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Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

Ann Med. 2021 Dec;53(1):1216-1226. doi: 10.1080/07853890.2021.1953126.

ABSTRACT

INTRODUCTION: Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.

OBJECTIVE: To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.

METHOD: This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.

RESULTS: Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I2=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I2=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.

CONCLUSION: This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.

PMID:34282698 | DOI:10.1080/07853890.2021.1953126

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Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis

J Thorac Dis. 2021 Jun;13(6):3509-3517. doi: 10.21037/jtd-21-229.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis is the main cause of patients’ dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.

METHODS: We retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy.

RESULTS: Primary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m2, P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis.

CONCLUSIONS: Thoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.

PMID:34277046 | PMC:PMC8264690 | DOI:10.21037/jtd-21-229

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Hyperhidrosis: treatment, results, problems

Khirurgiia (Mosk). 2021;(7):12-17. doi: 10.17116/hirurgia202107112.

ABSTRACT

OBJECTIVE: To analyze the results of thoracic sympathectomy for hyperhidrosis.

MATERIAL AND METHODS: The study included 166 patients aged from 15-51 years. There were 118 women and 48 men. Isolated palmar hyperhidrosis was observed in 46 patients, axillary – 46 patients, palmar-axillary – 74 cases. Video-assisted thoracic bilateral sympathectomy was performed. In patients with palmar hyperhidrosis, sympathetic chain was transected between the ribs II and III, axillary and palmar-axillary hyperhidrosis – between the ribs III and IV.

RESULTS: Intraoperative injury of intercostal artery occurred in 1 case. Cautery was effective. Postoperative complications occurred in 4 (2.4%) patients (pneumothorax followed by drainage for up to 2-3 days). Symptoms of hyperhidrosis disappeared early after surgery in all cases. Long-term results were followed in 47 patients. Persistent positive effect and patient satisfaction with postoperative outcome were noted in 44 (93.6%) cases. Recurrences occurred in 2 patients with palmar hyperhidrosis and 1 patient with axillary hyperhidrosis for the period from 2 weeks to 6 months. Compensatory sweating developed in 26 (55.3%) patients (within several weeks up to 6 months). Mild compensatory sweating occurred in 17 patients, moderate – 8 patients, severe – 1 patient. Compensatory sweating was more common in patients with axillary and palmar-axillary hyperhidrosis compared to those with isolated palmar hyperhidrosis (p<0.05). We found no significant difference in the incidence of compensatory sweating depending on the level of sympathetic chain intersection (p>0.05).

CONCLUSION: An effectiveness of thoracic sympathectomy for hyperhidrosis is obvious. Compensatory sweating is the main undesirable consequence of this surgery. Prediction and prevention of compensatory sweating are not possible. It is imperative to warn the patient about possible compensatory sweating.

PMID:34270188 | DOI:10.17116/hirurgia202107112

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‘Excessive sweating is not a feminine thing’: A qualitative study of women’s experiences suffering from primary hyperhidrosis

PLoS One. 2021 Jul 15;16(7):e0254689. doi: 10.1371/journal.pone.0254689. eCollection 2021.

ABSTRACT

BACKGROUND: Primary hyperhidrosis, excessive focal sweating is a common disease equally affecting men and women. Women tend to seek care more often and assess being more affected by hyperhidrosis in their daily life. The aim of this study was to explore experiences of living with primary hyperhidros in a sample of 15 women.

METHODS: Individual, semi-structured interviews with a purposive sample of 15 women diagnosed with primary hyperhidrosis and analysed by qualitative content analysis utilising an inductive approach.

RESULTS: The analysis resulted in a theme, constantly guarding the female image, based on three categories, misfitting the feminine norms, avoiding the attention of others and passing like any woman. Primary hyperhidrosis in women disrupted the ideal feminine appearance. Wearing clothes that concealed hyperhidrosis and distancing from social gatherings, in combination with negative remarks by others, created stress and anxiety and had a negative effect on self-esteem. Women felt poorly understood by others regarding the extent of their sweating and were misunderstood in intimate situations while trying to reduce the sweat production. Choices regarding education and career opportunities were affected, since being exposed and receiving attention due to primary hyperhidrosis was unwanted. Treatment with botulinum toxin liberated women from excessive sweating and removed a social handicap they described living with.

