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PubMedDate not supplied

Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.

Postoperative complications of endoscopic thoracic sympathectomy may be troublesome in some patients. Between January 1998 and September 2002, a total of 16 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic T2 and T3 sympathetic block. There were seven men and nine women, with a mean age of 21.1 years (range, 12-35 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the T2 sympathetic block for patients with still intact T2 ganglion using an 8-mm, 0 degrees thoracoscope. An additional T3 block should be given if patients received either previous T2 sympathectomy or elevated palmar temperature <1 degrees C after T2 sympathetic block. The mean operation time was 30 minutes. The level of sympathetic blocks were the T2 and T3 in five patients, only T2 block in four, patients, and only T3 block in seven patients. Improvement of palmar hyperhidrosis can be obtained in all patients. One patient received a reverse operation 12 days after the T2 and T3 clipping and obtained improvement of troublesome compensatory sweating and dry hands 1 day after removal of all clips. All patients obtained improvement of palmar hyperhidrosis without recurrence after a mean of 37.1 months of follow-up (range, 12-56 months). Endoscopic thoracic T2 with or without T3 sympathetic block by clipping is a safe and effective method in treating patients with recurrent palmar hyperhidrosis.

Adolescent↗

PubMed2006

[Comparison of curative effects of sympathectomy at different segments on palmar hyperhidrosis].

OBJECTIVE: To compare the curative effects of sympathectomy at different segments on palmar hyperhidrosis. METHODS: Four hundred patients with palmar hyperhidrosis, 191 males and 209 females, aged 21.9 +/- 3.4 (10 - 53), underwent bilateral sympathectomy However, bilateral sympathectomy was forced to be given up and replaced by unilateral sympathectomy in 2 patients because of severe pleural adhesion The 398 patients on which bilateral sympathectomy was successfully performed were randomly divided into 3 groups: Group A (n = 207) undergoing T2-4 sympathectomy, Group B (n = 131) undergoing T3 sympathectomy, and Group C (n = 60) undergoing T3-4 sympathectomy. The curative effects were compared. RESULTS: Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related post-operative complication occurred. The compensatory hyperhidrosis (CH) rate of Group B was 5.3%, not significantly different from that of Group C (6.7%, P > 0.05). The CH rate of the combined group, Group B + C was 5.8%, significantly lower than that of Group A (28.0%, P < 0.01). CONCLUSION: Safe and mini-invasive, T3 or T3-4 sympathectomy effectively reduce the development of CH and improves the patients' quality of life post-operatively.

Adolescent↗

PubMed2006

[Thoracic sympathetic block by clamping in the treatment of primary hyperhidrosis: indications and results in 281 patients].

AIM: Hyperhidrosis is a disabling troublesome characterized by excessive perspiration that produces a significant social and professional deficit for patients. It main involves the palmar sides of hands and feet, axillae, face and, with a lesser incidence, trunk and scalp. Thoracoscopic sympathectomy represents the best approach for this disorder. The aim of our prospective study is to assess the outcome, the safety and efficacy after thoracoscopic sympathetic block by clipping in the treatment of primary hyperhidrosis. METHODS: Between september 2002 and april 2005, 281 patients (117 female and 164 male, with a mean age of 28 years) underwent Endoscopic Thoracic Sympathectomy (ETS) to treat hyperhidrosis with palmar, axillar, facial and widespread localization. RESULTS: There were no deaths or major intra-operative problems. There was no conversion to open surgery. During intermediate and long-term follow up we obtained excellent results and few complications. In 3 patients (1.06%) we noted a major complication (Horner's Syndrome), but one patient only had the surgical operation reversed; compensatory sweating occurred in 61 individuals (21.7%). Gustatory sweating occurred in no patient. CONCLUSIONS: The clipping of the thoracic sympathetic chain is a reversible surgical technique considered safe and effective. Despite of an incidence of complications and/or compensatory sweating and according to our operatory results, we conclude that the sympathetic block by clamping is the elective treatment for hyperhidrosis.

