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Comparing Compensatory Sweating After Video-Assisted Thoracoscopic Sympathectomy: (T2-3) Versus (T2-4) Levels for Treating Palmar Hyperhidrosis

Cureus. 2024 Nov 20;16(11):e74077. doi: 10.7759/cureus.74077. eCollection 2024 Nov.

ABSTRACT

INTRODUCTION: Primary hyperhidrosis is a disease that is characterized by excessive sweating beyond what is required to maintain the normal temperature of the body. Moreover, it has a great adverse effect on the life of the affected persons because of problems in their social lives. There are different modalities to treat primary hyperhidrosis, including medical and surgical treatment. However, in sympathectomy, there is still a lack of strong evidence regarding which level should be targeted to achieve maximum benefit with fewer complications.

METHODS: This prospective clinical study was conducted at the Cardiothoracic Surgery Department, Alexandria Main University Hospital, Alexandria, Egypt, from September 2021 to Jan 2022. The study involved a total of 50 eligible consecutive patients who had bilateral primary palmar hyperhidrosis managed by bilateral, bi-portal, and tubeless thoracoscopic approach with conventional general anesthesia. Group A represents 25 patients with 13 males (52%) who had sympathetic chain cutting at the level of T2-3, and group B represents 25 patients with 15 males (60%) who had sympathetic chain cutting at the level of T2-4. The effect on palmar hyperhidrosis, compensatory hyperhidrosis, and overall patient satisfaction was assessed on the Visual Analog Scale (VAS).

RESULT: Ninety-eight percent of patients in both groups showed postoperative complete dryness of the hand and improvement of their symptoms. There was a statistically significant (p<0.001) difference regarding the degree of severity of compensatory sweating post-operatively between both groups. In group A, 44% of patients had compensatory sweating, while in group B, 96% of patients had symptoms of compensatory sweating with varying degrees from 1 to 5 on a VAS-Score of five degrees.

CONCLUSION: The level of cauterization has no significant effect on palmar hyperhidrosis dryness after cutting the sympathetic chain at level (T2-3) vs. (T2-4). However, the greater the number of levels that are cauterized, which are three levels rather than two, the more severe the compensatory sweating in this study.

PMID:39712769 | PMC:PMC11661883 | DOI:10.7759/cureus.74077

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Efficacy and safety of sofpironium in treatment of primary hyperhidrosis: a systematic review

J Dermatolog Treat. 2025 Dec;36(1):2441258. doi: 10.1080/09546634.2024.2441258. Epub 2024 Dec 13.

ABSTRACT

BACKGROUND: Primary axillary hyperhidrosis has limited noninvasive and effective treatment, and we present the use of sofpironium bromide as a promising treatment option. We aimed to assess the efficacy and safety of sofpironium in patients with primary hyperhidrosis.

METHODS: We systematically searched the databases for Studies that assessed sofpironium bromide in patients with primary axillary hyperhidrosis. Methodological quality was determined using the Cochrane Risk of Bias Assessment tool and Newcastle-Ottowa scale.

RESULTS: Five studies were included (752 patients). They used 5% sofpironium, except for one study that used 5%, 10%, and 15% sofpironium. Studies have shown a significant difference in the incidence of patients with an HDSS score of 1 or 2 ranging from 53.9% to 86.7% and reported a greater reduction in the mean change in the DLQI score in the sofpironium group. They also noted a more significant reduction in the total gravimetric weight of sweat in the sofpironium group. A 1.5 point or greater improvement in HDSM-Ax score ranged from 48.2% to 69.1%. Serious adverse events were not observed in the intervention group.

