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PubMed1990

A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris.

Although hyperhidrosis palmaris is a benign condition, it may cause considerable psychological, social, and occupational disturbances. There are many conservative measures used to treat hyperhidrosis, but surgical sympathectomy is the only permanent cure. Of the various surgical approaches to the upper thoracic sympathetic ganglia, one must select the approach that combines good functional results and a satisfactory cosmetic outcome with only minor complications. Twenty-one patients (10 men and 11 women) with hyperhidrosis palmaris underwent synchronous bilateral T2 sympathectomy between 1 October 1989 and 30 April 1990. These patients underwent a new method of thoracoscopic sympathectomy without preoperative pneumothorax. All were relieved of excessive sweating in their upper extremities immediately after the operation. In addition, the technique led to significant savings in operation and hospitalization time. We recommend thoracoscopic sympathectomy as the best approach for sympathectomy in cases of hyperhidrosis palmaris.

Adolescent↗

PubMed1999

Hyperhidrosis and sympathetic skin response in chronic alcoholic patients.

Palmoplantar hyperhidrosis is frequently observed in patients with a clinical history of chronic abnormal alcoholic intake. It can be related to peripheral or central mechanisms such as abnormal spontaneous activity in peripheral damaged fibres; receptor hypersensitivity; compensatory incremented activity in segmentary anhidrosis; or impairment of central sweat control. With the aim of quantifying this phenomenon and of identifying its possible origin, sympathetic skin response (SSR) analysis was performed in 20 chronic alcoholic patients with clinical diffuse acral hyperhidrosis, compared with 30 normal subjects and 2 patients affected by primary palmoplantar hyperhidrosis (PPH). SSRs were recorded by disc electrodes place on the hands and feet, simultaneously. At the hand level two recording sites were selected: palm-dorsum proximally and ventral-dorsal tip of the third finger distally. Attention was paid to the number of SSR after a single endogenous or exogenous stimulus. The alcoholic patients were divided into two groups, with and without mild polyneuropathy. Both patient groups showed synchronous SSR at recording sites, with the same pattern and the normal delay between upper and lower arms. In the control group one response was generally related to a single stimulus; if more responses were elicited an evident adaptation was shown; in the two groups of patients an increase of the waves was observed in all the recording sites without any adaptation. The SSR profile described in alcoholic patients was observed also in PPH. The pattern of SSR waves in alcoholic patients seems to suggest a possible central origin of this type of hyperhidrosis.

Adolescent↗

PubMed2001

Evidence-based medicine: botulinum toxin in focal hyperhidrosis.

All studies performed so far indicate that BTX-A is a safe and effective treatment for focal hyperhidrosis of the axillae and palms, for gustatory sweating, and for some other rare conditions associated with focal hyperhidrosis. Based on two large well-designed, double-blind, placebo-controlled study there is class 1 evidence for the efficacy of BTX-A in axillary hyperhidrosis, and class 2 evidence for BTX-A in gustatory and palmar sweating (classification according to the Quality Standards Subcommittee of the American Academy of Neurology, 1994). Other indications (forehead sweating, plantar hyperhidrosis, truncal sweating) are only anecdotally reported.

Animals↗

PubMed1995

[Pulsed direct current iontophoresis as a possible new treatment for hyperhidrosis].

Tap water iontophoresis with direct current represents the therapy of choice in palmoplantar hyperhidrosis. Side effects are minor discomfort and skin irritations. Improper use may induce iontophoretic burns at sites of minor skin injuries. The aim of this study was to find ways of minimizing side effects, increasing safety standards and reducing the technical complications of tap water iontophoresis without loss of efficacy. In a blind study, 30 patients with palmar hyperhidrosis were treated with tap water iontophoresis using pulsed direct current of 4.3 kHz or 10.0 kHz. Efficacy and side effects were compared with those of the conventional direct current method as a control. Normal sweat secretion rates of palms were found after an average of ten treatment sessions with the conventional direct current method and after twelve with pulsed direct current of 4.3 or 10 kHz. Treatment with pulsed direct current of 4.3 kHz failed to inhibit palmar hyperhidrosis in two of ten patients. Occasionally, such side effects as discomfort, skin irritation, and mild electric shock occurred when direct current was applied. Using pulsed direct current subjective sensations of discomfort and skin irritation were rare (4.3 kHz) or very rare (10 kHz). Electric shock was completely prevented. Because of the minimal side effects, despite minor loss of efficacy tap water iontophoresis with pulsed direct current can be a valuable alternative treatment for palmar hyperhidrosis.