Adolescent↗

PubMed1976

Hyperhidrosis and hypohidrosis.

Sweating has an important physiological function concerned with both temperature and fluid balance. Hypohidrosis is uncommon and rarely recognized by the patient. It usually represents damage to the central nervous system or peripheral nerves. Hyperhidrosis may be a feature of general medical diseases such as thyrotoxicosis and fevers. It may also be due to damage of the central of peripheral sympathetic nerves. Localized hyperhidrosis tends to occur on the palms, the soles, the axillae and, to a lesser extent, the face. Treatment of local hyperhidrosis with topical aluminium salts, or with topical or oral anticholinergics, may help some patients but surgery may be indicated in those with severe hyperhidrosis.

Age Factors↗

PubMed1989

[Quantitative evaluation of perspiration with equipment for continuous recording of local perspiration volume (II): Hyperhidrosis and hypohidrosis (or anhidrosis)].

To objectively evaluate perspiration volume, we tried to measure the perspiration volume from 6 cases of hyperhidrosis and 4 cases of hypo-(or an-) hidrosis using recently developed equipment for continuous recording of local perspiration volume. Patients with hyperhidrosis were loaded with various factors to possibly influence the perspiration volume, and the effects were compared. The results revealed: 1) The measurement of local perspiration volume with this equipment provides objective data useful for the diagnosis of hyperhidrosis and hypo-(or an-) hidrosis and for the judgement of its grade; 2) in case of palmar hyperhidrosis, mental stimuli most strongly induced perspiration; and 3) the responses to mental arithmetic or hand grasping and the base-line stable time are reliable parameters for measurement of perspiration volume.

Adolescent↗

PubMed1983

[Physiopathologic aspects and clinical pictures in hyperhidrosis].

Fully developed eccrine glands distributed over the entire integument are found only in man. The secretory mechanism is based on the active transport of sodium ions; water diffuses passively following the osmotic gradient. The thermoregulatory center in the hypothalamic region receives impulses from external and internal thermoreceptors and is modified by levels of hormones, by emotions, physical activity and pyrogens. Heat loss is controlled by the blood flow through the skin and by activity of eccrine glands. Thermoregulatory sweating occurs mainly on head and trunk. Emotions trigger eccrine sweating predominantly in the axillae, on palms, and soles. Generalized hyperhidrosis is mostly due to metabolic or endocrinologic disorders; in the state of acclimatization or following menopause hyperhidrosis is conceived to be physiologic. In underlying neurologic disorders hyperhidrosis follows a segmental or irregular pattern. Functional or anatomic eccrine nevi have been described. Gustatory sweating elicited by certain foods is found to be idiopathic and occurs symmetrically on the face. Subsequent to neurologic lesions (e.g., Frey's syndrome) gustatory sweating in segmental distribution may be associated with salivation and can be triggered by any foodstuff. The idiopathic localized hyperhidrosis of axillae, palms, and soles poses a frequent therapeutic problem in the dermatologist's office. Frequently, a familial predisposition is found. To what extent the disorder may be part of a general imbalance of psychovegetative functions is not yet fully understood.

Body Temperature Regulation↗

PubMed1984

[Therapy of hyperhidrosis].

In the treatment of hyperhidrosis stabilization of psychovegetative functions is certainly desirable. However, autogenic exercise, hypnosis, psychotherapy as well as the administration of sedatives and tranquilizers serve only as adjuvant therapeutic measures. Systemic antihidrotics, like sage or camphor, proved ineffective; anticholinergics pose the risk of side effects. For topical therapy aldehydes, organic acids, and especially metallic salts are favorable. Tanning agents are of limited effect. Topical anticholinergics suppress sweating but provoke systemic side effects, if resorbed in larger quantities. Surgical treatment includes sympathetic blockade, sympathectomy, excision or curettage of eccrine glands, and cryotherapy or application of sclerosing agents. Concerning efficacy and risks of therapy only excision of axillary skin fields can be advocated. Among physical measures X-ray therapy is rendered obsolete. However, tap water iontophoresis is gaining increasing significance as an effective and safe treatment in palmar and plantar hyperhidrosis. In hyperhidrosis axillaris, palmaris, or plantaris topical application of aluminum chloride solution is emphasized as an efficacious treatment modality. If it fails, axillary skin fields can be excised and hyperhidrosis of palms or soles can be treated with tap water iontophoresis.

