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PubMed2004

Current therapeutic options for treating primary hyperhidrosis.

Severe hyperhidrosis can cause extreme embarrassment that may lead to social and professional isolation. Therapeutic strategies to hyperhidrosis should employ the least invasive treatment that provides effective symptom control. The treatment options available for control of hyperhidrosis, non-surgical or surgical, differ in their invasiveness and efficacy. Mechanisms of action of antiperspirants, iontophoresis, cholinergic inhibitor drugs, botulinum toxin, and surgical sympathectomy are reviewed. There is little published evidence in the form of comparative randomised trials to support the use of one treatment over another. However, authors have tended to recommend those therapies that are available to their speciality. Specific therapies should be tailored to the patient's symptoms to gain maximum symptomatic improvement with minimum invasiveness and side-effects. To achieve this, the full range of treatment options should be available to, or accessible by the consulting doctor in order for the patient to have a meaningful choice.

Botulinum Toxins↗

PubMed1999

Outpatient thoracoscopic limited sympathectomy for hyperhidrosis palmaris.

Thoracoscopic sympathectomy is considered the most effective treatment for hyperhidrosis palmaris. We have treated 1,043 cases of this disease by this method. We have developed an outpatient technique of thoracoscopic sympathectomy using electrocautery. This procedure has been used in 47 patients with hyperhidrosis palmaris. The early results have been favorable. We describe this fast, safe, economic, and effective method for the treatment of hyperhidrosis palmaris.

Adolescent↗

PubMed1999

Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis.

BACKGROUND: Thoracoscopic sympathicotomy has proved successful in the treatment of palmar hyperhidrosis. However, up to 8% of patients experience Horner's syndrome, and about 50% show compensatory sweating. This study evaluates the role of video assistance in thoracoscopic sympathicotomy for primary hyperhidrosis of the upper limb. METHODS: Six hundred fifty-six thoracoscopic sympathicotomies were performed from below T1 to T4 in 369 patients. Of the operations, 558 were done under direct view (CTS group) and 98, with video assistance (VATS group). Follow-up was complete for 78.3% of patients after a median observation period of 16 years. RESULTS: Dry limbs were immediately achieved in 93% of the CTS group and 98% VATS group (p = 0.98). In the CTS group, Horner's syndrome occurred after 2.2% of all operations and rhinitis in 8.3%. No patient in the VATS group showed any symptom of Homer's triad (p = 0.03 versus CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating was observed in 66.8% in the CTS group versus 69% in the VATS group (p = 0.73) and gustatory sweating, in 50.4% versus 27.6%, respectively (p = 0.01). CONCLUSIONS: In performing thoracoscopic sympathicotomy for excessive upper-limb hyperhidrosis, we observed a significant decrease in the incidence of Horner's syndrome, rhinitis, and gustatory sweating when the procedure was guided by video imaging.

Adolescent↗

PubMed2003

[Primary hyperhidrosis: prospective study in 338 patients].

BACKGROUND AND OBJECTIVE: The objective of this report is to study the clinical aspects of the patients with primary hyperhidrosis (PH) and the social and occupational distressing condition. PATIENTS AND METHOD: From January 1998 to October 2002, 338 patients with PH completed a preoperative questionnaire to register: age, gender, profession, associated diseases, familiar hyperhidrosis history, sweating location, associated dermatological lesions and social embarrassesment. 179 patients were asked about their general symptomatology. RESULTS: In 86% of the patients PH started during infancy, 71.5% were female (mean age 28.8 years). A few patients had others diseases and 42.5% had some associated dermatological lesions. In 47.9% of the patients there is family history of PH. 96.4% reported palmar hyperhidrosis, 80.7% plantar PH and 71.3% reported axillary PH, being less frequent in others regions of the body. The most frequent clinical founding associated is facial blushing in 60.3%, 52.3% heart palpitations, 48% muscle stress, 31.8% reported trembling of the hands and 30,8% headache. In reference to social embarrassesment, we observe that relations between friends and professional environment are the most problematic situation. CONCLUSIONS: PH is a pathologic condition starting in infancy, family history of PH is frequent and most patients have some associated dermatological lesions. Excessive sweating is especially common in palms but no exclusively of this region as it extends to others regions with the same intensity. It can be associated with symptomatology suggestive of hyperexcitability of the sympathetic activity like facial blushing, trembling or headache, symptoms difficult to consider whether they are cause or consequence.

