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PubMed1990

Surgical management of palmar hyperhidrosis.

Hyperhidrosis is an idiopathic pathologic condition characterized by excessive sweating beyond that required to cool the body. Disturbance of the central nervous system, endocrine system, or obesity has been associated with this condition. Patients have a history of several years of occupational or social embarrassment. Individuals of Japanese ancestry and Jews of Northern African, Yemeni, or Balkan descent are predisposed to the condition. Nonoperative therapy is merely temporizing and unacceptable because of lack of efficacy or side effects. Surgical intervention provides effective and permanent control. The key to surgical correction appears to be the division of the sympathetic chain above the T-2 ganglion and below the T-3 ganglion of the involved side with removal of the entire T2-3 segment with its corresponding spinal nerves. This paper presents our experience with the dorsal thoracic approach for interruption of sympathetic innervation for severe palmar hyperhidrosis. We also review surgical efficacy of various approaches to the sympathetic chain, as well as possible side effects of operative intervention.

Adult↗

PubMed2002

Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods.

The goal was to review results of sympathectomy, performed with use of either cauterization or clamping, in patients with hyperhidrosis (n = 1,312): 653 early patients undergoing electrocautery sympathectomy, 305 later patients undergoing cauterization, and 354 patients treated with a clamping procedure. Patients were interviewed by telephone about the status of symptoms, adverse outcomes, and satisfaction. Palmar hyperhidrosis was cured in all but one patient, with a 98% satisfaction rate in the clamping group and 94.3% and 95.1% in the two cauterization groups ( < or = 0.025, clamping > cauterization). Facial sweating or blushing was cured in the majority (88%) of the 301 patients reporting this symptom. Severe compensatory hidrosis occurred in less than 6% (3% of the clamping group; < or = 0.001, clamping < cauterization). Recurrence rate was 3.0%. A number of factors were related to outcome. Endoscopic thoracic sympathectomy with clamping appears to be at least as safe and effective as earlier cauterization techniques, with the potential advantage of reversibility in those patients unhappy with the outcome.

Adolescent↗

PubMed2004

Developing an instrument to measure quality of life of patients with hyperhidrosis.

Quality of life (QOL) is an index of the state of wellness of an individual. The purpose of this study was to develop an instrument to measure quality of life of patients with hyperhidrosis. With a multi- dimensional model of QOL as the conceptual framework for instrument development, the study started from literature review which was followed by interviews with patients, staff nurses, and doctors to generate the original items for the instrument. The validity and reliability then were assessed. Six experts performed content validity (CVI =.70). Internal consistency and construct validity assessment followed. A quantitative research method was used in this study. During March 2002 to April 2003, 85 patients from the surgical outpatient clinic at a teaching hospital in southern Taiwan were purposively recruifed as subjects. Written consent was obtained before subjects answered a questionnaire that should take 8-10 minutes to finish. Data analysis was performed using SPSS for Windows 8.0. Mean, standard deviation, frequency, percentage, Cronbach ' s alpha, Pearson ' s correlation, and factor analysis were used to analyze the data. Exploratory factor analysis identified five factors. They were functional, social interaction, personal affective, psychological and physical function. The coefficients of Cronbach ' s alpha for these five factors ranged from 0.71 to 0.94. These five factors explained 68.90 % of the variance in QOL among the patients with hyperhidrosis. The results showed that the instrument had satisfactory validity and reliability. Implications of these results for future studies were discussed.

Activities of Daily Living↗

PubMed1991

A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema.

We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.

Adult↗

PubMed2004

Idiopathic unilateral hyperhidrosis with Holmes-Adie syndrome: case report.

Hyperhidrosis is a disease that is characterized by excessive sweating due to hyperactivation of eccrine sweat glands. It may be localized or generalized form. Holmes-Adie syndrome is an idiopathic disease with unilateral pupil dilatation and loss of deep tendon reflexes. We present a 37-year-old female patient diagnosed with unilateral hyperhidrosis coincident with Holmes-Adie syndrome because of this unusual presentation.

Adie Syndrome↗

PubMed1986

The surgical treatment of upper limb hyperhidrosis.

Primary hyperhidrosis is a common and poorly understood condition. Surgical thoracic sympathectomy, either by the cervical or transaxillary route, entails major surgery, so there is a tendency to offer this only to those most severely affected. Endoscopic thoracic sympathectomy is a simple, safe and effective procedure. The technique and results are described and it is recommended as the appropriate procedure for treating upper limb hyperhidrosis, including localized axillary sweating.

Adult↗

PubMed1987

Localized unilateral hyperhidrosis.

A case of unilateral hyperhidrosis of the face is described. Measurements of the rate of evaporative water loss from other areas of the body, showed a marked left-right difference in the sweating rate on the arms and on the legs which had not been suspected clinically. Unilateral hyperhidrosis is a rare and puzzling disorder. Possible neurological causes are discussed.

Adult↗

PubMed2006

Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients.