Aluminum Hydroxide↗

PubMed1994

Intraoperative cardiac arrest: a rare complication of T2,3-sympathicotomy for treatment of hyperhidrosis palmaris. Two case reports.

Endoscopic surgery, including thoracoscopic sympathicotomy for treatment of hyperhidrosis, is thought to be safe and entail fewer complications as compared with open methods. A total of more than 719 patients with hyperhidrosis have undergone thoracoscopic T2,3-sympathicotomy for treatment of hyperhidrosis at Tainan Municipal Hospital since October 1, 1989. Most of the complications have been minor; however, two of the patients suffered from sudden cardiac arrest at the time when the left T2,3-sympathetic nerve trunk was transected by the thoracoscopic method. Vigorous cardiopulmonary resuscitation was performed and both patients recovered completely without any sequelae. The purpose of this paper was to discuss the possible mechanism of cardiac arrest in thoracoscopic sympathicotomy, and to emphasise this rare but potentially fatal complication in the treatment of hyperhidrosis palmaris.

Adolescent↗

PubMed1995

[The use of the Drionic apparatus for treating essential hyperhidrosis].

40 patients with essential hyperhidrosis of palms, feet and axillary spaces were examined. All patients were divided into 2 groups: with permanent or remittent manifestations of hyperhidrosis. The prolongation of latent periods as well as the decrease of evoked skin sympathetic potentials amplitudes was observed in group with permanent type of hyperhidrosis as compared with remittent type patients or with control individuals. All patients were treated with "Drionic" apparatus (General Medical Co, USA) which therapeutic effect was based on water ionophoresis action. The decrease of sweating was demonstrated in 82.5% of cases. The treatment of palms and feet hyperhidrosis was more effective than of axillary spaces. The therapeutic effect in permanent group was better than in remittent group of patients. The investigation of evoked skin sympathetic potentials before the treatment resulted in the conclusion about high prognostic significance of potentials in curative effects of "Drionic" device.

Adolescent↗

PubMed1995

[Upper thoracic sympathectomy by thoracoscopic approach. A method of choice for the treatment of palmar hyperhidrosis].

Palmar hyperhidrosis is excessive sweating beyond physiological needs in the palm without recognized etiology. Although a benign disease, it is annoying to most patients. Currently the best treatment for this condition is upper thoracic sympathectomy via many different approaches. The video-thoracoscopic approach has been recommended a a minimally invasive procedure. We report our 1-year experience with transaxillary endoscopic sympathectomy in 99 patients with palmar hyperhidrosis. Standard video-laparoscopy was used via a transaxillary approach to perform sympathectomy. The mean operating time of this operation was 12 minutes and mean hospital stay was 32 hours. The results in terms of warm and dry hands were excellent. Only one case of transitory Horner syndrome was noted. Transaxillary thoracoscopic sympathectomy for palmar hyperhidrosis is a relatively simple and effective procedure which can be performed with standard laparoscopic instruments. The advantages are, short recovery time and hospital stay along with excellent functional and cosmetic results. We are convinced that thoracoscopic sympathectomy is the procedure of choice for the treatment of palmar hyperhidrosis.

Adolescent↗

PubMed1996

Minimally invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis.

