Microwaves offer solution for stubborn sweat glands

A novel noninvasive microwave technology is proving safe and effective for the treatment of axillary hyperhidrosis.

The treatment, which involves the delivery of microwave energy to eliminate sweat glands, has been used in more than 6,000 patients and is a welcome addition to a limited range of treatments for hyperhidrosis, Dr. Carolyn Jacob reported in Seminars in Cutaneous Medicine and Surgery.

Topical treatments, oral anticholinergics, surgical procedures, laser treatment, and injections all provide some benefit but have fallen short of the safe, long-term results patients want, said Dr. Jacob of Northwestern University, Chicago.

Microwaves, first introduced for medical use in the 1970s in surgical coagulation devices, can penetrate to depths where eccrine sweat glands are found.

"This depth is achieved by the use of an antenna that preferentially targets the skin-adipose interface, where most eccrine glands reside. There is an extremely dense network of sweat glands in the axillae (greater than 50,000), and their depth can vary from 2 to 5 mm below the skin surface, depending on the patient’s skin thickness," Dr. Jacob explained, adding that the microwave energy is concentrated along the dermal-adipose to create a focal energy zone.

"At the same time, continuous hydroceramic cooling prevents thermal conduction of heat superficially. The heat at the dermal-adipose energy zone leads to thermolysis of the eccrine glands," she said in her review article (Semin. Cutan. Med. Surg. 2013;32:2-8).

The current protocol for microwave therapy is two microwave treatments with a 3-month interval. Most patients experience mild edema and discomfort for a few days, and in rare cases, edema will occur outside of the treatment area (often in the dependent portion of the underarm and upper chest), Dr. Jacob noted. These effects resolve with standard posttreatment care, including application of ice packs for 20 minutes every 3-5 hours as needed and use of ibuprofen every 4-6 hours for 3 days.

In a recent Canadian study of this technology for axillary hyperhidrosis, 90% of 31 patients reported efficacy that persisted after 12 months, and patient satisfaction was 90% at 12 months (Dermatol. Surg. 2012;38:728-35).

Further follow-up showed 100% efficacy and 100% patient satisfaction at 18 months, the investigators reported.

"Efficacy was defined as a drop [in the Hyperhidrosis Disease Severity Scale] from 3 or 4 to a 1 or 2," noted Dr. Jacob, who was not involved in the study.

The average patient’s sweat reduction was 82%. Histology showed sweat gland necrosis at 11 days and sweat gland reduction at 6 months.

"The treatment of primary axillary hyperhidrosis can be rewarding using noninvasive microwave technology. Because the microwaves preferentially target the region of skin where the sweat glands reside, leading to localized thermolysis of the sweat glands, patients can now benefit from permanent targeted sweat reduction," Dr. Jacob said. With more studies and experience using this technology, parameters will be tightened, side effects further decreased, and patient satisfaction increased, she added.

Dr. Jacob is a board member of Miramar, which funded the Canadian study and manufactures microwave devices used to treat axillary hyperhidrosis.

A novel noninvasive microwave technology is proving safe and effective for the treatment of axillary hyperhidrosis.

The treatment, which involves the delivery of microwave energy to eliminate sweat glands, has been used in more than 6,000 patients and is a welcome addition to a limited range of treatments for hyperhidrosis, Dr. Carolyn Jacob reported in Seminars in Cutaneous Medicine and Surgery.

Topical treatments, oral anticholinergics, surgical procedures, laser treatment, and injections all provide some benefit but have fallen short of the safe, long-term results patients want, said Dr. Jacob of Northwestern University, Chicago.

Microwaves, first introduced for medical use in the 1970s in surgical coagulation devices, can penetrate to depths where eccrine sweat glands are found.

"This depth is achieved by the use of an antenna that preferentially targets the skin-adipose interface, where most eccrine glands reside. There is an extremely dense network of sweat glands in the axillae (greater than 50,000), and their depth can vary from 2 to 5 mm below the skin surface, depending on the patient’s skin thickness," Dr. Jacob explained, adding that the microwave energy is concentrated along the dermal-adipose to create a focal energy zone.

"At the same time, continuous hydroceramic cooling prevents thermal conduction of heat superficially. The heat at the dermal-adipose energy zone leads to thermolysis of the eccrine glands," she said in her review article (Semin. Cutan. Med. Surg. 2013;32:2-8).

