Conflicts of interest None declared.
Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients
Article first published online: 8 MAY 2006
British Journal of Dermatology
Volume 155, Issue 1, pages 115–118, July 2006
How to Cite
Lawrence, C.M. and Lonsdale Eccles, A.A. (2006), Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients. British Journal of Dermatology, 155: 115–118. doi: 10.1111/j.1365-2133.2006.07320.x
- Issue published online: 8 MAY 2006
- Article first published online: 8 MAY 2006
- Accepted for publication 29 January 2006
- axillary sweating;
- Shelley's procedure;
- skin excision
Background Limited axillary skin excision and selective sweat gland removal from adjacent skin (Shelley's procedure) is currently rarely used for hyperhidrosis.
Objectives To determine whether this technique is a good way of permanently reducing axillary sweating.
Methods This was a prospective, open, nonrandomized trial of the therapy, conducted in a university dermatology department. A small skin ellipse, parallel to the skin crease lines, was excised from the centre of the area of maximal sweating. The wound edges were undermined to the extent of maximal sweating and the skin reflected. Large visible sweat glands attached to the undersurface of the adjacent skin could be readily identified and were snipped off using scissors. We treated 15 axillae in eight patients with axillary hyperhidrosis. Sweat reduction was assessed by the patients who estimated the percentage reduction in sweating postoperatively. The scar appearance was graded by the surgeon. Haematoxylin and eosin-stained transverse sections of eight axillary skin ellipses from five subjects were examined histologically to establish the size, position and depth of the sweat gland tissue.
Results All of the patients responded to treatment: mean sweat reduction was 65% (range 40–90%). Mean follow up was 1·3 years (range 0·1–6) and sweat reduction was maintained over this period. Histological material was available from five patients: sweat glands lay slightly deeper than hair follicles; glandular tissue occupied an average thickness of 3·5 mm in the 5-mm thick piece of skin. Apocrine gland lobules were more numerous and larger than eccrine gland lobules. Both gland types were in close apposition and did not occupy distinctly different depths within the skin.
Conclusions Local surgery using limited axillary skin excision and selective sweat gland removal remains one of the safest ways of permanently reducing axillary sweating.