Palmar hyperhidrosis (PH) is a common disorder in Taiwan. It often causes social embarrassment and occupational handicaps. So far, there has been no satisfactory treatment for PH. In 1990, we first developed a minimally invasive technique: video endoscopic sympathectomy to treat PH. The procedure has subsequently proven to be a standard treatment for PH. In this study, a survey of 9988 cases of PH patients from 17 hospitals in Taiwan treated by this method during the past 5 years is presented. Although there were some variations in the model of anaesthesia, technique and extent of sympathectomy, the postoperative results were generally satisfactory. Both sides of sympathectomy were mostly accomplished within half an hour in one stage. The operative scars were tiny and concealed in the axillary region. The patients were discharged from the hospital after an overnight stay. Complications such as pneumothorax, haemothorax (0.3%) or Horner's syndrome (0.1%) were rare. There was no surgical mortality in this series. The most common complication was compensatory hyperhidrosis which was usually mild to moderate and tolerable after reassurance. The recurrence rate of PH was approximately 1% in the first year and less than 3% during the 3 years of follow up. Intraoperative monitoring of palmar skin temperature (PST) was advocated to confirm an adequate sympathectomy warranting a definite result. En bloc ablation of T2 segment invariably resulted in a rise of PST to about 2 degrees C and was considered as an adequate extent of sympathectomy for PH. The refined technique was extended to treat young children with PH and patients with craniofacial hyperhidrosis. The therapeutic results were generally excellent with minimal morbidity and rare recurrence. It is concluded that video endoscopic en bloc T2 sympathectomy is a simple, minimally invasive and effective treatment for both adults and children with PH and also for patients with craniofacial hyperhidrosis.

Adolescent↗

PubMed1996

A comparison of topical tannic acid versus iontophoresis in the medical treatment of palmar hyperhidrosis.

This is a report comparing the efficacy of tannic acid lotion (an astringent) and iontophoresis in the medical treatment of idiopathic hyperhidrosis. Ten patients with long-standing symptomatic idiopathic palmar hyperhidrosis were recruited into the study. One palm was treated with daily tannic acid (20%) lotion and the opposite palm with iontophoresis. Visual scoring using a visual analog scale by patients and assessors showed the mean score to be significantly lower on the iontophoresis treated palm than the tannic acid treated palm. There was significant reduction in the severity of hyperhidrosis on the iontophoresis treated palm after treatment. There was also a significant reduction in transepidermal water vapour loss on the iontophoresis treated palms. The study indicated that iontophoresis is an effective medical treatment for idiopathic hyperhidrosis. The disadvantage of iontophoresis is its short-lived effect. Patients need to undergo the treatment weekly to achieve euhidrosis.

Administration, Topical↗

PubMed2003

Treatment of compensatory gustatory hyperhidrosis with topical glycopyrrolate.

Gustatory hyperhidrosis is facial sweating usually associated with the eating of hot spicy food or even smelling this food. Current options of treatment include oral anticholinergic drugs, the topical application of anticholinergics or aluminum chloride, and the injection of botulinum toxin. Thirteen patients have been treated to date with 1.5% or 2% topical glycopyrrolate. All patients had gustatory hyperhidrosis, which interfered with their social activities, after transthroacic endoscopic sympathectomy, and which was associated with compensatory focal hyperhidrosis. After applying topical glycopyrrolate, the subjective effect was excellent (no sweating after eating hot spicy food) in 10 patients (77%), and fair (clearly reduced sweating) in 3 patients (23%). All had reported incidents of being very embarrassed whilst eating hot spicy foods. Adverse effects included a mildly dry mouth and a sore throat in 2 patients (2% glycopyrrolate), a light headache in 1 patient (1.5% glycopyrrolate). The topical application of a glycopyrrolate pad appeared to be safe, efficacious, well tolerated, and a convenient method of treatment for moderate to severe symptoms of gustatory hyperhidrosis in post transthoracic endoscopic sympathectomy or sympathicotomy patients, with few side effects.

Administration, Topical↗

PubMed2003

Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study.