Adolescent↗

PubMed1998

[Axillary hyperhidrosis: successful treatment with botulinum toxin A].

Severe hyperhidrosis may present as a vexing condition for the patient and a therapeutic challenge for the physician. As botulinum toxin-A (BT-A) can potently block cholinergic sympathic innervation of sweat glands it was used in an open trial for controlling severe axillary hyperhidrosis. After visualization of hyperhidrosis using the iodine-starch-test BT-A (Dysport, 400 Units) was injected intradermally in one axilla. One week later gravimetric quantification of sweat secretion revealed a reduction of sweating to 4-9% of initial values. In order to rule out daily variations as well as other factors interfering with sweat production BT-A treatment was restricted to only one axilla in each individual clearly demonstrating extensive anhidrotic efficacy on the treated side only. The treatment was well tolerated without side-effects and was assessed as 'completely satisfying' by all patients. BT-A may offer a fast, safe and highly effective therapeutic option for severe hyperhidrosis.

Adolescent↗

PubMed2000

Botulinum toxin for treatment of craniofacial hyperhidrosis.

The effect of botulinum toxin A (BTX) was studied on 12 patients with idiopathic craniofacial hyperhidrosis. After confirming the diagnosis by Minor's iodine starch test we first treated one-half of the forehead with an injection of 2.5-4 ng BTX (Dysport) equidistantly intracutaneously. After 4 weeks we assessed the efficacy by another Minor's iodine starch test and then treated the other half. Another 4 weeks later a standardized telephone interview was carried out. After 1-7 days the craniofacial sweating in the area injected had completely ceased in 11 patients and was mildly reduced in the remaining one. The efficacy was confirmed by repeated Minor's iodine starch tests. Mild weakness of frowning was the only side effect, lasting 1-12 weeks and completely resolving in all patients. Although sweating has not yet recurred in most patients at follow-up periods up to 27 months, one patient had a relapse 9 months after treatment. Following reports on palmar and axillary hyperhidrosis and gustatory sweating (Frey's syndrome) this is apparently the first report on the use of BTX in the treatment of idiopathic craniofacial hyperhidrosis. BTX seems a promising new treatment for localized hyperhidrosis.

Adult↗

PubMed2002

Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis: an analysis of 28 cases.

BACKGROUND: Endoscopic thoracic sympathectomy or sympathicotomy of the lower part of the stellate ganglion is an efficient method for the treatment of craniofacial hyperhidrosis, but postoperative compensatory sweating may be troublesome in some patients. Needlescopic thoracic sympathetic block by clipping may achieve a similar effect as well as providing a possible reverse operation for patients who suffer from intolerable postoperative compensatory sweating. METHODS: Between January 1998 and June 2000, we collected a total of 28 patients with craniofacial hyperhidrosis. There were 15 men and 13 women with a mean age of 39.2 years (ranges, 19-50). All patients were placed under single-lumen intubated anesthesia in a semisitting position. Two ports were needed. We used a 2-mm 0 degrees thoracoscope and endo clips to perform a sympathetic block by clipping the lower third of the stellate ganglion at the second intercostal space. RESULTS: The operation was usually accomplished within 20 min (ranges, 15-30). All patients were discharged within 4 h after the operation. There were no surgical complications or surgical mortality cases. All patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms after a mean of 25.3 months (range, 12-41) of follow-up. Twenty-five patients (85.7%) developed compensatory sweating of the trunk and lower limbs. One of these patients could not tolerate this postoperative sweating; he therefore underwent a reverse operation and obtained improvement of the compensatory sweating 18 days after removal of the endo clips. CONCLUSION: Needlescopic thoracic sympathetic block by clipping is a safe and effective method for the treatment of craniofacial hyperhidrosis; compensatory sweating may be improved after a reverse operation and removal of the endo clips.