CONCLUSION: Sofpironium gel provides notable improvements in symptom severity, sweat reduction, and quality of life, with mostly mild localized adverse events.Hyperhidrosis is relatively common, affecting 4.8% of the US population and negatively affects physical, social, and psychological well-being.Sofpironium bromide is recently approved by the FDA for the treatment of primary axillary hyperhidrosisSofpironium bromide showed promising results in terms of safety and efficacy for treating hyperhidrosisWe systematically assessed the use of sofpironium gel reported in five studies (752 patients)Sofpironium gel provides notable improvements in symptom severity, sweat reduction and quality of life, with mostly mild localized adverse events.

PMID:39668771 | DOI:10.1080/09546634.2024.2441258

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Continuous evaluation of exosomatic electrodermal activity in patients with primary palmoplantar hyperhidrosis

Einstein (Sao Paulo). 2024 Dec 9;22:eAO1152. doi: 10.31744/einstein_journal/2024AO1152. eCollection 2024.

ABSTRACT

OBJECTIVE: To objectively evaluate sweat intensity in patients with primary hyperhidrosis by measuring electrodermal activity using a continuous exosomatic technique without external stimuli.

METHODS: This prospective and transversal study analyzed 10 patients with palmoplantar hyperhidrosis (HH Group) and 10 individuals without it (Control Group) between January and August 2023. All participants underwent one clinical evaluation and completed two multiple-test questionnaires without any intervention from the interviewer, based on their own estimates of sweat perception and anxiety or depression symptoms. Then, the electrodermal activity was measured with the MP36R, a portable instrument from Biopac Systems Inc. (USA), using exosomatic and direct current techniques. Data were tested for normality using the Shapiro-Wilk test. Descriptive statistics were expressed as medians and interquartile ranges (p25-75) for numerical variables and as absolute and relative frequencies for categorical variables. Fisher’s exact test and Mann-Whitney U test were used to compare the groups. Statistical significance was set at p<0.05.

RESULTS: Palmoplantar sweating was significantly higher in the HH Group than in the Control Group (p<0.01). There were no statistically significant differences in anxiety and depression levels between the groups (p=0.87; p=0.32). Continuous exosomatic electrodermal activity resulted in significantly higher skin conductance in patients with hyperhidrosis than in controls.

CONCLUSION: Continuous exosomatic electrodermal activity without external stimuli proved to be suitable for the objective analysis of patients with hyperhidrosis in a non-invasive and sensitive manner.

PMID:39661855 | DOI:10.31744/einstein_journal/2024AO1152

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Hyperocclusive technique for topical anesthesia for injecting botulinum toxin in palmar hyperhidrosis

J Cutan Aesthet Surg. 2024 Oct-Dec;17(4):335-336. doi: 10.4103/JCAS.JCAS_224_22. Epub 2023 Jun 27.

ABSTRACT

Injecting botulinum toxin under simple topical anesthesia using a eutectic mixture of lignocaine and prilocaine is a painful procedure. A simple hyper-occlusive modification in the existing technique of topical anesthesia of palms facilitates painless injections leading to greater patient satisfaction and compliance.

PMID:39649766 | PMC:PMC11619159 | DOI:10.4103/JCAS.JCAS_224_22

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The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis

J Minim Access Surg. 2024 Nov 29. doi: 10.4103/jmas.jmas_75_24. Online ahead of print.

ABSTRACT

INTRODUCTION: Pathologically excessive sweating in areas such as the palmar, axillary and/or plantar together with sympathetic hyperactivity that occurs independently of systemic causes is called primary hyperhidrosis. Although primary idiopathic hyperhidrosis can be seen at any age, the disease is most commonly seen in adolescents and young adults. The frequency of male and female genders is usually equal. Some medical and minimally invasive methods can be used in the treatment of primary hyperhidrosis. However, the known curative gold standard treatment method for the disease is thoracoscopic thoracic sympathectomy operation.

PATIENTS AND METHODS: In this study, a total of 150 patients who applied to Trakya University Health Practice and Research Center, Department of Thoracic Surgery, between 15 October 2008 and 15 June 2021 and underwent thoracoscopic thoracic sympathectomy due to the diagnosis of hyperhidrosis were evaluated retrospectively. The patients were separated into two groups. Thoracoscopic thoracic sympathectomy was performed on the T2-T4 in the first group (Group I – n : 88) and on the T3-T5 sympathetic ganglions in the second group (Group II – n : 62).

