CHICAGO – An Nd:YAG laser used for facial fat plasty and laser liposuction treatment has shown promise for targeting axillary bromhidrosis and hyperhidrosis, according to the first prospective, long-term follow-up study for these indications.
After an iodine starch test at baseline, researchers treated both axillae of 18 patients with the disorders with a 1,444-nm pulsed Nd:YAG laser (AccuSculpt, Lutronic). Each operative field was anesthetized. Participants were then assessed at day 1, 7, 30, 60, and 180 for clinical effects.
"Outcome was good in this study" Dr. Sang Min Yi said. Patients rated 61% of axillary bromhidrosis and 86% of hyperhidrosis results as excellent or good.
Patients judged the severity of their condition at baseline and regular intervals using a 10-point scale (10 being the most severe). For example, average bromhidrosis severity was 1.2 on day 7 and 1.7 on day 60. Patients also rated their average pain severity as 1.2 on day 7 and 0.3 on day 60. Severity of limitation on movement was an average 2.6 on day 7 after treatment and 0.4 on day 60.
Participants also rated the severity of remaining sweating as 1.4 on day 7 and 1.7 on day 60. Overall satisfaction was an average 9 out of 10 on both days 7 and 60. Results at day 180 are pending.
The 1,444-nm pulsed Nd:YAG laser targets apocrine sweat glands in the deep dermis and subcutaneous fat layer. Pulse energy was 175 mJ, pulse rate was 40 Hz, power was 7 watts, and the energy density ranged from 20 J/cm2 to 30 J/cm2.
Other treatments for axillary bromhidrosis and hyperhidrosis include local topical medications, botulinum toxin injections, ultrasonic therapy, and liposuction curettage. However, this laser is one of the best modalities to treat these disorders, said Dr. Yi, of the department of dermatology, Korea University, Ansan Hospital, South Korea.
Most adverse events were temporary and mild. Bullae, mild ecchymoses, and bruises on the operative sites all resolved within 30 days, Dr. Yi said. "The most severe and unwanted complication was skin necrosis." This occurred in two patients. Necrosis is preventable if the tip of the probe is held properly and delivery of excess energy to any unit area is avoided, he noted.
Dr. Yi received research funding from Lutronic, which also funded the study.