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PubMed1993

Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis.

Tap-water iontophoresis (TWI) using direct current (DC) is the most effective therapy in palmoplantar hyperhidrosis. Side-effects of this method are discomfort, with burning and tingling, and skin irritation, including erythema and vesicles. Incorrect use may induce iontophoretic burns at sites of minor skin injury. Elaborate safety measures are required to prevent electric shock. The aim of this study was to minimize side-effects and to increase technical and safety standards of TWI, without loss of efficacy. In a controlled blind study, treatment of palmar hyperhidrosis by alternating current (AC) or by AC with DC-offset (AC/DC) was compared with the conventional DC method. Palmar hyperhidrosis was completely controlled after an average of 11 treatments by either AC/DC iontophoresis or the conventional DC method. Virtually no effect was seen when AC without DC-offset was used for TWI. There were no signs of cutaneous irritation, or subjective sensations of discomfort when AC with or without DC-offset was employed. AC/DC iontophoresis should become the treatment of choice for palmoplantar hyperhidrosis. The mechanism of action is unknown. It is hypothesized that an interrupted stimulus-secretion-coupling leads to a functional disturbance of sweat secretion.

Adolescent↗

PubMed2004

Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis.

BACKGROUND: Direct electrical current (d.c.) administration based on tap water iontophoresis has been used as a therapeutic option for palmoplantar hyperhidrosis. The placebo effect of this technique has not been investigated adequately. AIM: To investigate whether d.c. administration has a possible placebo effect in the treatment of palmoplantar hyperhidrosis. METHODS: As a placebo, low alternating electrical current (a.c.; 9-12 mA, 10-15 V, and 8-10 Hz) was applied to the palms of 15 patients with idiopathic palmoplantar hyperhidrosis. The placebo effect was evaluated by inspection and sweat intensity measurements performed before and after placebo application. Patients then received d.c. treatment (18-22 mA, 40-60 V) according to the same procedure as applied for placebo. The final sweat intensity measurements of the patients were performed 1 week after the last session of d.c. treatment. Sweat intensities measured before and after placebo and at the end of d.c. treatment were analyzed statistically by paired t-test. RESULTS: The initial sweat intensity measurements of the palms, before placebo application, were 3.12 +/- 0.39 g/h on the right side and 3.17 +/- 0.28 g/h on the left side. The second sweat intensity measurements, 1 week after the last session of placebo, were 3.08 +/- 0.46 g/h on the right side and 3.16 +/- 0.21 g/h on the left side. There were no significant differences between the initial and second sets of sweat intensity measurements of the hands (P > 0.05 for both sides). The final sweat intensity measurements, 1 week after the last session of d.c. treatment, were 0.38 +/- 0.06 g/h on the right side and 0.39 +/- 0.07 g/h on the left side. CONCLUSIONS: Statistical evaluation of sweat intensity measurements and inspections revealed that d.c. administration had no placebo effect in the treatment of palmoplantar hyperhidrosis.

Adolescent↗

PubMed2004

Treatment of plantar hyperhidrosis with botulinum toxin type A.

BACKGROUND: Hyperhidrosis (excessive, uncontrollable sweating) can be embarrassing and disabling, significantly impacting social and professional performance and quality of life. Treatments aim to reduce sweating, but few are effective, often carrying the risk of significant side-effects. The aims of this study were to evaluate the efficacy and safety of botulinum toxin type A (BTX-A) for plantar hyperhidrosis and to investigate the role of the Dermojet as a potential injection technique. METHODS: Ten adult patients (five men, five women), aged 19-51 years, with severe, previously unresponsive, plantar hyperhidrosis, were recruited to this single-center, open-label, noncomparative study. The hyperhidrotic area of each foot was injected over 15-20 sites without analgesia with 50 U BTX-A + 5 mL sterile saline using a Dermojet. Patients were followed up for 8 months with monthly sweat reduction assessments using Minor's iodine-starch test. Patients provided a treatment self-assessment after completion of follow-up. RESULTS: Within 7 days post-treatment, eight patients reported significantly decreased sweating, and seven patients were symptom free for up to 5 months. Patient self-assessment showed that seven of the 10 patients were satisfied with their treatment. One minor adverse event was reported comprising a temporary localized hematoma (one patient). CONCLUSIONS: Intracutaneous BTX-A injection using the Dermojet offers a simple, safe, and effective alternative for treatment of plantar hyperhidrosis.

