eccrine or apocrine? Clin Exp Dermatol. 2003;28:2–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Lakraj AD, Moghimi N, Jabbari B. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel). 2013;5:821–40.CrossRefGoogle Scholar
  19. 19.
    Elder DE, Elenitsas R, Rosenbach M, Murphy GF, Rubin AI, Xu X. Lever’s histopathology of the skin. 11th ed. Philadelphia: Press: Lippincott Williams & Wilkins; 2014.Google Scholar
  20. 20.
    Sato K, Ohtsuyama M, Samman G. Eccrine sweat gland disorders. J Am Acad Dermatol. 1991;24(6):1010–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Naumann M. Hypersecretory disorders. In: Moore P, Naumann M, editors. Handbook of botulinum toxin treatment. 2nd ed. Oxford: Blackwell-Science; 2003. p. 343–59.Google Scholar
  22. 22.
    Sato K, Sato F. Effect of VIP on sweat secretion and cAMP accumulation in isolated simian eccrine glands. Am J Phys. 1987;253:R935–41.Google Scholar
  23. 23.
    Saadia D, Voustianiouk A, Wang AK, Kaufmann H. Botulinum toxin type a in primary palmar hyperhidrosis: randomized, single-blind, two-dose study. Neurology. 2001;57:2095–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith FC. Hyperhidrosis. Vasc Surg. 2013;31(5):251–5.Google Scholar
  25. 25.
    Schnider P, Binder M, Kittler H, Birner P, Starkel D, Wolff K, et al. A randomized, double-blind, placebo-controlled trial of botulinum a toxin for severe axillary hyperhidrosis. Br J Dermatol. 1999;140:677–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Champion RH. Disorders of sweat glands. In: Champion RH, Burton JL, Ebling FJG, eds. Textbook of Dermatology. 5th edn. Oxford: Blackwell, 1992;3:1758–9.Google Scholar
  27. 27.
    Almeida AT, Boraso RZ. Palmar hyperhidrosis. In: Almeida AT, Hexsel D, editors. Hyperhidrosis and botulinum toxin. São Paulo: Author’s Edition; 2003. p. 167–74.Google Scholar
  28. 28.
    Hexsel D, Ave BR, Hexsel C, Dal Forno T. Inguinal hyperidrosis. In: Almeida AT, Hexsel D, editors. Hyperhidrosis and botulinum toxin. São Paulo: Author’s Edition; 2003. p. 181–5.Google Scholar
  29. 29.
    Hexsel DM, Dal’Forno T, Hexsel CL. Inguinal, or Hexsel’s hyperhidrosis. Clin Dermatol. 2004;22:53–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Kreyden OP, Schmid-Grendelmeier P, Burg G. Idiopathic localized unilateral hyperhidrosis. Case report of successful treatment with Botulinum Toxin Type A and review of the literature. Arch Dermatol. 2001;137:1622–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S. Unilateral hyperhidrosis with accompanying contralateral anhidrosis. Clin Exp Dermatol. 2009;34:e544–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Glaser DA, Herbert AA, Pariser DM, Solish N. Primary focal hyperhidrosis: scope of the problem. Cutis. 2007;79(5):5–17.PubMedGoogle Scholar
  33. 33.
    Chopra KF, Evans T, Severson J, Tyring SK. Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of HIV infection. J Am Acad Dermatol. 1999;41:119–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Connor KM, Cook JL, Davidson JR. Botulinum toxin treatment of social anxiety disorder with hyperhidrosis: a placebo-controlled double-blind trial. J Clin Psychiatry. 2006;67:30–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Davidson JR, Foa EB, Connor KM, Churchill LE. Hyperhidrosis in social anxiety disorder. Prog Neuro-Psychopharmacol Biol Psychiatry. 2002;26:1327–31.CrossRefGoogle Scholar
  36. 36.
