With Nd: YAG laser against sweating
Nd: YAG laser – the latest achievement in the laser liposuction technology is now also used in therapy for excessive sweating– hyperhydrosis
Human body has about two million sweat glands and acts like an air-conditioning device. When the body is heated, the brain sends a message to nervous cells to get rid of the excess heat. That way the body cools itself and gets relieved of damaging matter and toxins. Unpleasant odours occur later or never if you abide by hygienic and dietary advice.
Sweating is a natural and normal occurrence which, during the summer and due to high temperatures, may become a problem because at that time we tend to sweat more than usual. No one likes puddles under the armpit, wet clothes sticking to the body and unpleasant smells causing everyone to turn away. Human body has about two million sweat glands and acts like an air-conditioning device.
When the body temperature is increased, part of the brain, hypothalamus, initiates sweating, and when the body is cooled, sweating stops. When it is heated, the brain sends a message to nervous cells which then forward it to sweat glands in the skin. That is how sweating occurs, by means of which the body relieves itself of excess heat and cools but also eliminates damaging matter and toxins from the body. Many are not aware that sweat is odourless and that the unpleasant smells originate by mixing with matters present on the skin, clothes and in the air. Proper hygiene, both external and internal and intake of certain types of food and liquids may have a considerable effect on sweating.
Hyperhidrosis – excessive sweating
While most people have trouble with sweating only during the summer, approximately three percent of the world population has a problem with sweating all year long, both during summer and winter, regardless of the activity of the body and external temperature. People who sweat profusely, without control and constantly, regardless of the heat or emotional stimuli, have hyperhidrosis or excessive sweating which is a serious medical condition. It causes them numerous psychological, social and even existential problems.
Hyperhidrosis may be divided in
1. PRIMARY HYPERHIDROSIS /essential or idiopathic/ where the cause is unknown
2. SECONDARY HYPERHIDROSIS – occurring as a consequence of other disorders /endocrine disorders, tumours, hypophysis tumours, tuberculosis, diabetes mellitus, lymphomes, sympatic system disorders, neurological and psychiatric diseases, use of medication. . . /
Unlike functional sweating occurring as a consequence of physical exercise, tiredness, increased bodily or external temperature, primary hyperhidrosis occurs as a consequence of emotional problems and anxiety.
HYPERHIDROSIS IS FURTHER DIVIDED INTO
1. FOCAL HYPERHIDROSIS – when only certain body parts are affected by sweating /palms, armpits, face, foot soles/
2. GENERALIZED HYPERHIDROSIS – when entire body is affected by excessive sweating. PRIMARY HYPERHIDROSIS is almost always focal, while SECONDARY HYPERHIDROSIS is mostly generalized.
New research demonstrates that HYPERHIDROSIS is hereditary and in about 25—50% cases disorder is present with family members. When one parent has HYPERHIDROSIS the possibility of it occurring with the child is 255.
Therapy for hyperhidrosis:
1. Dietary regime – avoiding food which provokes excessive sweating (coffee, tea, coca-cola, chocolate), avoiding spicy and hot food.
2. Antiperspirants and deodorants - (Aluminium chloride hexahydrate 10% or 20%- Drysol ®, Xerac ®) are widely used worldwide, but their use is satisfactory only with mild and moderate forms of hyperhidrosis. They clog the outlet canals of the sweat glands and that way temporarily block the sweating. The effect is satisfactory only for a few months, allergic and other toxic reactions may occur at the spot of the application.
3. Medicines - (sedatives, anticholinergics, sympatholytics, β blockers, athropin) their use if limited by side effects which these medicines cause (mydriasis, photophobia, tachycardia, arrythmia, nausea, vomiting, confusion, exhaustion, constipation, reduction of bronchial secretion) as well as by the fact they are efficient only in mild cases of hyperhidrosis.
4. Ionophoresis – is most often used for palmar and axillary hyperhidrosis. It is conducted by fastening moist sponges with electrodes to the hands or placing them at the armpits and then conducting low voltage electricity for 20 minutes. The effect is reversible, so the intervention must be repeated at certain intervals. Side effects in the form of tingling, numbness, eryhtema or even burns limit the wide application of ionophoresis in the treatment of hyperhidrosis.
5. Botulinum A toxin (BOTOX®, Dysport ®) – blocks the release of acetylcholine from neuromuscular coupling and that way temporarily shuts down innervation of the sweat gland. It is performed by intradermal injection in certain body parts (palms, armpits). Intervention must be repeated at certain intervals which the patient determines subjectively based on intensity of repeated sweating.
6. Thoracoscopic sympathectomy. For already 30 years it has been performed all over the world with excellent results and it is regarded as a standard in treatment of more serious forms of primary focal hyperhidrosis.
7. New technology, which solves great problems which cause some people very unpleasant situations is called Laser Sweat Ablation (laser removal of sweat glands). It was performed in Brasil and is based on laser destruction of sweat glands under the armpits. Scars which occur then are invisible and sweating in that body part is permanently reduced considering that the sweat glands have been removed. In most cases one treatment is enough and the degree of reduction of sweating depends on the laser energy which may be applied depending on the individual skin structure and subcutaneous tissue. Permanent results are achieved in reduction of excessive sweating of the designated region by even 60-80%. If necessary, treatment may be repeated after 3 months without any problems. “Side effect” of this intervention is epilation i.e. removal of hairs in the designated region and is especially recommended with patients where, after epilation by other methods, there was an inflammation and pustules under the skin (most often in the armpit and groin regions).
Before the treatment itself, iodine and starch powder are applied onto the armpit so as to locate precisely the sweat glands. Under local anesthetic and less often in intravenous analgosedation, through a 2 millimeter puncture an Nd-YAG laser probe is introduced by means of which the energy is applied which removes the sweat glands and, just hours later, patients can return to their usual activities. Bandage remains 24 hours after the procedure and after that regular daily hygiene of the armpit by water and soap should be introduced as well as cream application. If necessary, an antiobiotic may be prescribed. Pain killers are rarely necessary.
COMPLICATIONS are extremely rare and in the domain of theory. Skin infections may occur (extremely rarely). Hematoma on the treated region may occur as a result of the treatment but the person feels the pain only during strenuous manual labour or during expressive movements. Side effect of the laser is also partial destruction of dark i.e. pigmented hairs under the armpit which again contributes to more simple subsequent epilations of the area.
