Axillary skin excision as a treatment for axillary hyperhidrosis.

Axillary skin excision in the management of axillary hyperhidrosis was first described by Hurley & Shelley in 1963. They explain that they discovered this treatment accidentally in 1957 during an investition of the histology of axillary sweat glands. A skin biopsy specimen taken from the axilla of a patient with intense hyperhidrosis produced a remarkable reduction in the amount of sweat in this axilla. Using Randall's method (1946) for assessing the distribution of sweat glands in man with starchpaper-iodine, they observed that 70-80% of axillary sweat is produced by glands found in the dome or central portion of the axilla. Having mapped out this region, an ellipse of this central axillary tissue was excised down to and including part of the subcutaneous tela, thus removing a sufficient number of the most active sweat glands in the axilla. The elliptical excision is placed transversely, i.e. across the mid axilla, and not in a longitudinal axis. After haemostasis, the skin edges are opposed with vertical mattress sutures. Hurley & Shelley carry out this procedure under local anaesthesia. In their initial paper they describe the effect of this operation on four patients and in their second paper, on twelve patients. In only one case in this series was the result thought to be of little or no effect. Interestingly enough, the value of this procedure does not seem to be widely appreciated in this country and even though the method has been used with some success in Britain, no evaluation of it has yet appeared in British literature. The purpose of this paper is to present three cases treated successfully with the above method and to draw attention to the value of this treatment in suitable cases.