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PubMed1979

Thermoregulatory sweating in palmar hyperhidrosis before and after upper thoracic sympathectomy.

To assess thermoregulatory sweating in palmar hyperhidrosis, the authors determined the responses of three groups of normal, hyperhidrotic, and denervated subjects to a variety of ambient temperatures (TA's), 22 degrees, 28 degrees, and 41 degrees C. The normal group had no hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palm hyperhidrosis with intact T2-3 ganglia, and the denervated group had hyperhydrosis treated with T2-3 ganglionectomy. Both groups of hyperhidrotic and denervated subjects maintained oral and mean skin temperatures within normal limits displayed by the normal group over a wide range of TA's tested. The local sweating rate (LSR) of both the palms and the soles of the feet in the hyperhidrotic group was decreased to a minimal level by either the T2-3 ganglionectomy or the subcutaneous administration of atropine sulfate. Furthermore, the denervated group had a significantly lower LSR of both the forehead and the upper chest regions, but showed a higher LSR or both the ventral thigh and the lateral lumbar regions at a TA of 41 degrees C when compared to the LSR of either the normal or the unoperated hyperhidrotic group. The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man.

Atropine↗

PubMed1980

Effects of cholinomimetic drugs on sudomotor, metabolic, respiratory, vasomotor, and temperature response in palmar hyperhidrosis.

The effects of cholinomimetic drugs such as mecholyl (methacholine) and pilocarpine on autonomic functions (including sudomotor, metabolic, respiratory, vasomotor, and temperature responses) were assessed at room temperature (24 degrees C) in three groups of individuals, including normal, hyperhidrotic, and denervated subjects. The normal group had no palmar hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3 ganglia, and the denervated group had palmar hyperhidrosis treated with T2-3 ganglionectomy. Subcutaneous administration of mecholyl and pilocarpine each produced a fall in oral temperature in the normal group. The hypothermia was brought about by a decrease in metabolic rate, an increase in local sweating rate (mainly of the upper limb and trunk), and an increase in cutaneous circulation (estimated by an increase in the upper limb and trunk skin temperatures). The autonomic functions induced by these cholinomimetic drugs were antagonized by pretreatment with atropine sulfate (an antagonist of cholinergic receptors). Moreover, the hypothermia induced by mecholyl or pilocarpine was greatly reduced in the hyperhidrotic group. The reduction in the cholinomimetic-induced hypothermia in the hyperhidrotic group was due to the reduced sudomotor and metabolic responses after the injections of these cholinomimetic drugs, as compared to those of the normal group. However, neither the excessive sweating of the palms nor the reduced cholinergic responses in the hyperhidrotic group was observed after T2-3 ganglionectomy. The data indicate that the T2-3 ganglia play a role in the elaboration or modulation of the sudomotor and metabolic responses induced by activation of certain cholinergic receptors in humans.

Adult↗

PubMed2003

The comparison of VATS ramicotomy and VATS sympathicotomy for treating essential hyperhidrosis.

This study was undertaken to determine if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic trunk) for treating essential hyperhidrosis. From August 2001 to February 2002, 29 consecutive patients underwent surgery of the sympathetic nerves in order to treat severe essential hyperhidrosis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and contralateral sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. There was no significant difference between the VATS ramicotomy group (VATS-R, n=13) and VATS sympathicotomy group (VATS-S, n=13) in terms of gender, pleural adhesions or comorbidities. However, the age of the VATS-S group at surgery was higher than that of the VATS-R group (p=0.050). The operation times, and hospital stays of the groups were 51.5 and 41.9 minutes, and 2.0 and 2.3 days, respectively. The recurrence rate of the operated sites according to the surgical methods (ramicotomy and sympathicotomy regardless of VATS) was 21.4% (6/28) in the ramicotomy group and 6.7% (2/30) in the sympathicotomy group, but there was no statistical significance (p=0.101). This study compared the dryness of the enervated sites and the severity of compensatory sweating among the ramicotomy (n=11, excluded 2 re-operated cases from 13 VATS-R), sympathicotomy (n=14, VATS-S 13 and T-S 1) and the synchronous or metachronous ramicotomy/sympathicotomy groups (n=4, included 2 reoperated cases of VATS-R). The sympathicotomy group had an over-dryness of the enervated sites (dryness 1.4, from 1 to 3; 1:over-dried, 2:humid, 3:persistent sweating) and complained of severe compensatory sweating (severity 3.5, from 1 to 4; 1:absent, 2:mild, 3:embarrassing, 4:disabling). However, the patients whounderwent a ramicotomy maintained some humidity of the enervated sites (dryness 2.0, p=0.012) and showed milder compensatory sweating (severity 2.7, p=0.056) than those in the sympathicotomy group. Furthermore, the dryness of the ramicotomy side was different from that of the sympathicotomy side in 3 out of 4 ramicotomy / sympathicotomy (R+S) patients (the side of the ramicotomy was humid and that of the sympathicotomy was over-dried). The average dryness and the compensatory sweating at these sites were in the midst of the two groups (dryness and severity 1.6 and 3.0, respectively). A ramicotomy can prevent over-dryness of the enervated area and decrease the severity of compensatory sweating through the selective division of the rami communicantes of the thoracic sympathetic ganglia. Postoperatively, almost all ramicotomy patients had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satisfaction rates. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotomy is recommended as a more selective and physiologic modality for treating essential hyperhidrosis.