Female↗

PubMed2002

Episodic hypothermia with hyperhidrosis in a pregnant woman.

BACKGROUND: Episodic hypothermia with hyperhidrosis is a disorder of thermoregulation, believed to be secondary to a hypothalamic dysfunction, which affects the body's thermoregulatory centers. During this rare condition, the body may sweat profusely in an attempt to maintain a lowered body temperature set point. The exact cause of episodic hypothermia with hyperhidrosis is not known. CASE: A multigravida at 35 weeks' gestation presented with symptoms consistent with hypothermia, although she was diaphoretic. Her basal body temperature was 91.2F, with a lowered blood pressure and heart rate. The fetal heart rate was 130 beats per minute and reassuring. Assisted rewarming occurred over a period of 3 hours, after which her temperature stabilized at 97.9F. The remainder of the pregnancy was uneventful, and the patient delivered a term infant with no apparent adverse effects from this episode. CONCLUSION: Episodic hypothermia with hyperhidrosis should be considered as a potential cause of hypothermia during pregnancy.

Female↗

PubMed1987

Efficacy of the Drionic unit in the treatment of hyperhidrosis.

A portable iontophoretic device (the Drionic unit) has recently been introduced for the treatment of hyperhidrosis. Twenty-two patients with hyperhidrosis were treated at twenty-seven sites (axillae, palms, soles) with this unit. Sweat output was measured by use of Persprint paper and the data were quantified by an image analysis computer. The data clearly demonstrate the efficacy of the Drionic unit at all treatment locations in the great majority of subjects. One month posttreatment follow-up showed a statistically significant continued sweat inhibition at the palmar sites. Side effects were common, but none was severe enough to necessitate discontinuation of treatment. Based on the results of this study, we conclude that the Drionic unit appears to have a definite place in the treatment of hyperhidrosis.

Female↗

PubMed1996

Endoscopic versus transaxillary thoracic sympathectomy for primary axillary and palmar hyperhidrosis and/or facial blushing: 5-year-experience.

Thoracic sympathectomy is effective in the permanent cure of primary axillary and palmar hyperhidrosis and facial blushing, which can be so troublesome for patients that their social and professional relations can be affected. Between October 1988 and April 1994, a total of 50 thoracic sympathectomies (10 surgical and 40 endoscopic) were performed on 5 and 23 patients, respectively. The operations were performed unilaterally, followed by the contralateral intervention after a period of 6-8 weeks. The thoracic ganglia T2-T5 were resected for hyperhidrosis. If the patient suffered from blushing, the lower 1/3 of the stellate ganglion was also resected. Postoperatively, all the operated limbs were warm and dry. In the group of patients who were operated bilaterally, only one had persistent facial blushing. The efficacy for blushing in this series was therefore 93.3%. The late relapse rate of sympathetic activity was 14.3%. Compensatory sweating was seen in 67%, gustatory sweating in 37.5% and phantom sweating in 29% of the patients. None of them considered these side effects to be troublesome. Although there is no difference between transaxillary thoracic sympathectomy and the endoscopic intervention in terms of efficacy, the latter is associated with less postoperative pain, shorter hospital stay and a rapid recovery. The thoracic sympathectomy is the treatment of choice for primary hyperhidrosis and excessive facial blushing.

Adult↗

PubMed1998

Sympathetic skin response and patient satisfaction on long-term follow-up after thoracoscopic sympathectomy for hyperhidrosis.