    Ruchinskas R. Hyperhidrosis and anxiety: chicken or egg? Dermatology. 2007;214:195–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Shaw JE, Parker R, Hollis S, Gokal R, Boulton AJ. Gustatory sweating in diabetes mellitus. Diabet Med. 1996;13:1033–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Blair D, Sagel J, Taylor I. Diabetic gustatory sweating. South Med J. 2002;95(3):360–2.PubMedCrossRefGoogle Scholar
  39. 39.
    de Bree R, Van der Waal I, Leemans R. Management of Frey syndrome. Head Neck. 2007;29(8):773–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Baskan EM, Karli N, Baykara M, et al. Localized unilateral hyperhidrosis and neurofibromatosis type I: case report of a New Association. Dermatology. 2005;211:286–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Almeida AT, Boraso RZ. Palmar hyperhidrosis. In: Almeida AT, Hexsel D, editors. Hyperhidrosis and botulinum toxin. São Paulo: Author’s Edition; 2003. p. 41–56.Google Scholar
  42. 42.
    Dua J, Grabczynska S. Eccrine nevus affecting the forearm of an 11-year-old girl successfully controlled with topical glycopyrrolate. Pediatr Dermatol. 2014;31(5):611–2.Google Scholar
  43. 43.
    Sen S, Chatterjee G, Mitra PK, Gangopadhyay A. Eccrine angiomatous naevus revisited. Indian J Dermatol. 2012;57(4):313–5.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Shah S, Boen M, Kenner-Bell B, Schwartz M, Rademaker A, Paller AS. Pachyonychia congenital in pediatric patients: natural history, features and impact. JAMA Dermatol. 2014;150(2):146–53. epublished:E1–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Biju V, Sawhney MP, Vishal S. Ross syndrome with ANA positivity: a clue to possible autoimmune origin and treatment with intravenous immunoglobulin. Indian J Dermatol. 2010;55(3):274–6.CrossRefGoogle Scholar
  46. 46.
    Ballestero-Diez M, Garcia-Rio I, Dauden E, Corrales-Arroyo M, García-Díez A. Ross Syndrome, an entity included within the spectrum of partial disautonomic syndromes. J Eur Acad Dermatol Venereol. 2005;19:729–31.PubMedCrossRefGoogle Scholar
  47. 47.
    Lyra Rde M, Campos JR, Kang DW, Loureiro MP, Furian MB, Costa MG, et al. Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis. J Bras Pneumol. 2008;34(11):967–77.PubMedCrossRefGoogle Scholar
  48. 48.
    Cerfolio RJ, Milanez de Campos JR, Bryant AS, Connery CP, Miller DL, de Camp MM, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91:1642–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995;33:78–81.PubMedCrossRefGoogle Scholar
  50. 50.
    Yazar S, Aslan C, Serdar ZA, Demirci GT, Tutkavul K, Babalik D. Ross syndrome: Unilateral hyperhidrosis, Adie’s tonic pupils and diffuse areflexia. J Dtsch Dermatol Ges. 2010;8:1004–6.Google Scholar
  51. 51.
    Saito H, Sakuma H, Seno K. A case of traumatic high thoracic myelopathy presenting dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk. J Exp Med. 1999;188:95–102.Google Scholar
  52. 52.
    Nishimura J, Tamada Y, Iwase S, Kubo A, Watanabe D, Matsumoto Y. A case of lung cancer with unilateral anhidrosis and contralateral hyperhidrosis as the first clinical manifestation. J Am Acad Dermatol. 2011;65(2):438–40.PubMedCrossRefGoogle Scholar
  53. 53.
    Smith CD. A hypothalamic stroke producing recurrent hemihyperhidrosis. Neurology. 2001;56:1394–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Recognition diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274–86.PubMedCrossRefGoogle Scholar
  55. 55.
    Vary JC Jr. Selected disorders of skin appendages – acne, alopecia, hyperhidrosis. Med Clin N Am. 2015;99(6):1195–211.PubMedCrossRefGoogle Scholar
  56. 56.
    Solish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupin M, et al. 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.PubMedGoogle Scholar
  57. 57.
    Hexsel D, Rodrigues TC, Soirefmann M, Zechmeister-Prado D. Recommendations for performing and evaluating the results of the minor test according to a sweating intensity visual scale. Dermatol Surg. 2010;36:120–2.PubMedCrossRefGoogle Scholar
  58. 58.
    Steiner D. Quantitative sweats tests: iodine-starch and gravimetry. In: Almeida ART, Hexsel DM, editors. Hyperhidrosis and botulinum toxin. São Paulo: Edition of authors; 2004. p. 59–61.Google Scholar
  59. 59.