Adolescent↗

PubMed2003

In hyperhidrosis (excess sweating), look for a pattern and cause.

Hyperhidrosis (excessive sweating) can be generalized or localized, and secondary or primary; thus, understanding the pattern can help in finding the cause. Generalized hyperhidrosis may be due to an underlying systemic disease or to medication use. Focal hyperhidrosis is often primary (idiopathic) and triggered by emotional stimuli, although it is not generally a psychiatric disease.

Humans↗

PubMed2000

Botulinum toxin type A therapy for palmar and digital hyperhidrosis.

OBJECTIVE: We evaluated the efficacy of subepidermal injections of botulinum toxin type A on recalcitrant palmar and digital hyperhidrosis. METHODS: Twenty patients with recalcitrant palmar and digital hyperhidrosis were treated with subepidermal injections of botulinum toxin. Nineteen patients completed the 12-month study. Injections were performed in 3 stages. The total dose of toxin for each hand, which included the palm, thenar eminence, and digits, was 165 units. Patients were followed up on a monthly basis. RESULTS: Botulinum toxin significantly reduced sweat production in the treated areas. Anhidrosis lasted 9 months in 3 patients, 8 months in 3 patients, 7 months in 8 patients, 6 months in 3 patients, 5 months in 1 patient, and 4 months in 1 patient. Reduced sweating of the palm and digits continued in all patients for the 12-month evaluation period, with the greatest reduction of sweating in the nondominant hand. Mild weakness of the thumb occurred in 4 patients at a mean duration of 3 weeks, with the greatest duration being 6 weeks. CONCLUSION: Botulinum toxin provides a safe and efficacious alternative in the treatment of recalcitrant palmar and digital hyperhidrosis.

Adolescent↗

PubMed2000

Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients.

Patients with essential hyperhidrosis (EH) syndrome may experience subjective suffering and social/occupational challenges. We examined the safety and efficacy of minimally invasive endoscopic surgery for treating EH. Single bilateral incisions, followed by endoscopic thoracic sympathectomy (ETS)-mediated bilateral ablation of the T2 sympathetic ganglia, were used to treat 650 patients with a primary diagnosis of palmar (90%) or facial hyperhidrosis (10%). Palmar and facial hyperhidrosis were resolved in 584 of 585 (>99%) and 62 of 65 (95%) patients, respectively. Surgery required less than 1 hour, and no patient experienced a life-threatening adverse event. Compensatory sweating was observed in 83% of patients and was considered mild or moderate in approximately 67% of those patients. Innovations in ETS have resulted in minimally invasive, highly efficient, safe treatment of EH. Surgery is minimally intrusive to patients, who were usually discharged within 2 hours after surgery and able to resume normal activities within 1 week.

Adolescent↗

PubMed2000

[Pontine hemorrhage presenting with Foville syndrome and transient contralateral hyperhidrosis].

This report concerns a 88-year-old diabetic and hypertensive woman with pontine hemorrhage who presented with Foville syndrome and contralateral hyperhidrosis. She was admitted to our hospital for sudden onset of headaches and disturbed consciousness. Neurologic examination revealed bilateral miosis, Foville syndrome and superficial hemianesthesia on the right side of the face and body. No associated Horner syndrome and other autonomic dysfunction were observed. Laboratory data were normal except for diabetic findings. Brain CT and MRI revealed a hematoma in the left side at the lower pons. One month after the onset, hemihyperhidrosis on the face, arm and upper trunk contralateral side of the lesion appeared abruptly, and gradually disappeared a week later. Sweating on the ipsilateral side was normal and no new lesion was seen on the brain CT then. Only a few cases of contralateral hyperhidrosis due to pontine lesion have been reported. We suggest that the contralateral inhibitory sweating pathway was disrupted though the ipsilateral excitatory one was intact. Contralateral hyperhidrosis attributed to imbalance of the perspiratory control can be observed in the subacute or late phase after pontine hemorrhage.