Adult↗

PubMed2006

Tumescent liposuction with dermal curettage for treatment of axillary osmidrosis and hyperhidrosis.

BACKGROUND: Axillary osmidrosis and hyperhidrosis are distressing social problems, particularly in Asian societies. Various treatment methods have been developed for removal of the apocrine and eccrine glands. But conventional surgical methods often lead to significant scarring and frequent recurrence. OBJECTIVE: To evaluate the effect of liposuction with curettage using a new device, the Fatemi cannula, in the treatment of axillary osmidrosis and hyperhidrosis. METHODS: From August 2003 through December 2004, 25 patients (15 women and 10 men) with axillary osmidrosis or hyperhidrosis were treated by tumescent liposuction and curettage. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. Changes in axillary sweating and hair growth, postoperative scarring, patient satisfaction degree, and complications were also evaluated. Biopsies of the axillary skin were performed in 14 patients. RESULTS: Of the 50 axillae, 38 (76.0%) were graded as excellent results, 11 (22.0%) were good, and one (2.0%) was fair. No serious complications were noted except temporary ecchymosis and local infection in minor cases. The preoperative histologic examinations showed large and numerous apocrine glands and postoperative significant decrease and degeneration of them. CONCLUSION: Tumescent liposuction with dermal curettage using the Fatemi cannula is an effective and safe method in the treatment of axillary osmidrosis and hyperhidrosis.

Adolescent↗

PubMedDate not supplied

Botulinum toxin in the treatment of axillary hyperhidrosis.

INTRODUCTION: Axillary hyperhidrosis can be a source of social isolation and embarrassment. The available treatments are either ineffective or have intolerable side effects. The search for a simple, long-lasting, and safe treatment has led to the use of botulinum-A toxin injections in those with excessive axillary hyperhidrosis. MATERIALS AND METHODS: Fifteen patients participated in this study. All had a history of axillary hyperhidrosis of 1-6 years duration and were using different types of therapies without any benefit. Each patient was injected intradermally with 125 units of botulinum-A toxin (Dysport, Spenywood Pharmaceutical) in 5-6 points over an elliptical area on each side. Patient follow-up was performed using the iodine-starch test. RESULTS: A total of 14 out of the 15 patients had complete anhidrosis 1 week after the injection. This result lasted for periods ranging from 1-6 months. No side effects were encountered. CONCLUSION: Intradermal injection of botulinum-A toxin seems to be a safe, rapid, and effective method of treatment in axillary hyperhidrosis.

Adolescent↗

PubMed2005

Heart rate variability in patients with essential hyperhidrosis: dynamic influence of sympathetic and parasympathetic maneuvers.

BACKGROUND: Essential hyperhidrosis has been associated with an increased activity of the sympathetic system. In this study, we investigated cardiac autonomic function in patients with essential hyperhidrosis and healthy controls by time and frequency domain analysis of heart rate variability (HRV). METHOD: In this study, 12 subjects with essential hyperhidrosis and 20 healthy subjects were included. Time and frequency domain parameters of HRV were obtained from all of the participants after a 15-minute resting period in supine position, during controlled respiration (CR) and handgrip exercise (HGE) in sitting position over 5-minute periods in each stage. RESULTS: Baseline values of HRV parameters including RR interval, SDNN and root mean square of successive R-R interval differences, low frequency (LF), high frequency (HF), normalized unit of high frequency (HFnu), normalized unit of low frequency (LFnu), and LF/HF ratio were identical in two groups. During CR, no difference was detected between the two groups with respect to HRV parameters. However, the expected increase in mean heart rate (mean R-R interval) did not occur in hyperhidrotic group, whereas it did occur in the control group (Friedman's P = 0.000). Handgrip exercise induced significant decrease in mean R-R interval in both groups and no difference was detected between the two groups with respect to the other HRV parameters. When repeated measurements were compared with two-way ANOVA, there was statistically significant difference only regarding mean heart rate in two groups (F = 6.5; P = 0.01). CONCLUSION: Our overall findings suggest that essential hyperhidrosis is a complex autonomic dysfunction rather than sympathetic overactivity, and parasympathetic system seems to be involved in pathogenesis of this disorder.

Analysis of Variance↗

PubMed2002

Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience.