    Bahmer F, Sachse M. Hyperhidrosis area and severity index. Dermatol Surg. 2008;34:1744–5.PubMedGoogle Scholar
  60. 60.
    French J, Gronseth G. Lost in a jungle of evidence: we need a compass. Neurology. 2008;71:1634–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Shelley WB, Hurley HJ Jr. Studies on topical antiperspirant control of axillary hyperhidrosis. Acta Derm Venereol. 1975;55:241–60.PubMedGoogle Scholar
  62. 62.
    Walling HW, Swick BL. Treatment options for hyperhidrosis. Am J Clin Dermatol. 2011;12:285–95.PubMedCrossRefGoogle Scholar
  63. 63.
    Flanagan KH, Glaser DA. An open-label trial of the efficacy of 15% aluminium chloride in 2% salicylic acid gel base in the treatment of moderate-to-severe primary axillary hyperhidrosis. J Drugs Dermatol. 2009;8:477–80.PubMedGoogle Scholar
  64. 64.
    MacKenzie A, Burns C, Kavanagh G. Topical glycopyrrolate for axillary hyperhidrosis. Br J Dermatol. 2013;69:483–4.CrossRefGoogle Scholar
  65. 65.
    Baker D. Topical glycopyrrolate spray 2% reduces axillary hyperhidrosis to a similar extent as Botox injections. Br J Dermatol. 2013;169(Suppl. 1):4.Google Scholar
  66. 66.
    Panting KJ, Alkali AS, Newman WD, Sharpe GR. Dilated pupils caused by topical glycopyrrolate for hyperhidrosis. Br J Dermatol. 2008;158:187–8.PubMedGoogle Scholar
  67. 67.
    Johnson C, Smereck J. Unilateral mydriasis due to a topical ‘antisweat’ preparation. J Emerg Med. 2013;44:673–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Madan V, Beck MH. Urinary retention caused by topical glycopyrrolate for hyperhidrosis. Br J Dermatol. 2006;155:634–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Glaser DA. Oral medications. Dermatol Clin. 2014;32:527–32.PubMedCrossRefGoogle Scholar
  70. 70.
    Wolosker N, De Campos JRM, Kauffman P, et al. A randomized placebo controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg. 2012;55:1696–700.PubMedCrossRefGoogle Scholar
  71. 71.
    Wolosker N, Schvartsman C, Krutman M. Efficacy and quality of life outcomes of oxybutynin for treating palmar hyperhidrosis in children younger than 14 years old. Pediatr Dermatol. 2014;31:48–53.PubMedCrossRefGoogle Scholar
  72. 72.
    Millán-Cayetano JF, Boz J, Rivas-Ruiz F, Blázquez-Sánchez N, Ibáñez CH, Troya-Martín M. Oral oxybutynin for the treatment of hyperhidrosis: outcomes after one-year follow-up. Australas J Dermatol 2017;58(2):e31–5.Google Scholar
  73. 73.
    Stolman LP. Hyperhidrosis: medical and surgical treatment. Eplasty. 2008;8:e22.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Stolman LP. Treatment of excess sweating of the palms by iontophoresis. Arch Dermatol. 1987;123:893–6.PubMedCrossRefGoogle Scholar
  75. 75.
    Togel B, Greve B, Raulin C. Current therapeutic strategies for hyperhidrosis: a review. Eur J Dermatol. 2002;12:219–23.PubMedGoogle Scholar
  76. 76.
    Karakoc Y, Aydemir EH, Kalkan MT, Unal G. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002;41:602–5.PubMedCrossRefGoogle Scholar
  77. 77.
    Almeida AT, Cernea SS. Tratamento da hiperidrose. In: Hexsel D, Almeida AT, editors. Uso cosmético da toxina botulínica. Porto Alegre: AGE; 2002. p. 226–7.Google Scholar
  78. 78.
    Hexsel DM, Soirefmann M, Rodrigues TC, do Prado DZ. Increasing the field effects of similar doses of Clostridium botulinum type A toxin-hemagglutinin complex in the treatment of compensatory hyperhidrosis. Arch Dermatol. 2009;145(7):837–40.PubMedCrossRefGoogle Scholar
  79. 79.