Aged↗

PubMed2000

Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe?

The authors hypothesize that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function; consequently, thoracoscopic sympathectomy to alleviate symptoms in the hands may result in heat dissipation because sweating is transferred to other sites. To investigate this phenomenon and to determine whether it adversely affects patient satisfaction, a standard questionnaire was administered to 626 patients who underwent sympathectomy at a university-associated public hospital between 1991 and 1998; only patients treated at least 6 months before questionnaire distribution were included in the study. Replies were received from 336 (53.7%) individuals. The surveyed patients underwent bilateral T2, T3 (palmar sweating), or T3, T4 (axillary sweating) sympathectomy by a standard video-assisted transthoracic technique. Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena; in addition, patient perception of the success of the surgical procedure was assessed. After sympathectomy, 97.3% (P < 0.0001) and 29.2% (P < 0.001) of patients reported significant improvement in palmar hyperhidrosis and axillary sweating, respectively. Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), and axillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients. Thirty-seven patients (11%) regretted having undergone the surgical procedure. In contrast, 25% and 64% of patients were either satisfied or very satisfied with the outcome of the procedure. From the survey results, the authors conclude that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function and that thoracic sympathectomy may alleviate symptoms in a large proportion of patients. However, for some individuals, compensatory sweating may prove to be an equally troublesome handicap. Because the occurrence of severe compensatory sweating is unpredictable, a reversible sympathectomy may be desirable.

Adolescent↗

PubMed2001

Axillary injection of botulinum A toxin in a patient with muscle cramps associated with severe axillary hyperhidrosis.

Muscle cramps may be caused by fluid and salt loss induced by diffuse or focal hyperhidrosis. Recent reports have described the efficacy of botulinum, toxin in the treatment of primary focal hyperhidrosis. Botulinum toxin inhibits sweating by blocking exocytosis of acetylcholine from presynaptic cholinergic nerve terminals. We report the case of a patient who complained of frequent muscle cramps associated with unusually severe axillary hyperhidrosis. We used botulinum toxin to treat the excessive focal sweating presuming that it would also reduce the muscle cramps. A total dose of 200 MU of botulinum A toxin (Dysport) per axilla markedly reduced sweating and cramps. The beneficial effect started four days after the injection and it was still present five months later. Treatment was repeated in the sixth month with analogous results. No side-effects were observed and no compensatory sweating occurred.

Axilla↗

PubMed2001

Endoscopic t4-sympathetic block by clamping (ESB4) in treatment of hyperhidrosis palmaris et axillaris--experiences of 165 cases.

Prevention of postoperative complications becomes relatively important when surgical procedures are easy to learn and perform. Endoscopic Thoracic Sympathetic Surgery (ETS), which is now more accessible to surgeons after the 2nd International Symposium of Thoracic Sympathicotomy, would be the typical examples in surgery. Reflex sweating is one of the famous and annoying complications that surgeons endeavor to avoid but in vain in ETS. Incidentally, we found that preservation of sympathetic tone to the head is the main influential factor in avoiding reflex sweating in ETS; and with the lower sympathetic ganglion blocked, the more sympathetic tone to the head is preserved. T4-sympathetic block is an ideal procedure that can treat palmar and/or axillary hyperhidrosis and preserve most of sympathetic tone to head. We used T4-sympathetic block by clamping (ESB4) in treatment of 165 cases of Hyperhidrosis et axillaris and attained excellent operative results without reflex sweating from August 1, 2000 to February 28, 2001. We concluded, ESB4 is the method that can treat hand and axillary hyperhidrosis without inducing reflex sweating.

Adolescent↗

PubMed2000

[Partial sympathectomy for treating palmar hyperhidrosis with VATS].