The current protocol for microwave therapy is two microwave treatments with a 3-month interval. Most patients experience mild edema and discomfort for a few days, and in rare cases, edema will occur outside of the treatment area (often in the dependent portion of the underarm and upper chest), Dr. Jacob noted. These effects resolve with standard posttreatment care, including application of ice packs for 20 minutes every 3-5 hours as needed and use of ibuprofen every 4-6 hours for 3 days.

In a recent Canadian study of this technology for axillary hyperhidrosis, 90% of 31 patients reported efficacy that persisted after 12 months, and patient satisfaction was 90% at 12 months (Dermatol. Surg. 2012;38:728-35).

Further follow-up showed 100% efficacy and 100% patient satisfaction at 18 months, the investigators reported.

"Efficacy was defined as a drop [in the Hyperhidrosis Disease Severity Scale] from 3 or 4 to a 1 or 2," noted Dr. Jacob, who was not involved in the study.

The average patient’s sweat reduction was 82%. Histology showed sweat gland necrosis at 11 days and sweat gland reduction at 6 months.

"The treatment of primary axillary hyperhidrosis can be rewarding using noninvasive microwave technology. Because the microwaves preferentially target the region of skin where the sweat glands reside, leading to localized thermolysis of the sweat glands, patients can now benefit from permanent targeted sweat reduction," Dr. Jacob said. With more studies and experience using this technology, parameters will be tightened, side effects further decreased, and patient satisfaction increased, she added.

Dr. Jacob is a board member of Miramar, which funded the Canadian study and manufactures microwave devices used to treat axillary hyperhidrosis.

A novel noninvasive microwave technology is proving safe and effective for the treatment of axillary hyperhidrosis.

The treatment, which involves the delivery of microwave energy to eliminate sweat glands, has been used in more than 6,000 patients and is a welcome addition to a limited range of treatments for hyperhidrosis, Dr. Carolyn Jacob reported in Seminars in Cutaneous Medicine and Surgery.

Topical treatments, oral anticholinergics, surgical procedures, laser treatment, and injections all provide some benefit but have fallen short of the safe, long-term results patients want, said Dr. Jacob of Northwestern University, Chicago.

Microwaves, first introduced for medical use in the 1970s in surgical coagulation devices, can penetrate to depths where eccrine sweat glands are found.

"This depth is achieved by the use of an antenna that preferentially targets the skin-adipose interface, where most eccrine glands reside. There is an extremely dense network of sweat glands in the axillae (greater than 50,000), and their depth can vary from 2 to 5 mm below the skin surface, depending on the patient’s skin thickness," Dr. Jacob explained, adding that the microwave energy is concentrated along the dermal-adipose to create a focal energy zone.

"At the same time, continuous hydroceramic cooling prevents thermal conduction of heat superficially. The heat at the dermal-adipose energy zone leads to thermolysis of the eccrine glands," she said in her review article (Semin. Cutan. Med. Surg. 2013;32:2-8).

The current protocol for microwave therapy is two microwave treatments with a 3-month interval. Most patients experience mild edema and discomfort for a few days, and in rare cases, edema will occur outside of the treatment area (often in the dependent portion of the underarm and upper chest), Dr. Jacob noted. These effects resolve with standard posttreatment care, including application of ice packs for 20 minutes every 3-5 hours as needed and use of ibuprofen every 4-6 hours for 3 days.

In a recent Canadian study of this technology for axillary hyperhidrosis, 90% of 31 patients reported efficacy that persisted after 12 months, and patient satisfaction was 90% at 12 months (Dermatol. Surg. 2012;38:728-35).

Further follow-up showed 100% efficacy and 100% patient satisfaction at 18 months, the investigators reported.

"Efficacy was defined as a drop [in the Hyperhidrosis Disease Severity Scale] from 3 or 4 to a 1 or 2," noted Dr. Jacob, who was not involved in the study.

The average patient’s sweat reduction was 82%. Histology showed sweat gland necrosis at 11 days and sweat gland reduction at 6 months.

"The treatment of primary axillary hyperhidrosis can be rewarding using noninvasive microwave technology. Because the microwaves preferentially target the region of skin where the sweat glands reside, leading to localized thermolysis of the sweat glands, patients can now benefit from permanent targeted sweat reduction," Dr. Jacob said. With more studies and experience using this technology, parameters will be tightened, side effects further decreased, and patient satisfaction increased, she added.

Dr. Jacob is a board member of Miramar, which funded the Canadian study and manufactures microwave devices used to treat axillary hyperhidrosis.