Adult↗

PubMed2003

Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4.

BACKGROUND: Endoscopic thoracic sympathicotomy of T2 to T4 (ETS 2-4) has evolved into an effective treatment for severe hyperhidrosis of the upper limb. Complications such as bleeding or Horner's syndrome are rare, but side effects such as compensatory and gustatory sweating occur in 30-50% of patients. Following the Lin-Telaranta classification, we aimed to reduce these side-effects by clipping T4 solely [endoscopic thoracic sympathetic block (ESB 4)]. We present our experience and clinical results using this method, with emphasis on patients' quality of life. METHODS: A total of 176 procedures (91 patients) were carried out in the ETS 2-4 group and 103 procedures (53 patients) in the ESB 4 group: 60.4 and 43.4% had palmar hyperhidrosis, 8.8 and 5.7% had isolated axillary, and 30.8 and 50.9% had combined manifestations, respectively. Follow-up was 22.1 months (obtained from 79.1% of patients) for the ETS 2-4 group and 7.5 months for the ESB 4 group (obtained from 88.7%). RESULTS: The success rate was similar for both groups: 87.9 and 64.5% had completely dry limbs, 9.9 and 35.5% ( p < 0.0002) were nearly dry, and 2.1 and 0% remained wet. (ETS 2-4 vs ESB 4). Although the armpits remained slightly humid in more patients in the ESB 4 group, 100% stated full satisfaction. Complications did not differ significantly. However, compensatory sweating (55.6 vs 8.5%, p = 0.0002) and gustatory sweating (33.3 vs 2.1%, p = 0.0019) were markedly reduced (ETS 2-4 vs ESB 4). Quality of life was assessed by a hyperhidrosis index, which significantly improved in most patients. CONCLUSIONS: ETS 2-4 and ESB 4 have similar success rates in the treatment of upper limb hyperhidrosis. The major side effects of compensatory and gustatory sweating were effectively reduced by the limited method of clipping T4, and patients' satisfaction and improvement in quality of life were remarkable.

Adult↗

PubMed2001

Endoscopic clipping in video-assisted thoracoscopic sympathetic blockade for axillary hyperhidrosis. An analysis of 26 cases.

BACKGROUND: Endoscopic thoracic sympathectomy or sympathicotomy is the standard method for the treatment of axillary hyperhidrosis. But postoperative compensatory sweating may be troublesome in some patients. Therefore, we use endoclips to perform the T3 and T4 sympathetic blockade instead of permanently interrupting the transmission of nerve impulses from the sympathetic trunk. METHODS: Between May 1997 and June 1998, a total of 26 patients with axillary hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T3 and T4 ganglia at our hospital. There were 10 men and 16 women with a mean age of 31.7 years (range, 16-47). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the sympathetic blockade by clipping the T3 and T4 ganglia at the level of the third, fourth, and fifth rib beds using an 8-mm 0 degree thoracoscope. RESULTS: Bilateral T3 and T4 sympathetic blockade was achieved in all 26 patients. The operation was usually completed within 30 min (range, 20-42). Most patients were discharged within 4 h after the operation. Surgical complications were minimal, with only one case of segmental atelectasis (3.8%). There were no deaths. The mean postoperative follow-up period was 31.3 months (range, 24-37). Twenty-three patients (88.5%) developed compensatory sweating of the trunk and lower limbs. Twenty-four patients (92.3%) were satisfied with the results of the operation. Improvement of axillary hyperhidrosis was obtained in all patients. One patient underwent a reverse operation to remove the endoclips due to intolerable compensatory sweating; improvement was seen 25 days after removal of the clips. CONCLUSION: Video-assisted thoracoscopic T3 and T4 sympathetic blockade by clipping is a safe and effective method for the treatment of patients with axillary hyperhidrosis. Patients who experience excessive compensatory sweating may require a reverse operation for endoclip removal.

Adolescent↗

PubMed1979

Hyperhidrosis and the sympatho-adrenal system.