OBJECTIVES: To determine effect of sympathectomy for hyperhidrosis on sympathetic skin response (SSR) during long-term follow-up. Patient satisfaction was assessed and surgical complications noted. DESIGN: Prospective, Open, Non-randomised study. MATERIALS AND METHODS: Patients who had undergone bilateral thoracoscopic sympathectomy for hyperhidrosis underwent postoperative assessment of SSRs. A 15 mA stimulus was applied over the median nerve contralateral to the sympathectomy and evoked electrodermal activity was recorded from the sympathectomised palm using a Dantec Counterpoint Mk 2. Patient satisfaction with surgery was assessed by questionnaire and visual analogue score (0-1.0). RESULTS: Of 26 patients, 21 were female. Mean (range) age was 23 (9-36) years. Mean (range) follow up was 39 (4-138) months. 12% of cases had residual or recurrent symptoms. Median (range) patient satisfaction was 0.83 (0.06-1.0). In 7/52 palms recurrent SSRs were not detected. Repeated measures analysis of variance found amplitude of SSR to be of low significance with respect to time since surgery (F = 0.48; p = 0.49) and incidence of compensatory sweating (F = 2.38; p = 0.14). CONCLUSION: Thoracoscopic sympathectomy for hyperhidrosis is an effective procedure. Following sympathectomy SSRs are not permanently abolished, but return of SSRs does not correspond with symptom recurrence. As such, SSRs are a poor tool for objective assessment of long-term outcome following sympathectomy.

Adolescent↗

PubMed1998

Segmental hyperhidrosis as a manifestation of spinal and paraspinal disease.

BACKGROUND: Segmental hyperhidrosis is an uncommon finding which is usually associated with irritation or infiltration of pre-ganglionic sympathetic fibres or the sympathetic chain. METHODS: We report two cases of segmental hyperhidrosis with striking clinical features. RESULTS: In one case, a mesothelioma produced ipsilateral simultaneous underactivity and overactivity of sympathetic outflow and in the other case a thoracic central disc herniation was probably responsible for a band of sweating which clearly extended beyond the segmental level of injury. CONCLUSION: Segmental hyperhidrosis should trigger a search for structural disease in the spinal and paraspinal region.

Humans↗

PubMed2003

A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis.

Injection of botulinum toxin type A (BTX-A) is an effective method of controlling palmar hyperhidrosis. It is, however, an uncomfortable procedure without adequate anaesthesia. We outline the techniques used, the reasons for them and potential pitfalls that can be avoided, with an outline of the neural anatomy relevant to the palmar injection of BTX-A. We have been using peripheral nerve blockade as local anaesthesia during BTX-A treatment of palmar hyperhidrosis for the last few years, and have found it an effective method of providing pain relief during the procedure, giving greater anaesthesia than that given by topical anaesthetic cream under occlusion and ice. It has been our experience that patients prefer wrist blockade to topical anaesthesia and ice when receiving BTX-A injections for treatment of palmar hyperhidrosis.

Anesthesia, Local↗

PubMed1999

Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis.

BACKGROUND: This report examines the intermediate-term results of endoscopic transaxillary T2 sympathectomy for palmar hyperhidrosis. METHODS: A retrospective review was carried out of 91 consecutive patients, 38 men and 53 women, with a mean age of 23 years. Attention was focused on patient satisfaction, late complications and morbidity. RESULTS: After operation, no patient died or developed Horner's syndrome. Nine of 21 patients with craniofacial, five of 16 with axillary and 17 of 73 with plantar hyperhidrosis showed simultaneous improvement. Fifteen patients (16 per cent) developed recurrent sweating, but none required reoperation. The overall mean satisfaction rate was 78 per cent with a median 80 per cent improvement using a visual linear analogue scale from 0 (poor) to 100 per cent (excellent). Twelve patients (13 per cent) were dissatisfied with the operative results, mainly owing to compensatory hyperhidrosis, which occurred in 88 patients (97 per cent) within the first year. CONCLUSION: The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.

Adolescent↗

PubMed1999

Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: intermediate term results.

BACKGROUND: The authors' experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined. METHODS: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview. RESULTS: Follow-up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner's syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X-ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction. CONCLUSIONS: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.