CONCLUSION: Primary hyperhidrosis in women disrupts the feminine appearance, lowers self-esteem and hinders social interactions. Clinicians assessing primary hyperhidrosis need to be aware that women may report the impairments from primary hyperhidrosis as being more associated with body image and appearance than with functional reductions in daily life. Educating patients, providing accurate information regarding the disease via media and cooperating with patient groups are important for increasing awareness and achieving progress in care for women with primary hyperhidrosis.

PMID:34264995 | DOI:10.1371/journal.pone.0254689

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Cost-of-illness study for axillary hyperhidrosis in Japan

J Dermatol. 2021 Jul 9. doi: 10.1111/1346-8138.16050. Online ahead of print.

ABSTRACT

The prevalence of primary axillary hyperhidrosis in Japan is 5.75% (males, 6.60%; females, 4.72%) in the population aged 5-64 years. No study on comprehensively evaluated direct medical costs, hygiene product costs, and productivity loss in axillary hyperhidrosis patients has been published in Japan. The aim of this study was to estimate the cost of illness for axillary hyperhidrosis in Japan by conducting a nationwide insurance claims database analysis and a cross-sectional Web-based survey. Among patients diagnosed with primary axillary hyperhidrosis at least once between November 2012 and October 2019, health insurance receipt data of 1447 patients were analyzed. A cross-sectional Web-based survey was conducted on 321 patients aged 16-59 years with axillary hyperhidrosis to calculate hygiene product costs and productivity loss using a Work Productivity and Activity Impairment questionnaire. Furthermore, nationwide estimation was performed for the hygiene product costs and productivity loss based on the number of patients estimated from the prevalence. The annual direct medical costs per axillary hyperhidrosis patient were ¥91 491 in 2016, ¥93 155 in 2017, and ¥75 036 in 2018. In all of these years, botulinum toxin type A injection accounted for approximately 90% of the total costs. The annual total cost of hygiene products per axillary hyperhidrosis patient was ¥9325. The overall work impairment (%) of working patients with axillary hyperhidrosis was 30.52%, and its monthly productivity loss was ¥120 593/patient. The activity impairment (%) of full-time housewives with axillary hyperhidrosis was 49.05% and its monthly productivity loss was ¥176 368/patient. The annual hygiene product cost based on the nationwide estimation was ¥24.5 billion and the monthly productivity loss was ¥312 billion. The significant cost associated with axillary hyperhidrosis was clarified. If out-of-pocket expenses for treatments not covered by health insurance are included in the estimation, the cost will further increase.

PMID:34245048 | DOI:10.1111/1346-8138.16050

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Current treatment options for craniofacial hyperhidrosis

J Vasc Bras. 2020 Nov 16;19:e20190152. doi: 10.1590/1677-5449.200152.

ABSTRACT

Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.

PMID:34211510 | PMC:PMC8218019 | DOI:10.1590/1677-5449.200152

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Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin

Clinics (Sao Paulo). 2021 Jun 28;76:e2892. doi: 10.6061/clinics/2021/e2892. eCollection 2021.

ABSTRACT

OBJECTIVES: Studies have identified correlations between the psychological characteristics of individuals with primary hyperhidrosis (HH), the degree of sweating, and the quality of life (QoL). This study aimed to evaluate the prevalence of anxiety and depression symptoms in patients with HH before and after oxybutynin treatment.

METHODS: Data were collected from 81 patients. Palmar or axillary HH was the most frequent complaint (84.0%). All patients were evaluated before the medication was prescribed and after five weeks of treatment. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety.

RESULTS: Improvement in HH occurred in 58 patients (71.6%), but there was no improvement in 23 patients (28.4%). The QoL before treatment in all patients was either “poor” or “very poor.” Patients who experienced improvement in sweating rates also experienced a greater improvement in QoL than patients who did not experience improvement in sweating at the main site (87.9% vs. 34.7%) (p<0.001). A total of 19.7% of patients showed an improvement in their level of depression, and a total of 46.9% of patients exhibited improvements in their level of anxiety. A significant correlation was observed between sweating and anxiety (p=0.015).

CONCLUSION: Patients with HH who experienced improvements in sweating immediately after treatment with oxybutynin exhibited small improvements in their levels of depression and significant improvements in their levels of anxiety and QoL.

PMID:34190853 | DOI:10.6061/clinics/2021/e2892

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Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis

J Vasc Bras. 2020 May 8;19:e20190072. doi: 10.1590/1677-5449.180072.

ABSTRACT

Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.

PMID:34178057 | PMC:PMC8202175 | DOI:10.1590/1677-5449.180072