Primary hyperhidrosis of the palms, face, and axillae has a strong negative impact on social and professional life. A retrospective analysis of 40 laparoscopic transaxillary thoracic sympathectomies performed in a district general hospital over a five year period was undertaken in order to determine the effectiveness of this procedure. A postal questionnaire was sent to all patients to assess the benefit from the operation; postoperative pain and time off work were collated. Immediate failure was noted in three patients, of whom two later underwent successful reoperation. Recurrence was noted in three patients (8%). Though immediate complications were minimal, the major long term postoperative morbidity was compensatory hyperhidrosis on the back, chest, and thigh (77%) along with gustatory sweating over the face (22%). Thoracoscopic sympathectomy is a safe, effective, and minimally invasive surgical treatment for hyperhidrosis, Raynaud's phenomenon of the upper limb, and excessive facial blushing; however, the chance of long term compensatory hyperhidrosis is high.

Adolescent↗

PubMed1996

Thoracoscopic sympathicolysis for essential hyperhidrosis: effects on pulmonary function.

Bilateral interruption of the upper dorsal sympathetic chain at the D2 and D3 level represents the only permanent cure for essential hyperhidrosis. Following surgical sympathectomy, significant and symptomatic changes in pulmonary function have been observed. Since functional effects of the surgical intervention cannot be excluded, we wondered whether such alterations also occurred after thoracoscopic sympathicolysis; these should then be attributable to the surgical denervation itself. Pulmonary function tests (PFTs), including spirometry and body plethysmographic measurement of lung volumes and airway resistance and conductance, were compared before and 6 weeks after thoracoscopic sympathicolysis in 47 patients. In order to virtually exclude any effects of thoracoscopy on the test results PFTs were repeated 6 months after thoracoscopic sympathicolysis in 35 patients. Essential hyperhidrosis was completely relieved in all patients, thereby confirming the interruption of the D2-D3 sympathetic chain. None of the patients developed respiratory symptoms after thoracoscopic sympathicolysis. Forced expiratory volume in one second (FEV1) (-3%), forced expiratory flow after exhaling 75% of vital capacity (FEF75) (-8%) and total lung capacity (TLC) (-3%) were slightly but significantly reduced at six weeks after thoracoscopic sympathicolysis; whereas airway resistance (Raw) had increased (+12%). After correction for the small decrease in lung volume (FEV1/forced vital capacity (FVC), specific airway resistance (sRaw), specific airway conductance (sGaw))significant changes in "volume-dependent" PFT parameters were no longer observed. Smoking status had no influence on the reduction in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had returned to preoperative values, whereas FEF75 remained decreased (-8.6%). The decrease in airway calibre was confirmed by small but significant changes in FEV1/FVC (-2%) and Raw (+29%). We conclude that thoracoscopic sympathicolysis in patients with essential hyperhidrosis causes only minimal and subclinical changes in pulmonary function secondary to a temporary small decrease in lung volume, which in turn is probably inherent to the thoracoscopic procedure. D2-D3 sympathicolysis, in itself, is responsible only for a small and permanent decrease in forced expiratory flow, which suggests that, at least in essential hyperhidrosis patients, airway bronchomotor tone is influenced by sympathetic innervation.

Adolescent↗

PubMed2005

Peripheral vascular endothelial function in essential hyperhidrosis.

BACKGROUND: Essential hyperhidrosis, a disorder of the eccrine sweat glands, is associated with sympathetic overactivity and the aim of the present study was to determine endothelium-dependent vasodilator function in patients with this condition. METHODS AND RESULTS: Using high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperemia (flow-mediated dilatation, %FMD endothelial-dependent stimulus to vasodilatation), as well as after sublingual administration of nitroglycerin (%NTG endothelium-independent vasodilatation) was measured in 18 subjects (mean age 27+/-5 years) with essential hyperhidrosis and 24 healthy control subjects (mean age 29+/-5 years). Baseline brachial artery diameter and FMD were comparable in both groups (BAD: 4.1+/-0.7 mm vs 4.3+/-0.5 mm (control), p = 0.8; FMD: 5.6+/-1.9% vs 6.7+/-2.2%, p=0.1). The time-averaged flow velocity during peak reactive hyperemia was similar in the 2 groups (75+/-11 cm/s vs 72+/-10 cm/s, p = 0.5), nor did NTG-induced dilatation in the patients with essential hyperhidrosis differ significantly from that in healthy control subjects (12.8+/-2.7% vs 14.0+/-3.6%, p = 0.3). CONCLUSION: These findings suggest that endothelium-dependent dilatation of large conduit arteries is preserved in essential hyperhidrosis and it seems to be a localized disorder of the eccrine sweat glands rather than a generalized disorder involving vascular endothelium.