OBJECTIVE: To evaluate the safety and efficacy of botulinum toxin type A (BTX-A) (BOTOX) over 16 months in the treatment of bilateral primary axillary hyperhidrosis. DESIGN: A 16-month study with initial double-blind randomization to 50 U of BTX-A or placebo per axilla. After 4 months, participants could receive up to 3 further treatments with open-label BTX-A over 12 months. SETTING: Fourteen dermatology or neurology clinics in Germany, Belgium, and the United Kingdom. PARTICIPANTS: Of 207 individuals aged between 17 and 74 years who had persistent bilateral primary axillary hyperhidrosis that interfered with daily activities, 174 (84%) completed the study. The baseline gravimetric assessment was a spontaneous sweat production of 50 mg or greater in each axilla prior to initial treatment. MAIN OUTCOME MEASURES: At week 4 after each treatment, the response rate of subjects who had at least a 50% reduction from baseline in axillary sweating, as measured by gravimetric assessment, was evaluated. Adverse events were spontaneously reported throughout the study, together with quality-of-life parameters and assessment of neutralizing antibodies to BTX-A. RESULTS: Over the 16-month period, 356 BTX-A treatments were given to 207 subjects. After placebo treatment, the response rate at week 4 was 34.7%. After the first, second, and third treatment with BTX-A, response rates at week 4 were 96.1%, 91.1%, and 83.3%, respectively. For subjects receiving more than 1 treatment, the mean duration between BTX-A treatments was approximately 7 months; however, 28% of subjects completed the study after only 1 BTX-A treatment. Subjects' satisfaction after treatments was consistently high, their quality of life improved, and there was a reduction in the impact of the disease on their lives. The safety profile of BTX-A after repeated treatments was excellent and no confirmed positive results for neutralizing antibodies to BTX-A occurred. CONCLUSION: Repeated intradermal injections of BTX-A over 16 months for treatment of primary axillary hyperhidrosis is safe and efficacious.

Adolescent↗

PubMed2026

Efficacy and safety of rib-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation at two different targets for primary palmar hyperhidrosis: a randomized controlled trial.

OBJECTIVES: To compare the efficacy and safety of computed tomography-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation (RFT) targeting the upper versus lateral margin of the fourth rib head for severe primary palmar hyperhidrosis (PPH). METHODS: Patients with severe PPH were randomly divided into Group U (upper margin target) and Group L (lateral margin target). Outcome measures included 1-year recurrence rate, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI), palm skin temperature, finger perfusion index (PI), compensatory hyperhidrosis and patient satisfaction. RESULTS: Both groups (n = 55 each, 110 sides) successfully underwent RFT. No preprocedural PI differences were found (p > 0.05). Immediately post-RFT, PI in Group L was significantly higher than in Group U (left p = 0.025, right p = 0.013). No significant differences in HDSS grades were observed between groups before and at 1 day, 2 weeks, 1 month and 3 months post-procedure. However, at 6 and 12 months, Group L showed significantly lower HDSS grades (left p = 0.033 and 0.016; right p = 0.039 and 0.025) and lower DLQI scores (p = 0.037 and 0.024) than Group U. Patient satisfaction did not differ within 6 months, but Group L had significantly higher satisfaction at 12 months (p = 0.036). CONCLUSIONS: Targeting the lateral margin of the fourth rib head for RFT achieved greater efficacy, better quality of life and higher patient satisfaction compared to the upper margin target.

Humans↗

PubMed2001

Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy.