OBJECTIVE: To review the experience with partial sympathectomy for treating palmar hyperhidrosis with VATS. METHODS: Between July 1995 and June 1999, 50 patients with palmar hyperhidrosis (26 males and 24 females, mean age 26.7 years) were operated. The major symptom was excessive sweating of hands, feet, and axcillaries, sometimes in drops. Thoracoscopy was performed under general anesthesia with a standard single-lumen endotracheal intubation with the patient in a semi-sitting position and arms stretched at 90 degrees. The approach through two small ports on the chest wall was done using VATS. As the lung was depressed by CO(2) insufflation in a low pressure, an excellent view of the upper mediastinum was obtained. Ganglia T(2) through T(4), sometimes T(5) were resected with a electrocautery probe. Bilateral procedures were completed in the same position. RESULTS: All patients after operation became dry immediately after sympathetic denervation with a few minor complications. Occasional side effect was moderate compensatory sweating of the trunk. One case had recurrence but sweating was much less than before operation. CONCLUSIONS: Because of excellent view of the upper mediastinum for sympathetic denervation of the hand and axcillaryies, the effect of partial sympathectomy for palmar hyperhidrosis is satisfactory and permanent.

Adolescent↗

PubMed2002

Emotionally induced hyperhidrosis.

Hyperhidrosis, a disorder that usually begins in childhood or adolescence, is defined as sweating in excess of what is required for normal thermoregulation. This condition may adversely affect one's quality of life by causing emotional disturbance and social embarrassment. Three forms of hyperhidrosis exist: emotionally induced, localized, and generalized. Hyperhidrosis may be either idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or drugs. Diagnosis usually is made based on the patient's history and visible signs of excessive sweating. Various effective treatment options are available.

Diagnosis, Differential↗

PubMed2002

Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate.

Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and beta-blockers may be effective but also carry significant side effects. We describe a healthy, active 27-year-old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating was especially pronounced on the forehead, nose, and upper lip. Daily topical application of a 0.5% glycopyrrolate solution to the face and forehead was offered. After the first treatment, facial sweating was significantly reduced and was well controlled under stressful situations, without any discomfort to the skin. No loss of efficacy was seen after multiple face washings. Facial hyperhidrosis recurred after withdrawal of the glycopyrrolate for 2 days, confirming its therapeutic effect. Two years later, he continues to use glycopyrrolate as needed. We conclude that topical glycopyrrolate is effective in treating craniofacial hyperhidrosis and is associated with few adverse effects.

Administration, Cutaneous↗

PubMedDate not supplied

Upper thoracic sympathetic chain neurolysis under CT guidance. A two year follow-up in patients with palmar and axillary hyperhidrosis.

PURPOSE: To evaluate the efficacy, safety and middle-term results of upper thoracic sympathetic chain neurolysis performed under CT guidance in patients with palmar/axillary hyperhidrosis. MATERIALS AND METHODS: From April 1999 to July 2000 we performed 30 upper thoracic sympathetic chain neurolysis in 15 patients presenting with palmar/axillary hyperhidrosis (6 M, 9 F, mean age 29.5 years). Neurolysis was performed under CT guidance injecting 2-10 ml of a solution of phenol 8%, glycerine 20% and saline through 22 G needles placed in the paraspinal space at T3 level through a paraspinal extrapleural approach. At least one week was allowed between neurolysis of right and left thoracic sympathetic chain in the same patient. Procedures were performed on outpatient basis. Patients were followed up with interviews and/or physical examination every 6 months for 2 years. RESULTS: All patients experienced immediate cessation of symptoms. Three patients (20%) experienced one-sided recurrence of symptoms 5, 7 and 12 months respectively after the first neurolysis, which disappeared after a repeated procedure. Two (13%) patients showed a slight Horner's syndrome immediately after the procedure, which resolved in 1 and 2 months respectively. Two patients (13%) experienced pain in the arm on the same side of the neurolysis, which resolved in 1 week. Three (20%) patients experienced mild compensatory sweating. All patients declared they were satisfied with the outcome of the neurolysis when interviewed at 2 years follow up from the first procedure, with no recurrence of symptoms. CONCLUSIONS: Upper thoracic sympathetic chain neurolysis performed under CT guidance in patients with palmar/axillary hyperhidrosis is a safe procedure, with low rate of complications and good results at 2 years follow-up.

Adult↗

PubMed2005

Surgical treatment of axillary hyperhidrosis with liposuction equipment: risks and benefits.