BACKGROUND: Limited axillary skin excision and selective sweat gland removal from adjacent skin (Shelley's procedure) is currently rarely used for hyperhidrosis. OBJECTIVES: To determine whether this technique is a good way of permanently reducing axillary sweating. METHODS: This was a prospective, open, nonrandomized trial of the therapy, conducted in a university dermatology department. A small skin ellipse, parallel to the skin crease lines, was excised from the centre of the area of maximal sweating. The wound edges were undermined to the extent of maximal sweating and the skin reflected. Large visible sweat glands attached to the undersurface of the adjacent skin could be readily identified and were snipped off using scissors. We treated 15 axillae in eight patients with axillary hyperhidrosis. Sweat reduction was assessed by the patients who estimated the percentage reduction in sweating postoperatively. The scar appearance was graded by the surgeon. Haematoxylin and eosin-stained transverse sections of eight axillary skin ellipses from five subjects were examined histologically to establish the size, position and depth of the sweat gland tissue. RESULTS: All of the patients responded to treatment: mean sweat reduction was 65% (range 40-90%). Mean follow up was 1.3 years (range 0.1-6) and sweat reduction was maintained over this period. Histological material was available from five patients: sweat glands lay slightly deeper than hair follicles; glandular tissue occupied an average thickness of 3.5 mm in the 5-mm thick piece of skin. Apocrine gland lobules were more numerous and larger than eccrine gland lobules. Both gland types were in close apposition and did not occupy distinctly different depths within the skin. CONCLUSIONS: Local surgery using limited axillary skin excision and selective sweat gland removal remains one of the safest ways of permanently reducing axillary sweating.

Adolescent↗

PubMedDate not supplied

Treatment of hyperhidrosis with topical methenamine.

Idiopathic palmar and plantar hyperhidrosis is a relatively common disorder of eccrine sweat gland function. Treatment with glutaraldehyde of formaldehyde, although successful, may cause undesirable side effects. Methenamine is a polycyclic organic compound which release ammonia and formaldehyde at acid pH. Five per cent methenamine in a firm stick gel, applied daily to one palmar or plantar surface of 109 patients with hyperhidrosis, resulted in significantly less sweating after one month. No patients were sensitized to formaldehyde.

Chemical Phenomena↗

PubMed2004

Iontophoresis with glycopyrrolate for the treatment of palmoplantar hyperhidrosis.

To determine the comparative efficacy of tap water iontophoresis to iontophoresis with the anticholinergic glycopyrrolate, we undertook a single-blinded right-left comparison study in 20 patients with palmoplantar hyperhidrosis. Most patients had their palms treated and one patient had the soles treated. We compared the duration of symptom relief following iontophoresis with glycopyrrolate unilaterally to iontophoresis with glycopyrrolate bilaterally. Patients filled in daily efficacy assessment cards. Each palm was rated as 'dry', 'slightly wet', 'moderately wet' or 'very wet'. Following treatment with unilateral tap water iontophoresis, unilateral glycopyrrolate and bilateral glycopyrrolate, patients reported hand dryness for a median of 3, 5 and 11 days, respectively. As the data was paired, treatment differences were analysed using a sign-rank test. Bilateral glycopyrrolate was superior to both unilateral glycopyrrolate and tap water in most patients. Unilateral glycopyrrolate was superior to tap water in most patients. All differences between groups were found to be statistically significant. We postulate that the increased efficacy of bilateral glycopyrrolate when compared with unilateral glycopyrrolate relates to its systemic absorption. We conclude that glycopyrrolate iontophoresis is more effective than tap water iontophoresis in the treatment of palmoplantar hyperhidrosis and that glycopyrrolate iontophoresis has both local and systemic effects on perspiration.

Adolescent↗

PubMed2005

Liposuction for axillary hyperhidrosis.

Excessive axillary sweating is a common problem for which many patients frequently seek dermatological advice. The removal of axillary sweat glands using liposuction with tumescent anaesthesia in an outpatient setting is a relatively short and simple procedure with few complications, as seen in this case series. We present 10 patients treated with axillary liposuction under tumescent anaesthesia. Of the 10 patients treated, four relapsed with axillary hyperhidrosis and required additional liposuction to the same area. The longest time to relapse was 15 months, with 4 months being the shortest time. Six patients have not required additional liposuction, with 7 years being the longest time of remission. The complications reported were bruising in the axillae of two patients and relapse of hyperhidrosis in four patients.

Adult↗

PubMed1998

Hyperhidrosis treated by botulinum A exotoxin.

BACKGROUND: Hyperhidrosis, or excessive sweating, can be emotionally challenging and socially and professionally disruptive, and there have been few effective treatments. Recently, botulinum toxin has been demonstrated to be an effective treatment for hyperhidrosis of the axillae and palms and for gustatory sweating. OBJECTIVE: This article reviews the current treatments and outcomes achieved with chemodenervation of the eccrine sweat glands. RESULTS: The antihydrotic response lasted 6-17 months for gustatory sweating, 2-8 months for axillary sweating, and 13 weeks to 12 months for palmar sweating. CONCLUSIONS: Intracutaneous injections of botulinum toxin offer a simple, safe, and effective alternative to other conservative and surgical options.