HYPOTHESIS: A more selective sympathectomy can improve the outcome of axillary hyperhidrosis and osmidrosis and minimize the potential sequelae. DESIGN: Retrospective cohort. SETTING: Tertiary care center. PATIENTS: Between July 1, 1996, and May 30, 2000, 171 patients with axillary hyperhidrosis and osmidrosis were studied. INTERVENTIONS: T3-4 sympathectomies were performed in 40 patients (group 1), T4 sympathectomies were performed in 56 patients (group 2), and T4-5 sympathectomies were performed in 75 patients (group 3). MAIN OUTCOME MEASURES: The surgical outcomes were evaluated by direct patient interview in the outpatient clinic or by telephone or mail questionnaires. The results were categorized as excellent (significant or complete disappearance of symptoms), good (>/=50% improvement), or poor (<50% improvement). RESULTS: There were no surgical mortalities in this study. Twenty-eight group 1 patients (70%), 16 group 2 patients (29%), and 22 group 3 patients (29%) developed compensatory perspiration (P<.001). Six group 1 patients (15%), 1 group 2 patient (2%), and 1 group 3 patient (1%) developed dry hands (P =.02). In the group 1 patients, the surgical outcomes were excellent in 21 (52%), good in 6 (15%), and poor in 13 (32%). In the group 2 patients, the surgical outcomes were excellent in 29 (52%), good in 10 (18%), and poor in 17 (30%). In the group 3 patients, the surgical outcomes were excellent in 53 (71%), good in 11 (15%), and poor in 11(15%) (P =.04). (Percentages may not sum to 100 because of rounding.) CONCLUSION: T4-5 sympathectomies provide higher patient satisfaction rates in treating axillary hyperhidrosis and osmidrosis, with fewer sequelae.

Adolescent↗

PubMed1990

Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis.

Endoscopic transthoracic electrocautery of the sympathetic chain has been the preferred treatment for palmar or axillary hyperhidrosis in this unit since 1980. A retrospective study was carried out of the first 112 patients with case material derived from a postal questionnaire, chart review and outpatient assessment. Eighty-five patients undergoing bilateral transthoracic electrocautery who replied to the questionnaire (76 per cent response rate) form the basis of this study. There were 65 females and 20 males with a mean age of 24.3 years (range 15-40 years). The hands alone were affected in 20 patients (24 per cent), the axillae alone in 17 (20 per cent) and both areas in 48 (56 per cent). Mean hospital stay was 3.1 days (range 1-7 days). Outcome was assessed by 92 per cent of patients immediately after operation as 'very much improved' or 'moderately improved', and this assessment persisted in 85 per cent after a mean follow-up of 43 months (range 3-95 months). Cosmetic results were rated as satisfactory by 95 per cent. Apart from pain after operation, morbidity was limited to transient Horner's syndrome in three patients, surgical emphysema in three, and pneumothorax requiring a chest drain in one. A repeat procedure was needed in one patient because of an inadequate first operation. Some compensatory hyperhidrosis occurred in 54 (64 per cent) patients. As a minimally invasive procedure, endoscopic transthoracic electrocautery should be considered the treatment of choice for palmar and axillary hyperhidrosis.

Adolescent↗

PubMed2006

Hyperhidrosis in Parkinson's disease.

We studied the sudomotor skin response (SSR) in patients with Parkinson's disease with and without symptomatic hyperhidrosis. The study was carried out in 13 patients who complained of excessive sweating and in 37 patients who did not have excessive sweating. Patients were matched for age, sex, degree of impairment, duration of the disease, and number and severity of autonomic disturbances. Excessive sweating involved mainly the face, head, and trunk. The SSR was recorded from the palm of the hands to electrical stimulation of the median nerve at the wrist. We analyzed onset latency, peak to peak amplitude, and waveform. Patients with hyperhidrosis had more often absent responses (chi(2) = 5.292; P = 0.021), their responses were of lower mean amplitude (analysis of variance [ANOVA]; F[2,101] = 11.678; P < 0.001), and they had a reduced number of responses with a predominantly negative component (chi(2) = 8.493; P = 0.004) than patients who did not complain of sweating disturbances. Our results indicate that excessive sweating in Parkinson's disease concurs with decreased activation of sweat glands in the palms of the hands and suggests that axial hyperhidrosis could be a compensatory phenomenon for reduced sympathetic function in the extremities.

Aged↗