Some disorders in which excessive sweating, hyperhidrosis, is a symptom are also characterized by increased sympatho-adrenal activity. Such disorders are hypotension, hypoglycemia, pheochromocytoma and hyperthyroidism. Sweat glands are controlled by a cholinergic innervation but can also be stimulated by adrenergic agents whose effects can be blocked by both alpha- and beta-receptor blocking drugs. An adrenergic innervation has also been demonstrated. There is evidence that the adrenergic component of sweating particularly secretion of the adrenal medulla, is responsible for the enhancement of sweating during exercise but not for the hyperhidrosis present in these disorders since sweating in these circumstances can be effectively blocked by cholinergic blocking compounds. Cutaneous vasoconstriction due to elevated plasma catecholamines reduces the rate of evaporation of sweat and allows sweat to accumulate on the skin. It is suggested that in the case of hypotension and insulin hypoglycemia sweating results from general sympathetic stimulation and that adrenal medullary hormones are not an essential component of the response. Hyperhidrosis in pheochromocytoma may be due to central activation of heat loss mechanisms resulting from the passage of plasma catecholamines across the blood-brain barrier combined with increased thermogenesis and cutaneous vasoconstriction. The hyperhidrosis of hyperthyroidism is probably due to increased thermogenesis.

Adrenal Gland Neoplasms↗

PubMed2005

Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection.

BACKGROUND: Endoscopic thoracic sympathectomy has been considered an effective treatment for palmar hyperhidrosis. However, the extent of resection has not been determined in terms of efficacy and complications. We compared the efficacy and complications of 2-ganglion and single-ganglion resection in patients with palmar hyperhidrosis. METHODS: From 1995 to 2000, 75 patients underwent resection of thoracic ganglion T2 and T3. From 2000 to 2003, 67 patients underwent resection of only the T2 ganglion. Eighty of the 142 patients (56%) answered a detailed questionnaire, the results of which were analyzed. RESULTS: Gender, age, family history, and distribution of sweating were similar in both groups. Recurrence rates 1 and 2 years after endoscopic thoracic ganglionectomy were between 0% and 3% in T2 and T3 resection, and between 15% and 19% in T2 resection only. In the combined T2 and T3 resection group, 100% of patients noticed compensatory sweating; in T2 resection, 90% of patients noticed compensatory sweating. As for rates of satisfaction, T2 and T3 resection was superior to T2 resection. CONCLUSIONS: High recurrence rates of palmar hyperhidrosis after single-ganglion resection are reported in the present study. Two-ganglion resection is a superior surgical method to prevent recurrence of palmar hyperhidrosis.

Adolescent↗

PubMed2001

Video-assisted thoracoscopic "resympathicotomy" for palmar hyperhidrosis: analysis of 42 cases.

BACKGROUND: There are rare reports of video-assisted thoracoscopic resympathicotomy for patients with palmar hyperhidrosis. I present our experience in treating a persistent or recurrent palmar hyperhidrosis after primary endoscopic sympathectomy or sympathicotomy and discuss the perioperative management. METHODS: We reoperated on 42 patients using a technique of video-assisted thoracoscopic resympathicotomy. All patients were placed in a semi-sitting position under single- or double-lumen intubated anesthesia. An 8-mm, 0 degrees thoracoscope was used to interrupt the nerve conduction to the palms from the T2 and T3 ganglia, through one or two 0.8-cm subaxillary incisions. RESULTS: The reasons for failure of endoscopic sympathectomy or sympathicotomy in 26 patients included pleural adhesion (15 of 26, 57.7%), incorrect identification of T2 ganglion (3 of 26, 11.5%), vessel overriding or close to sympathetic nerve (3 of 26, 11.5%), incomplete interruption of sympathetic nerve (2 of 26, 7.7%), medially located sympathetic nerve (2 of 26, 7.7%), and aberrant venous arch (1 of 26, 3.8%). The causes of recurrent palmar hyperhidrosis after primary transthoracic endoscopic sympathicotomy or sympathectomy (TES) in 16 patients included a possible effect of T3 ganglion (8 of 16, 50%), Kuntz fiber (3 of 16, 18.8%), nerve regeneration (3 of 16, 18.8%), and incomplete interruption of T2 ganglion (2 of 16, 12.5%). Surgical complications included pneumothorax (1 patient, 2.4%), hemothorax (1 patient, 2.4%), and compensatory sweating (36 patients, 86%). All patients had obtained successful bilateral sympathectomies and had satisfactory results after a mean of 32.1 months of follow-up. CONCLUSIONS: Video-assisted thoracoscopic resympathicotomy is an effective and safe method for a previously unsuccessful sympathectomy or recurrent palmar hyperhidrosis if the surgeon acknowledges possible anatomic variations and can overcome the problems related to pleural adhesions.