Axillary hyperhidrosis poses a serious problem to the affected patients. So far, the conservative measures employed seem to be disappointing, operations with axillary skin excision, undermining and/or skin reconstruction may cause secondary functional and cosmetic problems, whereas botulinum A toxin injections need to be repeated frequently. The aim of this study was to establish the safety, efficacy, and durability of subdermal (subcorial) suction sweat gland curettage in the treatment of axillary hyperhidrosis. So far, the method seems to be devoid of possible risks and drawbacks. In the last 4.5 years, 15 patients with axillary hyperhidrosis were operated on with the use of liposuction tools. First operations were performed in general anesthesia, then in tumescent anesthesia. The procedure of suction curettage was performed with the use of 3- to 4-mm wide liposuction cannulas. The patients were closely monitored during early stages of the healing process; then they were evaluated at 1 and 3 months, and finally at 1-4 years of the operation, when they were asked to assess the effects of the operation. Four patients had recurrence of the disease within 3 months; three of them were reoperated on, with good result. At 1-4 years of the operation, all our responders (ten of 15 patients) stated that the disease had completely subsided. The following complications were observed during the process of healing: hematomas, transient skin unevenness, and partial skin flap necrosis. In conclusion, subdermal suction curettage seems to be superior to botulinum A toxin injections by the effect durability, and to the surgical methods with skin excision and undermining by the probably lower complication rates.

Adult↗

PubMed2006

[Minimally invasive surgery for primary hyperhidrosis].

Nine hundred twenty-three thoracoscopic sympathectomies for primary hyperhidrosis were performd in 462 patients (180 men, 282 women). Mean age was 29.2 (11-61) years. Synchronous bilateral sympathectomies were performed in 461 patient: right side alone in 1 patient. We started thoracic sympathectomy for primary hyperhidrosis under a thoracoscope using a 10 mm rigid endoscope in 1992. At present, we perform the surgery using a 3 mm rigid scope. The majority of our patient were satisfied with the result of operation. There is general agreement that postoperative side effect, such as compensatory and gustatory sweating, can cause discomfort and affect overall success. Thoracoscopic sympathectomy for primary hyperhidrosis is minimally invasive surgery and provides less pain and better cosmesis and short hospital stay, as compared with the conventional techniques. However, new technique is necessary to decrease compensatory sweating after the operation in the future and we should undergo a meticulous and critical selection to the patients in outpatient clinic.

Adolescent↗

PubMed2006

[A comparison of T3 sympathectomy versus T4 sympathectomy in the treatment of primary palmer hyperhidrosis].

OBJECTIVE: To evaluate the effect and side effect of T(3) versus T(4) sympathectomy in the surgical management of primary palmar hyperhidrosis through prospective multi-center randomized controlled trial. METHODS: From Sep 2004 to Feb 2006, 106 consecutive patients (49 males and 54 females) with primary palmar hyperhidrosis were enrolled in the study and randomly assigned into T(3) or T(4) level sympathectomy groups. 66 patients received T(3) sympathetic chain transection and 37 patients received T(4) sympathetic chain transection. The two groups were comparable in all other parameters. RESULTS: All procedures were carried out successfully without severe morbidity or mortality. After a mean follow-up period of 8.6 months, both groups remained satisfactory in palmar sweating control. The T(4) group had more moisture hands compared with the T(3) branch (54.1% vs 15.2%, P < 0.01), but this didn't compromise the patients' satisfactory. The patients in T(4) group showed significantly less dry hand problems than the patients in the T(3) group (5.4% vs. 25.8%, P < 0.05), and so did compensatory sweating (21.6% vs. 45.6%, P < 0.05). CONCLUSION: The procedure of T(3) or T(4) sympathectomy, both transecting the sympathetic chain in one single position in relatively lower segment, are comparatively effective in the treatment of primary palmar hyperhidrosis, but T(4) sympathectomy shows less side effect.

Adolescent↗

PubMed2006

[Colorimetric determination of eccrine sudoriferous glands functional condition in case of hyperhidrosis and their correction by belladonna].

For study of the sweat secretion in 27 patients suffered by local hyperhidrosis method of colorimetric determination of functioning sudoriferous glands number and a Minor's tests were used. The confines and intensity of sweat secretion have been determined. Study was carried out before and during the treatment as well as at the moment of clinical recovery. Revealing of vegetative syndromes was provided by Vein's inquirer. In patients with hyperhidrosis vegetative abnormalities were combined with asthenic disorders. Duration of illness had impact on frequency and character of neurasthenic syndrome manifestation. Offered scheme of local hyperhidrosis treatment with staged use of belladonna and antihistaminic preparation "hydroxyzine" (having antimuscarinic action) could be characterized as a well endurable and significantly ameliorative of patient's clinical status.

Adolescent↗