Adolescent↗

PubMed2001

Botulinum A toxin improves life quality in severe primary focal hyperhidrosis.

Focal hyperhidrosis is a condition that may disturb emotional, social and professional life. Treatment options for severe cases are surgical sympathectomy and local chemical sweat gland denervation by intradermal injections of botulinum toxin A (Btx A). The Dermatology Life Quality Index (DLQI) is a simple validated questionnaire designed to measure and compare disability in different skin diseases. The aim of this study was to assess quality of life with the DLQI before and after treatment with botulinum toxin injections in a group of patients with severe hyperhidrosis. DLQI was administered to 58 randomly chosen patients before and after treatment. All patients answered the DLQI questionnaire prior to treatment and 53/58 at mean 5.2 months after treatment. The mean DLQI score in the 58 patients before treatment was 10.3 (2-23). In the group of 16/53 patients who had a relapse of sweating when answering the DLQI a second time, no significant improvement was seen [score 10.6 before and 8.8 after treatment (P = 0.21)]. In patients without relapse, a 76% improvement was obtained (DLQI was reduced from 9.9 to 2.4; P < 0.0001). The study showed that focal hyperhidrosis may considerably reduce life quality and the disability experienced by the patients can be largely reversed by botulinum toxin injections.

Adolescent↗

PubMed2001

Botulinum toxin A for palmar hyperhidrosis.

OBJECTIVE: We evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis. METHODS: Ten patients with recalcitrant palmar hyperhidrosis were treated with intercutaneous injections of botulinum toxin A (Botox; 200 U for each hand). Patients were followed up to 23 months (mean +/- SD: 12.1 +/- 6.2 months). RESULTS Botulinum toxin significantly reduced abnormal sweating within 1 week in 100% of the patients. In six patients with a follow-up of 12 months or more the antisudorific effect lasted 12.3 +/- 5.5 months. The longest response duration was 22 months. Repeated treatment was performed in five patients with unchanged clinical efficacy. The only side-effect was tolerable pain from the intracutaneous injections in patients where a nerve block was not performed. CONCLUSIONS: Botulinum toxin A (200 U Botox per palm) was able to induce long-term remission in palmar hyperhidrosis without significant acute and long-term side-effects. Strictly intracutaneous injection of small volumes is recommended. So far, response to repeated treatments did not show evidence of neutralizing antibody induction.

Adult↗

PubMed2002

Long-term quantitative benefits of botulinum toxin type A in the treatment of axillary hyperhidrosis.

BACKGROUND: Although axillary hyperhidrosis is readily treated with botulinum toxin, the time course of benefits is not well established. OBJECTIVE: To quantify the long-term effectiveness of botulinum toxin type A (BTX-A) for the treatment of axillary hyperhidrosis. METHODS: This was a double-blind, placebo-controlled study. Eighteen patients received intradermal injections of either 100 U BTX-A (50 U/ml/axilla) or placebo. Sweating per surface area was quantified monthly for 5 months. RESULTS: The BTX-A group had an average reduction in sweat production of 91.6% at 2 weeks (from 5.03 ml/min/m(2) to 0.42 ml/min/m(2), P <.05). The average reduction over 5 months was 88.2%. At the end of the study, only 1 of 12 BTX-A-treated patients had returned to baseline sweat production. CONCLUSION: These quantitative results demonstrate that BTX-A is a safe and effective treatment for axillary hyperhidrosis and that the benefits last for at least 5 months.

Adolescent↗

PubMed2002

Efficacy and safety of botulinum toxin type a in the treatment of palmar hyperhidrosis: a double-blind, randomized, placebo-controlled study.

