Is the starch-iodine test effective at determining the treatment zone or could it cause problem spots to be missed?

Question

My hyperdrosis is due to stress/anxiety (not due to physical activity). The iodine test they did indicated sweat from doing a few squats + only marked a small spot on each armpit to target the miradry treatment. I read that it's mainly the eccrine sweat glands that sweat to cool the body while the apocrine sweat glands connected to the hair follicles are involve in emotional sweating (anxiety, stress etc). Wouldn’t it have been more effective in my case to treat the entire hair follicle area?

Stewart Wang, MD, FACS · Answer

We use the starch-iodine test as a guide to help us capture the most active areas to treat. This test will help us adjust the treatment template placement on the axilla. The treatment template will cover the most active areas as well encompasses the entire hair follicle area. We always try to use the largest template when it’s feasible in order to achieve maximal improvement. Over the past several hundred patients that we have treated, our average improvement after single treatment is about 70% at 3 months and 60% at one year.
Sincerely,
Stewart Wang, MD FACSBoard Certified Plastic SurgeonMedical Director, Wang Plastic Surgery & Med Spa

Aldo Guerra, MD · Answer

Its very unlikely the iodine-starch test would miss a spot, but I do like to treat the largest area which is "lit up" during the test. Most patients, have about 75 to 82 percent reduction in the sweat glands and some do need a second treatment to be even drier.
Best wishes, Dr. ALDO :)

Payman Kosari, MD, FAAD · Answer

We also treat the whole axillae.  A starch-iodine test may not reveal the whole picture since different circumstances may cause more sweating.  If your treatment is already complete, wait to see how you responded.  If you really have no more sweating, then it was a success.  If you have sweat zones that weren't properly treated, you should let the physician know so they can appropriately assess you.  Best of luck!

Hratch Karamanoukian, MD, FACS · Answer

Iodine starch is an idiotic test. I have been taking care of hyperhidrosis patients since 1999 and have rarely  used it.Of course you must treat the entire area, esp hair bearing areas. And of course, some people will only sweat excessively with stress. Excessive sweating is a disorder of the autonomic nervous system, i.e. fight or flight system.Your dermatologist was overthinking this problem and missed the boat. H Karamanoukian MD FACSCenter for Excessive Sweting, established 1999

Shareef Jandali, MD · Answer

Hi EagleStriker,
We typically use the hair bearing area to create the treatment template for anyone receiving a miraDry treatment. This is where the majority of the sweat and odor glands reside. The starch iodine test is indicated to identify post treatment if there continues to be an area of sweating, which would be targeted with an additional treatment.

Chien C. Kat, MD · Answer

Thank you for your question.It is better to treat the whole hair bearing area. Allow everything to settle and assess your sweating, if you have any concerns contact your practitioner.

Jared Mallalieu, DO · Answer

The entire hair bearing portion of the axilla should be treated. We only use the test to identify areas that may require additional treatments. Best of luck, Dr. M

Leon Egozi, MD · Answer

Thank you for your question.  I do believe that you are correct in your inquiry regarding the effectiveness of treating the entire area rather than a small localized area.  Even if you are not sweating so much I would have recommended treating the entire axilla.  In those cases it only takes one treatment instead of the 2 treatments that are required for actual hyperhidrosis.  At this point you may need the second treatment to get the desired effect.

Is the starch-iodine test effective at determining the treatment zone or could it cause problem spots to be missed?

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