Characteristics of refractory sweating areas following minimally invasive surgery for axillary hyperhidrosis.

Background: Several surgical strategies have evolved for the treatment of focal axillary hyperhidrosis (FAH). However, nonresponders are found in every procedure. Until now no characterization of the recurrent sweating areas has been reported. The aim of this study was to characterize the axillary sweat area by using the iodine starch test in nonresponders prior to surgery.

Methods: Prior to minimally invasive surgery, 24 (15 females, 9 males) nonresponders underwent a repetitive iodine starch test to define the area of recurrent sweating. Size and distribution of the hyperhidrotic area were documented.

Results: Eighteen patients had undergone previous liposuction and six liposuction curettage. The size of recurrent sweating area was 10.2 cm(2) (range = 5.5-24.5 cm(2)). We were able to identify three different patterns of recurrent sweating: crescent (33%), circular (41%), and insertion-spot type (26%).

Conclusion: Patterns of recurrent sweating areas may partially indicate insufficient planning and implementation of surgery, resulting in nonresponders. We suggest that exact preoperative identification of the hyperhidrotic area be mandatory.