BACKGROUND: Recent studies demonstrate that botulinum toxin type A (BTX-A) decreases palmar hyperhidrosis. OBJECTIVE: To evaluate the efficacy and safety of BTX-A for palmar hyperhidrosis. METHODS: Patients (n = 19) received injections of placebo (normal saline) in one hand and BTX-A in the other. Assessments included gravimetric measurement of sweat production and physician's and patient's rating of severity. Safety evaluations included measuring grip strength. Preliminary 28-day results are reported. RESULTS: The mean percentage decrease in gravimetric measurement at day 28 was significantly greater with BTX-A versus placebo. One hundred percent of 17 patients rated the treatment as successful, while only 12% (2/17) rated placebo injection successful. Grip and hand strength were unchanged with either treatment. Only 21% (4/19) reported mild adverse events. CONCLUSION: BTX-A injections produce significant improvements in palmar hyperhidrosis without a concomitant decrease in grip or dexterity, or the occurrence of serious adverse events.

Adolescent↗

PubMed2003

Diffusion and short-term efficacy of botulinum toxin A after the addition of hyaluronidase and its possible application for the treatment of axillary hyperhidrosis.

BACKGROUND: Botulinum toxin adequately treats hyperkinetic facial lines and hyperhidrosis. Higher doses of botulinum toxin appear to enhance efficacy and longevity possibly through greater evenness of diffusion; however, recurrent treatments with higher doses are expensive. OBJECTIVE: To admix botulinum toxin with hyaluronidase and to test whether there is maintenance of efficacy, a spread of effect, and possibly a decrease in required dose compared with botulinum toxin. METHODS: Six patients participated in a double-blinded side-to-side comparison pilot study with photographic analysis for frontalis overactivity and Minor's iodine and gravimetric testing for axillary hyperhidrosis. RESULTS: Initial efficacy of botulinum with admixed hyaluronic acid appeared maintained with possibly increased diffusion when hyaluronic acid is added. No difference was evident on short-term review of patients treated with 50 U of botulinum in one axilla compared with the contralateral side injected with 25 U with admixed hyaluronidase. CONCLUSION: There may be a role for hyaluronic acid in aiding diffusion and decreasing the required dose of botulinum toxin in hyperhidrosis axillaris.

Axilla↗

PubMed2002

High-dose botulinum toxin type A therapy for axillary hyperhidrosis markedly prolongs the relapse-free interval.

BACKGROUND: Axillary hyperhidrosis is a common condition that can be personally distressing and can interfere with professional and social life. Intracutaneous injections of botulinum toxin type A (BTXA) have recently been shown to induce an effective but temporary anhidrosis, usually for 4 to 6 months. High-dose BTXA was shown to have a lower relapse rate, but it remained unclear whether it could induce a prolongation of the antihidrotic effect. OBJECTIVE: Our aim was to evaluate the long-term effectiveness of "high-dose" botulinum toxin therapy in axillary hyperhidrosis, the response to repeated treatment, and the possible side effects. METHODS: In an open study in a university medical center, 47 patients with axillary hyperhidrosis unresponsive to previous therapies were treated with intracutaneous injections of botulinum A toxin. A total dose of 200 U of BTXA was used per axilla. Patients were followed up for periods up to 29 months. The main outcome measures were patients' satisfaction with the antihidrotic effect, response to repeated treatment, and safety of treatment. RESULTS: Within 6 days of the injection of BTXA, all patients reported cessation of excessive sweating. The follow-up was 17.0 +/- 8.3 months (range, 3-29 months). The relapse rate within 12 months of treatment was 4 of 34 patients (11.8%). The longest relapse-free interval observed was 29 months. Twenty-two patients showed a relapse-free interval of 19 months or more. The number of patients with at least 12 months of remission was significantly higher with 200 U of botulinum toxin than with lower doses reported in current literature (P <.05). Relapsed patients (a total of 6/47) showed an unchanged excellent response to a second or third treatment. The only side effect was temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed. CONCLUSION: High-dose BTXA treatment is capable of prolonging the antihidrotic effect of intracutaneous BTXA in most patients for more than 19 months. It reduces the percentage of relapses after 12 months of follow-up to less than 12%. So far, there is no clinical evidence of the induction of neutralizing antibodies. High-dose treatment seems to be as safe as low-dose treatment.

Adolescent↗