Treatment of severe compensatory hyperhidrosis with a microwave device

Dear Editor, Severe compensatory hyperhidrosis (CH) is difficult to manage after sympathetic surgery. Although the incidence of CH differs across reports, many patients regret the surgery.1,2 Pharmacological and surgical treatments have been proposed. However, results have not reached a level of satisfaction; botulinum toxin injection is a reliable but temporary treatment.2 A microwave device (MD) has been developed for nonsurgical, prolonged sweat reduction through thermoablation of the sweat glands. Longlasting results are expected.1,3 This report focuses on MD use for severe CH of the trunk. A 29yearold man visited our clinic with recurrent severe sweating of the trunk after thoracic sympathectomy for hyperhidrosis of the palms 7 years ago. The patient had frequent episodes of heavy sweating when nervous or with changes in the environmental temperature. The Hyperhidrosis Disease Severity Scale (HDSS) score was four and the Dermatology Life Quality Index (DLQI) score was 21. His treatment included glycopyrrolate and botulinum toxin with limited effectiveness before being treated with an MD. The patient was anaesthetized prior to initiation of microwave thermal ablation with 250 ml of standard tumescent solution. The syringe adapter anaesthesia delivery protocol was adopted.4 Once anaesthesia was complete, the area of the chest or back marked with a temporary tattoo template was targeted for treatment (Figure 1). An A4sized of the affected chest or back was treated in each session. The device used was the MiraDry system (Miramar Labs, Inc.) for the treatment of axillary hyperhidrosis. All sessions (chest: one session; back: one session each right and left sides) were conducted every other day at a maximum energy level of 5 (Figure 2). Ice was applied immediately after the session, and prednisolone with analgesics was administered. Postoperative complications included transient erythema and oedema. One year after the procedure, the patient reported significantly reduced sweating in the treated truncal region. The HDSS and DLQI values were significantly reduced to two and six respectively. He reported reduced sweating during daily activities and exercise, which led to a better quality of life. DOI: 10.1111/jdv.18519