RESULTS: The median age of patients included in the study was found to be 24 (20.75-28) years. Group I and Group II were similar in terms of gender characteristics, but Group II was older. Our success rate was found to be 92% ( n = 138). There was no mortality, major complication such as bleeding requiring open thoracotomy, chylothorax or Horner’s syndrome in any of the patients. Minor complications were seen in the early and late period of the operation at a low rate. Our overall compensatory hyperhidrosis rate was 52% ( n = 78). Compensatory hyperhidrosis was detected more in Group I, although this was not statistically significant. We determined the overall satisfaction rate of our patients as 87.3% ( n = 133). The satisfaction rates of the patients in Group I and Group II were found to be similar.

CONCLUSIONS: Thoracoscopic thoracic sympathectomy is a fast, safe and minimally invasive treatment method with a low complication rate. More than 90% success and a significant increase in psychosocial condition and professional quality of life can be achieved with this procedure. Future studies are needed to reveal the relationship between operated ganglion levels and the development of compensatory hyperhidrosis.

PMID:39611563 | DOI:10.4103/jmas.jmas_75_24

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A Review of the Etiologies and Key Clinical Features of Secondary Hyperhidrosis

Am J Clin Dermatol. 2024 Nov 27. doi: 10.1007/s40257-024-00908-6. Online ahead of print.

ABSTRACT

Secondary hyperhidrosis is a multifactorial condition that poses unique diagnostic and management challenges. Distinguishing secondary from primary hyperhidrosis remains difficult due to overlapping symptoms. This review consolidates existing evidence on the numerous underlying causes and pathophysiologic mechanisms of secondary hyperhidrosis across various disciplines. Secondary hyperhidrosis typically manifests in the fourth decade of life or later, whereas primary hyperhidrosis usually begins earlier. Generalized hyperhidrosis often suggests a secondary cause, though the distribution can vary, including focal symmetric/asymmetric or regional patterns depending on the underlying condition. Key clinical features such as lack of family history and associated symptoms provide additional clues favoring a secondary etiology. Recognizing these distinct characteristics is crucial for accurate differentiation between secondary and primary hyperhidrosis, thereby guiding appropriate evaluation and management of the underlying cause.

PMID:39604775 | DOI:10.1007/s40257-024-00908-6

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Patient satisfaction after miraDry() treatment for axillary hyperhidrosis. Results of an online patient survey after miraDry() treatment to reduce excessive axillary sweating

GMS Interdiscip Plast Reconstr Surg DGPW. 2024 Oct 15;13:Doc06. doi: 10.3205/iprs000188. eCollection 2024.

ABSTRACT

Hyperhidrosis, with a prevalence of 1 to 2% of the population, primarily affects young people under 40 years of age. The individually perceived burden of odor and amount of sweat leads to a reduced quality of life. In recent years, conservative and surgical measures have been used to treat hyperhidrosis. The miraDry® method based on microwave technology is a non-invasive treatment that enables comparable results in terms of effectiveness while at the same time reducing the burden. In the Park-Klinik Birkenwerder, 282 hyperhidrosis patients were treated with the miraDry® method between 2017 and 2024. An online survey was conducted in May and June 2024. 220 patients were contacted, the results of 80 patients are available (response rate: 36.4%). Changes in the restrictions caused by increased sweating in various areas of life were asked before and after the treatment. In addition, the assessment of general quality of life before and after the treatment was compared. There is a significant reduction in restrictions and a corresponding increase in quality of life after treatment with miraDry®. Satisfaction with the method is high, which is reflected in a high recommendation rate of over 80%.

PMID:39559459 | PMC:PMC11570828 | DOI:10.3205/iprs000188