Adult↗

PubMed2000

[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain].

We reported the cases of thoracoscopic sympathectomy, that is, six cases of hyperhidrosis, three of post herpetic neuralgia, and four of reflex sympathetic dystrophy, including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness, less pain, early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreased the sweating. The balance of autonomic nerve system, toward parasympathetic dominant, was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis, so an adequate preoperative informed consent was thought to be necessary.

Adolescent↗

PubMed2000

[Toxin treatment of sweat pearls. A review of the treatment of hyperhidrosis with a special view of a new therapy option using botulinum toxin A].

Hyperhidrosis is defined as an excess of sweating beyond the amount needed to cool down elevated body temperature. We distinguish a primary and a secondary form, where an underlying endocrinological or neurological disease is found. The innervation of eccrine sweat glands is sympathetic but the transmitter is cholinergic (ACh). There are variable modalities in the treatment of focal hyperhidrosis, such as topical aluminium chloride application, tapwater iontophoresis, anticholinergic drugs or surgery (axillary sweat gland extraction, liposuction or thoracoscopic sympathectomy). Only recently botulinum toxin (BTX) has been introduced as a therapeutic tool for hyperhidrosis. As BTX inhibits the release of ACh at the cholinergic synapse, perspiration is arrested completely after intradermal injection. BTX is a very potent alternative to the surgical approach in the treatment of hyperhidrosis, though the treatment must be repeated regularly to maintain the effect.

Botulinum Toxins, Type A↗

PubMed2001

Video-assisted thoracoscopic sympathetic ramicotomy for hyperhidrosis--a way to reduce the complications.

Endoscopic resectional surgery of sympathetic nerves is now the most acceptable method to treat palmar hyperhidrosis, though the resection of the sympathetic trunk and ganglia can result in the irreversible compensatory hyperhidrosis. The ideal way to treat the palmar hyperhidrosis, without the undesirable complication of the compensatory hyperhidrosis, is still pending. We adapt endoscopic cutting of the second and third sympathetic rami without injury to the sympathetic ganglia and trunk, and find that it is a good way to reduce the complications. Most importantly, it has a cure rate comparable with the conventional technique. The longer operation time and the higher operation risk are the drawbacks.

Adolescent↗

PubMed2002

Botulinum toxin-A therapy for palmar and plantar hyperhidrosis.

In an open study regarding focal hyperhidrosis, we injected 45-65 mouse units of botulinum toxin A (Btx-A) per palm and 100 per sole intracutaneously to 28 hands and 6 feet. We observed patients for up to 10 months to evaluate the efficacy and tolerability of Btx-A for palmar and plantar hyperhidrosis. The mean sweat production significantly declined for both palmar and plantar hyperhidrosis quantitatively on the first month of therapy (P < 0.01). One patient had transient muscle weakness and mild thenar atrophy interfering with her daily activities for 10 days. Injections were otherwise tolerated well by the patients. In this trial Btx-A injection is found to be an effective and safe method of treatment for palmar and plantar hyperhidrosis.

Adolescent↗

PubMed2002

Type A botulinum toxin: a new treatment for axillary and palmar hyperhidrosis.

Hyperhidrosis is an invalidating condition, and one that is difficult to treat. It is characterized by an excessive and uncontrolled production of sweat by the sweat glands, often causing psychological, social, and occupational problems for the patient. Hyperhidrosis can be distinguished in two forms: idiopathic (of unknown etiology), or secondary, due to an alteration of the endocrine system (ex: hyperthyroidism, neuropathy, neoplasia etc.) It is found in about 0.3-0.5% of the population and can be localized (axillary, palmar, plantar, facial) or diffused. The subcutaneous injection of type A botulinum toxin, until now used only for the treatment of blepharospasm or hemifacial spasm, has shown to be a useful treatment for localized hyperhidrosis. The objective of the authors is to evaluate the therapeutic efficacy, safety, and management of botulinum toxin treatment in patients affected with axillary or palmar hyperhidrosis resistant to conventional therapies.

Adult↗

PubMed1992

[Unilateral persistent hyperhidrosis after ischemic stroke].

