Excision of axillary tissue may be more effective

EDITOR—We read with interest the editorial on hyperhidrosis by Collin and Whatling.1 They suggest that botulinum toxin should be the treatment of choice for axillary hyperhidrosis. Early studies have shown that intradermal injection of botulinum toxin produces an effective but temporary inhibition of sweating.2 The therapeutic effects of botulinum toxin have been reported to last three to eight months in healthy volunteers.3 There is some evidence to suggest that higher doses of botulinum toxin may produce a satisfactory reduction in sweating for as long as one year in some patients.4 Continued treatment is inevitable in order to maintain anhidrosis. Repeated injections and hospital visits may be unpleasant and inconvenient for the patient and expensive for the NHS.

Collin and Whatling fail to mention the role of surgical excision of axillary tissue for the treatment of hyperhidrosis. Breach described a simple method of surgical excision of subcutaneous axillary tissue that produced a high satisfaction rate among the reported case group of 25 patients (50 axillae) at follow up after one year.5 The method described uses three parallel transverse incisions to the axilla, through which the subcutaneous axillary tissue is removed. This technique carries a low complication rate and produces aesthetic scars with negligible functional deficit. Many of the patients attend after thorascopic sympathectomy which resolved their palmar, but not axillary, hyperhidrosis. Surgical excision of axillary tissue remains an important treatment modality for a large proportion of hyperhidrotic patients. It has the ability to provide a permanent and satisfactory solution to a frustrating problem. It is not as yet a redundant method of treatment.

Iontophoresis should be tried before other treatments

EDITOR—We read with interest the editorial by Collin and Whatling about the treatment options for hyperhidrosis.1 Hyperhidrosis is a socially debilitating, and patients with the condition often do not do well with …