Failure of Sweat Gland Curettage to Relieve Axillary Hyperhidrosis: A Salutary Lesson

AbstractIntroductionSeveral treatment options are available for primary hyperhidrosis. Selection for individual patients is influenced by symptom severity, success rates and the relative risk of compensatory hyperhidrosis.Case reportA 24-year-old female presented with a 10-year history of palmar, pedal and axillary hyperhidrosis. Following recurrent relapse after botulinum toxin (BOTOX®) injections for axillary hyperhidrosis bilateral axillary sweat gland curettage was performed with immediate procedural success. At 6 month follow-up recurrent hyperhidrosis was reported affecting both axillae. A starch-iodine test showed a rim of persisting sweating at the periphery of both axillae.DiscussionCurettage is generally performed without specific identification of sweat gland distribution, perhaps explaining the recurrence in this patient. In contrast, a starch–iodine test is used to guide administration of BOTOX® for hyperhidrosis. We propose pre-operative use of this technique before axillary curettage