A 64-year-old right hemiplegic woman, who had been treated for hypertension for 15 years, was admitted to our hospital. Neurologic examination on admission disclosed right hemiplegia and motor aphasia; however, ophthalmoparesis, pupillary abnormality, and blepharoptosis were not evident. Excessive sweating on the right side of the body, which was most marked on the face, was observed. Amount of sweating on the left side of the body was normal. Unilateral hyperhidrosis persisted for more than 2 months. MRI revealed hemorrhagic infarctions in the left basal ganglia, internal capsule, thalamus, hypothalamus, and medial part of the cerebral peduncle. 123I-IMP SPECT disclosed hypoperfusion in the left striatum, thalamus, occipital cortex, and right cerebellar hemisphere. Cerebral angiography revealed arteriosclerotic changes in the basilar artery, but that the left posterior cerebral artery and its branches were not occluded. Unilateral persistent hyperhidrosis is rare after ischemic stroke. Hypothalamic lesion was thought to be responsible for the hyperhidrosis in this patient. As the hypothalamus receives its blood supply from the posterior cerebral artery, unilateral persistent hyperhidrosis may be an important sign of cerebral infarction in the posterior cerebral artery region.

Cerebral Infarction↗

PubMed2004

[Surgical treatment for compensatory hyperhidrosis in Adie syndrome].

Ross syndrome is characterized by a triad of tonic pupil, areflexia and segmental hypohidrosis. Hypohidrosis may be accompanied by contralateral hyperhidrosis, probably due to a compensatory mechanism. We report a case of Ross syndrome with socially disabling left-sided hyperhidrosis. Sympathectomy of the second and third thoracic ganglia was performed with satisfactory results. With excellent results in primary hyperhidrosis and very low morbidity, thoracic sympathectomy is the definitive treatment for hyperhidrosis.

Adie Syndrome↗

PubMed2003

Early experience with thoracoscopic sympathectomy for palmar hyperhidrosis.

Excessive craniofacial, palmar and axillary hyperhidrosis can be very distressing in young people, especially in hot climates. In this study, we are presenting our operative experience and the long-term effect of the technique of thoracospic electrocoagulation of the thoracic sympathetic chain in the treatment of this condition. We reviewed the results of 22 thoracoscopies performed on 16 patients at Asir Central Hospital in Abha, Saudi Arabia during the period from January 1999 to December 2002. The patients were 11 males and five females with a mean age of 26.9+/-5 years (range 19-35 years). Except for one patient who presented with post-traumatic, left upper limb chronic regional pain syndrome (CRPS), the rest presented with craniofacial, palmar and axillary hyperhidrosis. In the first 10 patients, sympathectomy was performed unilaterally and in the following six patients it was performed bilaterally in the same sitting. While pneumothorax occurred in three patients (19%), only one patient (6%) required chest tube insertion. During the mean follow-up period of 25.6+/-14.2 months (range 4-47 months), only one patient (6%) presented with recurrent left axillary hyperhidrosis. The patient underwent another thoracoscopy which failed due to lung adhesions and required subcutaneous electrocautery of the sweat glands. In conclusion, thoracoscopic sympathectomy is very effective (94%) in the treatment of palmar and axillary hyperhidrosis with no mortality, minimal morbidity and durable long-term effect.

Adult↗

PubMedDate not supplied

Treatment of palmar hyperhidrosis using needlescopic T2 sympathetic block by clipping: analysis of 102 cases.

Endoscopic thoracic sympathicotomy, or sympathectomy by a 2-mm scope, is an effective method for treating palmar hyperhidrosis. However, postoperative compensatory sweating may be troublesome in some patients. We report needlescopic T2 sympathetic block by clipping, which may provide reverse operation for patients encountering compensatory sweating. Between January 1998 and January 2002, a total of 102 patients with palmar hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T2 ganglion. There were 47 males and 55 females (mean age, 24.1 years; range, 9-50 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed T2 sympathetic block by clipping at the second and third intercostal spaces using a 2-mm, 0 degrees thoracoscope. Among these 102 patients, all bilateral T2 sympathetic blockings were achieved. The operation was usually accomplished within 30 minutes (range, 16-40 minutes). All patients were discharged within 4 hours after the operation. There were no surgical complications or surgical mortality cases. The mean postoperative follow-up period was 37.1 months (range, 16-64 months). Improvement of palmar hyperhidrosis can be obtained in all patients. Eighty-six patients (84%) have developed compensatory sweating of the trunk and lower limbs. Two patients had a reverse operation and had improvement of compensatory sweating at 2 and 13 days after removal of endo clips. Needlescopic T2 sympathetic block by clipping is a safe and effective method for treating palmar hyperhidrosis; compensatory sweating may be improved after reverse operation removal of endo clip.

Adolescent↗