Axillary Curettage with Tumescent Anesthesia for Hyperhidrosis: Once and Done

Hyperhidrosis is a condition of excessive sweating that usually involves the sweat glands of the hands, feet and underarms. There is considerable emotional and social stigma attached to this condition. People who suffer from hyperhidrosis can routinely soak through clothing in a matter of minutes, no matter what they do. Simply shaking hands can become an intolerable ordeal. This condition can put a person in solitary confinement, avoiding all contact with friends and family, so that they do not inflict their condition on others.

 

Although the sweat glands of people with hyperhidrosis appear normal, they seem to be hypersensitive to normal stimuli. When our bodies need to sweat, as in exercise, fear, or anger, special muscle cells around the gland contract in response to sympathetic nerve pulses. People with hyperhidrosis can sweat while completely relaxed, without any excessive stimuli.

 

Therapies for hyperhidrosis include topical, oral and surgical therapies. Applications of special antiperspirant liquids (aluminum salts) can slow sweating but can be irritating to the skin. Iontophoresis is a special topical therapy that uses an electric current to push special salts into the skin. Oral medicines that block the nerve pulses have also been used with varying success. All of these therapies only work as long as they are used. Endoscopic sympathectomy (cutting the nerves that control hand sweating) does have risks, but should be considered because it is a permanent solution for the hands. However, this has little effect on underarm sweating.

 

There is a way to end sweating under the arms permanently, in a virtually painless, in-office procedure, done under local numbing. It is called Axillary Curettage with Tumescent Anesthesia. Translated from the Medicalese, it means scraping under the skin of the underarms to remove the sweat glands.

 

You will shave your underarms the night before the procedure and shower normally. You can do your regular activities and eat a normal meal before your procedure. The underarms will be cleaned. The areas of sweating will first be visualized by applying a special chemical and some corn starch. This is called the Starch-Iodine Test. Photos will be taken so that we can see how complete the result is after the procedure is done. Once the areas are outlined, the sites will be cleaned and prepped. The numbing solution will be slowly introduced and allowed to take effect for 30-45 minutes.

 

Once complete numbing has been achieved, small incisions will be made at 3-4 points around each area, so that they will be hidden in skin folds after the procedure is done. A special instrument will be used to scrape the underside of the skin and remove the glands. When the procedure is complete, healing ointment and a thick bolster of gauze will be taped in place. This will be changed once daily and as needed. You can shower regularly. It really is as simple as that!

 

You will be sore and bruised for at least a few days, but this won’t last long. You will be given pain meds and some anti-inflammatory medicine after the procedure. Tylenol may be all you need to take care of any discomfort. You will be able to shower regularly and engage in normal activities within reason, but no exercise or heavy lifting. You will be seen on day 4 after your procedure in follow-up and then again in 2 weeks. Of course, you will be seen at any time for issues of concern.

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