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New microwave device for hyperhidrosis proves promising

Joely Kaufman, M.D.
Hyperhidrosis, or excessive sweating, can be a physically and emotionally distressing condition. In 2004, the United States prevalence rates were estimated to be 1.4 percent (more than 4 million people; Strutton DR, Kowalski JW, Glasser DA, et al. J Am Acad Dermatol. 2004;51(2):241-248).

Though there are many forms of hyperhidrosis, primary hyperhidrosis is the type not associated with any underlying disease. Axillary hyperhidrosis accounts for the majority of the cases of primary hyperhidrosis. The effects on quality of life can be devastating, with currently no ideal permanent treatment (Basra MK, Fenech R, Gatt RM, et al. Br J Dermatol. 2008;159(5):997-1214).

Sweat is produced primarily from eccrine glands, with a small contribution from apocrine glands. The glands are composed of coiled ducts that are deeply seated in the dermis, with a portion of the duct traveling through the epidermis to secrete its contents to the skin surface. They have muscarinic receptors that are activated by acetylcholine (hence the efficacy of botulinum toxin). There is some evidence to the presence of adrenergic receptors in addition to the muscarinic receptors. This may be one reason why botulinum toxin does not offer 100 percent reduction in sweating in all patients.

Glandular tissue can be present at 1.25 mm through depths of 3.5 mm, which is generally at the interface between deep dermis and subcutaneous fat (Lawrence CM, Lonsdale Eccles AA. Br J Dermatol. 2006;155(1):115-118). Obviously, there are variations in skin thickness between individuals and within the same individual at different body sites, altering these depths. Depth is important when considering the approach to treatment with laser and light devices.

Microwave option

Microwave energy was first introduced to the medical literature at least 60 years ago (Herrick JF, Krusen FH, et al. Fed Proc. 1947;6(1 Pt 2):129). It is not until recently, however, that microwave technologies are being used more commonly in medicine. Currently, microwave energy is being used for the treatment of prostate enlargement and some tumors, both malignant and benign. Microwave energy has also been shown to kill malaria and other parasites, making it an interesting option for future treatment of infectious disease (New York Times. August 2011).

Microwaves are part of the electromagnetic spectrum at wavelengths between 1 mm and 1 meter and frequencies typically between 300 MHz and 300 GHz. Microwave ovens emit waves of 2.45 GHz (12.23 cm,

The term "micro" is actually a misnomer, since the wavelengths are not in the micron size but in the range of millimeters to meters in length. In medical devices, an antenna or antennae are used to transfer the electromagnetic energy to the tissue.

Recently, Northwestern University Feinberg School of Medicine surveyed their third- and fourth-year residents and found that even though it is not on the official curriculum, the residents are learning defensive medicine. Whether it's an attending mentioning that a particular biopsy isn't necessary or deciding not to offer a patient a particular medication because it of a potential lawsuit, the residents are seeing defensive medicine in practice.

In the quest for new vaccines, developers must balance clinical promise with practical concerns, said Kenneth Tomecki, M.D., at the 70th annual meeting of the American Academy of Dermatology. "The future for vaccines is very encouraging," says Dr. Tomecki, vice chairman, department of dermatology, Cleveland Clinic.

A tangential biopsy performed on melanonychia may often be the superior biopsy technique in exacting an accurate diagnosis of suspect lesions, according to Nilton Di Chiacchio, M.D., department of dermatology, Hospital of Public Service, Sao Paulo.

Merkel cell carcinoma (MCC) is a neuroendocrine tumor of the skin that is very aggressive and potentially lethal. As such, treatment approaches and disease management should also be aggressive and appropriately address the patient's disease and symptoms. Treatment choices depend on the stage of the tumor, however, as well as the general health of the affected patient.

Achieving meaningful use and avoiding common mistakes in implementing an electronic health record (EHR) system require careful planning and learning from others' experiences, said Michael Doyle, chairman of Medsphere Systems Corporation, at the 70th annual meeting of the American Academy of Dermatology.