Adolescent↗

PubMed2000

Needle thoracic sympathectomy for essential hyperhidrosis: intermediate-term follow-up.

BACKGROUND: Essential hyperhidrosis is a condition with excessive sweating localized to certain part of the body. A definitive cure can be obtained by upper thoracic sympathectomy. METHOD: Between June and October 1997, 117 patients with essential hyperhidrosis underwent needle thoracoscopic sympathectomy. Of the 94 patients, 42 were men and 52 women. Their ages ranged from 14 to 63 years, with a mean age of 23 years. RESULTS: There were no mortality or life-threatening complications. Symptomatic improvement was found in 95.7%. Compensatory hyperhidrosis was found in 71.2% of the patients, but in these compensatory hyperhidrosis were mostly tolerable. CONCLUSIONS: This therapeutic procedure is minimally invasive and very effective. Further development of the new device and surgical technique are expected to follow.

Adolescent↗

PubMed1999

Long-term results of 45 thoracoscopic sympathicotomies for primary hyperhidrosis in children.

BACKGROUND/PURPOSE: Thoracoscopic sympathicotomy (TS) is successful in treatment of excessive hyperhidrosis of the upper limb after limited follow-up observation. The aim of the study was to assess for the first time long-term results of TS in children. METHODS: A total of 26 children (9 boys, 17 girls) aged 11 to 17 years with severe palmar or axillar hyperhidrosis underwent TS, and 19 patients were treated bilaterally. A total of 19 patients were observed after a median follow-up period of 16 years by questionnaire or clinical examination. RESULTS: Permanent relief from palmar hyperhidrosis was given in all examined patients. Twelve patients had compensatory and 12 patients gustatory sweating. Postoperatively, 1 subcutaneous emphysema and 1 temporary miosis and ptosis were noted. Eleven patients were fully satisfied with the result. Seven patients were only partially satisfied because of compensatory or gustatory sweating but would again undergo operation. One patient was not satisfied because of excessive compensatory sweating. CONCLUSIONS: TS is a safe and efficient procedure even after long-term follow-up. Severe palmar hyperhidrosis often starts in childhood; thus, early surgical treatment can improve social development. Compensatory and gustatory sweating are the most frequent and enduring side effects and should be mentioned in preoperative patient and parent information.

Adolescent↗

PubMed2004

[Multiple sclerosis with sensory disturbances and hyperhidrosis of the hand].

INTRODUCTION: Hyperhidrosis may result from brain, spinal cord or peripheral nervous system injuries. We report the case of a 26-year-old patient who presented with sensorial disorders and focal hyperhidrosis of the right hand. OBSERVATION: MRI revealed multiple lesions very suggestive of active demyelinization. A lesion in the left paramedian posterior portion of the pons was enhanced after gadolinium infusion. The diagnosis of multiple sclerosis was suggested by MRI data and oligoclonal IgG bands on cerebrospinal fluid electrophoresis. CONCLUSIONS: Focal hyperhidrosis may be due to a lesion of the crossed sympathetic inhibitory tract. Although autonomic dysfunction is common during the late course of multiple sclerosis this case is, to our knowledge, the first report of focal hyperhidrosis revealing multiple sclerosis.

Adult↗

PubMed1998

Botulinum toxin therapy for palmar hyperhidrosis.

