Surgical treatment of hyperhidrosis and chronic hidradenitis suppurativa

Abstract

Severe hyperhidrosis and chronic hidradenitis suppurativa both respond promptly to surgical treatment. In less clearly defined clinical situations, the treatment of choice varies widely. When topical preparations and systemic therapy are ineffectual, surgery offers the best possibility for permanent cure. Sympathectomy eliminates severe sweating and is especially applicable in controlling pathologic sweating of the hands and feet. Excisional procedures are best for excessive sweating of the axilla. The areas of maximum sweating are excised and the defects closed primarily. Extensive involvement necessitates larger areas of excision and repairs with flaps and z plasty or its modifications. Most cases of hidradenitis suppurativa can be cured by incision, or by incision and curettage, with or without fulgeration. In widespread, deeply penetrating cases, cures may require excision of the entire axillary organ. Reparative procedures include skin grafts, regional pedicle flaps, z plasties, and modified z plasties. Hidradenitis of various regions can be managed by similar surgical procedures. Carcinoma can develop in chronic hidradenitis suppurativa.