Chemodenervation of eccrine glands; both axillae
CPT4 code
Name of the Procedure:
Chemodenervation of Eccrine Glands; Both Axillae
Common name: Botulinum toxin injection for excessive armpit sweating
Summary
This procedure involves injecting botulinum toxin (commonly known as Botox) into the sweat glands in both armpits to reduce excessive sweating.
Purpose
The procedure addresses hyperhidrosis, a condition characterized by excessive sweating that can interfere with daily activities and cause social embarrassment. The goal is to significantly reduce sweating and improve the patient's quality of life.
Indications
- Severe primary axillary hyperhidrosis (excessive underarm sweating)
- Failure to respond to other treatments like antiperspirants or medications
- Criteria: Must be over 18 years old and generally in good health
Preparation
- Avoid shaving the armpit area for 2-3 days before the procedure.
- Stop using antiperspirants and deodorants 24 hours before the appointment.
- No specific fasting or medication adjustments unless otherwise advised by the doctor.
- Pre-procedure diagnostic test: Minor’s starch-iodine test may be done to locate areas of excessive sweating.
Procedure Description
- The armpit area is cleaned and disinfected.
- A topical anesthetic or ice pack may be applied to minimize discomfort.
- Using a fine needle, botulinum toxin is injected into the superficial skin layer at multiple sites within the armpit.
- The injection sites are chosen based on areas identified using the starch-iodine test.
Duration
Approximately 30 to 45 minutes.
Setting
Outpatient clinic or a dermatology office.
Personnel
- Dermatologist or trained healthcare professional
- Nurse or medical assistant for support
Risks and Complications
- Common: Mild pain or discomfort at injection sites, bruising, swelling, or redness.
- Rare: Infection, unintended muscle weakness, allergic reactions, compensatory sweating in other areas. Management: Over-the-counter pain medication, ice packs, and follow-up consultations for any serious complications.
Benefits
- Significant reduction in sweating, usually within a week after the procedure.
- Improved comfort and confidence in social and occupational settings.
Recovery
- Resume normal activities immediately, but avoid vigorous exercise for 24-48 hours.
- Follow-up appointment in 1-2 weeks to assess the effectiveness.
- Results can last from 6 to 12 months, after which repeat treatments may be necessary.
Alternatives
- Prescription antiperspirants
- Oral medications
- Iontophoresis (electronic device treatment)
- Microwave therapy and surgical options like sweat gland removal or nerve surgery Pros and cons vary by effectiveness, invasiveness, and potential side effects. Botulinum toxin injections are minimally invasive with relatively quick results and little downtime.
Patient Experience
Patients may feel slight stinging or burning during injections. Pain is typically minimal and well-managed with topical anesthetics or ice. Post-procedure, discomfort is usually mild. Most individuals notice a significant reduction in sweating within a week, enhancing their quality of life.