BACKGROUND: Severe palmar hyperhidrosis is a chronic disease, resistant to conventional therapy. Botulinum toxin inhibits sweat production by blocking release of acetylcholine from presynaptic membranes. OBJECTIVE: Our purpose was to evaluate the short- and long-term effectiveness of botulinum toxin therapy in treatment of palmar hyperhidrosis. METHODS: Four patients with severe palmar hyperhidrosis were treated with subepidermal injections of botulinum toxin. Fifty injections, 2 mouse units each, were used in each palm. Regional nerve blocks of the median and ulnar nerves were performed before the procedure. Patients were observed for 12 months after treatment. RESULTS: Botulinum toxin injections significantly reduced sweat production in the treated areas of the palms. Anhidrosis lasted for 12 months in one patient, 7 months in two patients, and 4 months in one patient. Mild weakness of the thumb lasting 3 weeks occurred in one patient. No other side effects were observed. CONCLUSION: Botulinum toxin provides an effective, safe, and long-lasting alternative therapeutic modality for treatment of severe palmar hyperhidrosis. Additional studies are needed for optimization of the technique.

Adolescent↗

PubMed1996

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results.

PURPOSE: The purpose of this study was to examine the immediate and mid-term results of thoracoscopic upper dorsal (T2-T3) sympathectomy for primary palmar hyperhidrosis. METHODS: From June 1993 to October 1994 we performed 106 sympathectomies on 53 patients with palmar hyperhidrosis. Thirty-four female patients and 19 male patients ranging in age from 15 to 44 years, (mean 23.1 years) were studied. Both sides were operated during the same surgical procedure. The T2-T3 ganglia were resected by electrocuting with a hook and were removed for histologic examination. Follow-up for a mean of 19.25 months was obtained on 52 patients (104 operated limbs). RESULTS: All limbs were completely dry at the end of the procedure, and hyperhidrosis did not recur during the whole follow-up period. Short-term postoperative complications (mainly atelectasis, pneumonia, pneumothorax, and hemothorax) occurred in six (11.3%) patients. Long-term sequelae were observed in 43 (81.1%) patients and included Horner's syndrome (9 patients, 17.3%, one side only in each patient), neuralgia (7 patients, 13.5%), and compensatory hyperhidrosis (35 patients, 67.3%). These sequelae were not permanent in all cases, and the degree of severity was variable. Six (11.5%) patients, three of whom regretted being operated, were dissatisfied with their results: one because of Horner's syndrome, one because of persisting neuralgia, and four because of compensatory sweating. CONCLUSIONS: Despite the large number of postoperative long-term sequelae, 88.5% of patients expressed subjective satisfaction from the procedure. Obtaining 100% of dry hands on mid-term follow-up makes this approach rewarding.

Adolescent↗

PubMed2000

'Needlescopic' video-assisted thoracic surgery for palmar hyperhidrosis.

OBJECTIVE: The video-assisted thoracic surgery (VATS) approach for thoracodorsal sympathectomy has been well accepted. We report the use of ultra-fine thoracoscopic equipment for this procedure, based on the experience from two centers in Asia. MATERIALS AND METHODS: Thirty-eight patients with palmar hyperhidrosis underwent bilateral VATS thoracodorsal sympathectomy using 2-mm instruments exclusively. General anesthesia with selective one lung ventilation was used. Carbon dioxide insufflation was used when lung collapse was found to be inadequate. In 11 patients, the sympathetic chain was excised (T2-T3 for palmar hyperhidrosis alone, extending to T4 for axillary hyperhidrosis), and in 27 patients, the chain was cauterized. The choice of procedure reflects the surgeon's preference. No chest drains were left after the procedure and no stitching of the wound was necessary. RESULTS: There was no mortality or major complications. A small pneumothorax was found in the postoperative chest X-ray in three patients. They all resolved without further intervention. Twenty-seven patients were discharged on the same day of admission, and 11 patients were discharged on postoperative day one. After an average follow-up of 16 months (range 5-28), there has been no recurrence of symptoms. Compensatory truncal hyperhidrosis was encountered in two patients, but the symptoms were not severe enough to interfere with lifestyle, and this required no further treatment. CONCLUSION: Thoracodorsal sympathectomy using 2-mm instruments is technically feasible and is associated with an excellent clinical outcome. Limitations of the equipment, however, exist (narrow field of vision, lower resolution and difficulty in maintaining fine control), and we are currently restricting its use to relatively simple procedures.

Adult↗