    Hexsel D, Soirefmann M, Porto MD, Schilling-Souza J, Siega C. Fields of anhidrotic effects of abobotulinumtoxin A in patients with compensatory hyperhidrosis. Dermatol Surg. 2015;41:S93–S100.PubMedCrossRefGoogle Scholar
  80. 80.
    Heckmann M, Ceballos-Baumann AO, Plewig G. Botulinum toxin a for axillary hyperhidrosis (excessive sweating). N Engl J Med. 2001;344:488–93.PubMedCrossRefGoogle Scholar
  81. 81.
    Naumann M, Lowe NJ. Botulinum toxin type a in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. 2001;323:596–9.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Odderson IR. Long-term quantitative benefits of botulinum toxin type A in the treatment of axillary hyperhidrosis. Dermatol Surg. 2002;28:480–3.PubMedGoogle Scholar
  83. 83.
    Simonetta Moreau M, Cauhepe C, Magues JP, Senard JM. A double-blind, randomized, comparative study of Dysport vs Botox in primary palmar hyperhidrosis. Br J Dermatol. 2003;149:1041–5.PubMedCrossRefGoogle Scholar
  84. 84.
    Lowe NJ, Glaser DA, Eadie N, Daggett S, Kowalski JW, Lai PY. Botulinum toxin type a in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol. 2007;56:604–11.PubMedCrossRefGoogle Scholar
  85. 85.
    Vadoud-Seyedi J, Simonart T. Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study. Br J Dermatol. 2007;156:986–9.PubMedCrossRefGoogle Scholar
  86. 86.
    TalaricoFilho S, Mendonça do Nascimento M, Sperandeo de Macedo F, De Sanctis Pecora C. A double-blind, randomized, comparative study of two type a botulinum toxins in the treatment of primary axillary hyperhidrosis. Dermatol Surg. 2007;33:S44–50.CrossRefGoogle Scholar
  87. 87.
    Gregoriou S, Rigopoulos D, Makris M, Liakou A, Agiosofitou E, Stefanaki C, Kontochristopoulos G. Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production. Dermatol Surg. 2010 Apr;36(4):496–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Dressler D, Adib SF. Towards a dose optimisation of botulinum toxin therapy for axillary hyperhidrosis: comparison of different Botox(®) doses. J Neural Transm. 2013;120(11):1565–7.PubMedCrossRefGoogle Scholar
  89. 89.
    Letada PR, Landers JT, Uebelhoer NS, et al. Treatment of focal axillary hyperhidrosis using a long pulsed Nd: YAG 1064 nm laser at hair reduction settings. J Drugs Dermatol. 2012;11:59–63.PubMedGoogle Scholar
  90. 90.
    Aydin F, Pancar GS, Senturk N, et al. Axillary hair removal with 1064-nm Nd:YAG laser increases sweat production. Clin Exp Dermatol. 2010;35:588–92.PubMedCrossRefGoogle Scholar
  91. 91.
    Hong HC, Lupin M, O’Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg. 2012;38:728–35.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Lee S, Chang K, Suh D, et al. 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.PubMedCrossRefGoogle Scholar
  93. 93.
    Glaser DA, Coleman WP, Fan LK, et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg. 2012;38:185–91.PubMedCrossRefGoogle Scholar
  94. 94.
    Nestor MS, Park H. Safety and efficacy of micro-focused ultrasound plus visualization for the treatment of axillary hyperhidrosis. J Clin Aesthet Dermatol. 2014;7(4):14–21.PubMedPubMedCentralGoogle Scholar
  95. 95.
    Feldmeyer L, Bogdan I, Moser A, Specker R, Kamarashev J, French LE, et al. Short- and long-term efficacy and mechanism of action of tumescent suction curettage for axillary hyperhidrosis. J Eur Acad Dermatol Venereol. 2015;29(10):1933–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Ojimba TA, Cameron AE. Drawbacks of endoscopic thoracic sympathectomy. Br J Surg. 2004;91:264–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Bell D, Jedynak J, Bell R. Predictors of outcome following endoscopic thoracic sympathectomy. ANZ J Surg. 2014;84:68–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Brazilian Center for Studies in DermatologyPorto AlegreBrazil
  2. 2.Hexsel Dermatology ClinicPorto AlegreBrazil

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