Botulinum Toxins, Type A↗

PubMed2004

Plantar hyperhidrosis and pitted keratolysis treated with botulinum toxin injection.

BACKGROUND: Sulcate plantare keratolysis or pitted keratolysis (plantar keratolysis sulcatum) is a disease that is commonly found in tropical countries. Patients have also reported plantar hyperhidrosis. OBJECTIVE: Two patients with pitted keratolysis resistant to topical and systemic treatments are described. METHODS: Both patients were injected with botulinum toxin distributed evenly through the plantar extension. RESULTS: The response to the treatment was excellent despite using a low dose of botulinum toxin with the plantar keratolysis healing completely. CONCLUSION: Hyperhidrosis may be considered the major etiologic factor for pitted keratolysis that does not respond to treatment.

Adult↗

PubMed2007

Control of palmar hyperhidrosis with a new "dry-type" iontophoretic device.

BACKGROUND: Palmar hyperhidrosis is characterized by excessive sweating on the palm, and among the various treatment modalities, tap water iontophoresis has been widely used. OBJECTIVE: The objective of this study was to assess the effect of a new "dry-type" iontophoretic device that was locally manufactured and did not use tap water to control sweating. METHODS: Ten subjects with palmar hyperhidrosis were enrolled in this study. To be treated the patients were instructed that they only have to grasp the device. Only one palm was treated for 2 weeks, and then the treatment was discontinued the following next 2 weeks. The other palm was not treated as a control. At the end of second week, biopsy specimens were obtained from untreated and treated palm, respectively, and examined histologically. RESULTS: Nine of 10 patients were satisfied with this therapy reducing their sweat outputs from 33% to 51% of baseline at the end of 2 weeks' treatment, and after 2 weeks of discontinuation of treatment sweat productions returned to near baseline. The pathologic examinations showed some occlusions and destruction of intraepithelial eccrine ducts only in the treated palm. CONCLUSION: We suggest that dry-type iontophoresis could reduce palmar sweating more conveniently than other conventional methods.

Adolescent↗

PubMed1978

Axillary hyperhidrosis treated with alcoholic solution of aluminium chloride hexahydrate.

Sixty-five patients with axillary hyperhidrosis took part in a trial of treatment with a solution of 20% aluminium chloride hexahydrate in absolute alcohol, applied topically each night for a week and then whenever the patient thought it necessary. Excellent control of sweating was achieved in 64 patients, and occlusion of the area was found to be unnecessary. No troublesome side effects were reported. The results of this study indicate that 20% aluminium chloride hexahydrate in absolute alcohol is the treatment of first choice for patients with axillary hyperhidrosis.

Administration, Topical↗

PubMed1997

Stimulation of left stellate ganglion prolongs Q-T interval in patients with palmar hyperhidrosis.

With the advent of transthoracic video-assisted endoscopic electrocautery of the second and the third sympathetic ganglia for the treatment of palmar hyperhidrosis, it is possible to approach the stellate ganglia with ease. To see whether stimulation of stellate ganglia in humans is similar to the case in dogs, we stimulated the sympathetic ganglia in 18 palmar hyperhidrosis patients with a coagulation power of 5 W at a frequency of three times every 2 s. We found that left stellate stimulation prolongs the Q-T interval and increases the heart rate, whereas right stellate stimulation affects the Q-T interval and heart rate insignificantly, just like the case in dogs in which the left stellate ganglion predominates the right one in determining the Q-T interval. Left stellate stimulation after destruction of the left second and third ganglia also prolongs the Q-T interval, suggesting that the left stellate ganglion is more important in determining the Q-T interval.

Adolescent↗

PubMed2005

Localized unilateral hyperhidrosis and neurofibromatosis type 1: case report of a new association.

Localized unilateral hyperhidrosis (LUH) is an uncommon but well-defined special form of localized hyperhidrosis with diverse causes. It often occurs within a sharply demarcated area on the face or upper extremities. Here, we report a case of LUH in a 16-year-old male with neurofibromatosis type 1 (NF1) and review related data in the literature. The association of this rare entity and NF1 has not yet been described. Subcutaneous botulinum toxin A injection provided a good clinical response with symptomatic relief.

Adolescent↗

PubMed1994

Thoracoscopic ganglionectomy for hyperhidrosis.

Thoracoscopic sympathectomy for the treatment of hyperhidrosis has been carried out with techniques that involve either monopolar coagulation or laser injury to the T2 ganglion. Although this has the advantage of being minimally invasive, it has not been established whether these techniques are superior to complete ganglion excision, as carried out during open surgery. A new technique of complete T2 ganglion excision for palmar hyperhidrosis (with T3 ganglionectomy for axillary sweating) was developed using thoracoscopic techniques. Sixteen patients were treated with thoracoscopic T2 ganglion excision on the right side, and simple coagulation (Nd-YAG laser or monopolar) on the left side. Results were excellent with no posttreatment differences between hands at 1 year follow-up. However, long-term follow-up of these patients will be carried out to determine whether differences exist between these two techniques.

Adult↗