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How to diagnose and measure primary hyperhidrosis: a systematic review of the literature

Clin Auton Res. 2021 Mar 27. doi: 10.1007/s10286-021-00794-6. Online ahead of print.

ABSTRACT

PURPOSE: Hyperhidrosis (i.e. excessive sweating) is diagnosed from patient medical history and physical examination. In addition, focal sweat measurements can substantiate the hyperhidrosis diagnosis. Likewise, the impact of living with hyperhidrosis can be assessed with patient-reported outcome measures. However, no consensus exists on how to diagnose hyperhidrosis, how to quantify the disease, or how to measure the impact hyperhidrosis has on patients. Therefore, the objective of this review was to summarize the literature on diagnostic criteria, focal sweat measurement methods, and patient-reported outcome measures of hyperhidrosis.

METHODS: A literature search of Cochrane Library, Embase, and PubMed was conducted. Studies that included and aimed at developing or validating hyperhidrosis diagnostic criteria, focal sweat measurement methods, or patient-reported outcome measures for individuals with hyperhidrosis were eligible for inclusion. The methodological quality of diagnostic accuracy studies about focal sweat measurement methods was determined using the Quality Assessment of Diagnostic Accuracy Studies-2.

RESULTS: Overall, 33 studies were included. We identified two sets of hyperhidrosis diagnostic criteria, one scale for assessment of severity of hyperhidrosis sweating, four focal sweat measurement methods, and 15 patient-reported outcome measures.

CONCLUSION: The algorithm for diagnosing hyperhidrosis and focal sweat measurement methods needs validation in large cohorts. Most patient-reported outcome measures for hyperhidrosis are not adequately validated. A potential solution is to develop a core outcome set that can standardize outcomes reported in clinical trials.

PMID:33772671 | DOI:10.1007/s10286-021-00794-6

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Bilateral one-stage single-port sympathicotomy in primary focal hyperhidrosis, a prospective cohort study: treat earlier?

J Cardiothorac Surg. 2021 Mar 25;16(1):50. doi: 10.1186/s13019-021-01430-0.

ABSTRACT

BACKGROUND: Primary Focal Hyperhidrosis (PFH) has a detrimental effect on Quality of Life. Repetitive, non-curative symptomatic strategies dominate current treatment of PFH, in spite of the availability of an effective and permanent curative treatment like Endoscopic Thoracic Sympathectomy (ETS). Current surgical optimization may allow for a re-established position of sympathetic modulation in this treatment algorithm. We sought to evaluate the safety, effectiveness, and long-term results of a Bilateral One-stage Single-port Sympathicotomy (BOSS) procedure in PFH patients and to identify subgroups benefitting most.

METHODS: Prospective analysis of 163 patients, 35 (21.5%) underwent Rib-3 (R3) BOSS for palmar PFH, 58 (35.6%) R3-R5 BOSS for axillary PFH and 70 (42.9%) R3-R5 BOSS for combined palmar/axillary PFH. Effectiveness was measured using Skindex-29 and the Hyperhidrosis Disease Severity Scale (HDSS).

RESULTS: Overall Skindex-29-rating (46.5 ± 14.8 preoperatively vs 20.1 ± 20.6 postoperatively, p < 0.001), and HDSS score (3.71 ± 0.45 preoperatively vs 1.82 ± 0.86 postoperatively, p < 0.001) indicated a significant improvement in health-related quality of life after BOSS. R3 BOSS was superior to R3-R5 BOSS in terms of HDSS score (1.49 vs 1.91 respectively, p = 0.004) and in terms of severe compensatory hyperhidrosis, a frequently reported side-effect (17.1% vs 32.8% respectively, p < 0.001). No major complications occurred.

CONCLUSIONS: BOSS is safe, effective, and offers a long-term curative solution in the treatment of PFH. Especially in the palmar PFH subgroup, R3 BOSS treatment results compare favorably to the treatment results of non-curative alternatives published in the current literature. Therefore, R3 BOSS should be offered to all patients with severe PFH, reporting insufficient benefit of treatment options such as oral and/or local agents.

PMID:33766091 | DOI:10.1186/s13019-021-01430-0

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Evaluation of The Serum Magnesium and Vitamin D Levels and The Risk of Anxiety in Primary Hyperhidrosis

J Cosmet Dermatol. 2021 Mar 18. doi: 10.1111/jocd.14075. Online ahead of print.

ABSTRACT

BACKGROUND: Excessive sweating is considered primary hyperhidrosis if it is triggered by emotional states without any thermogenic or other underlying disease from the eccrine glands. This may be due to dysfunction in the autonomic nervous system.

AIM: To investigate the relationship between Vitamin D and Mg deficiency and the risk of anxiety and depression in patients with primary hyperhidrosis.

METHODS: This cross-sectional, case-control study was conducted between July and October 2019. 49 primary hyperhidrosis patients in Group I and 47 age and gender matched healthy individuals in Group II were included in the study.

RESULTS: The mean 25 (OH) D and Mg levels in Group I were statistically significantly lower than in Group II (p <0.001 and p = 0.002, respectively). Statistically significant differences were found between the groups in terms of anxiety and depression (p <0.001 and p = 0.033, respectively). There was no significant relationship between the HADS-A / HADS-D scores and the severity of primary hyperhidrosis (r = -0.131, p = 0.096; correlation coefficient = 0.232, p = 0.447). However, a significant correlation was observed between HADS-A scores and serum Mg levels (r = -0.439, p = 0.007).

CONCLUSION: Anxiety and depression are common in patients with primary hyperhidrosis. As shown in this study, both anxiety and depression can be seen with low Mg levels in patients with primary hyperhidrosis. This could possibly be related to the pathological mechanism involving Vitamin D and Mg, which determines the common pathway affecting primary hyperhidrosis and anxiety / depression.

PMID:33738914 | DOI:10.1111/jocd.14075

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Epidemiology of Hyperhidrosis in Danish Blood Donors

Acta Derm Venereol. 2021 Mar 18. doi: 10.2340/00015555-3790. Online ahead of print.

ABSTRACT

The risk factors and disease implications of hyper-hidrosis are unknown. The objectives of this retrospective cohort study were to estimate the prevalence of hyperhidrosis and to compare demographic, life-style, and socioeconomic parameters in blood donors with and without self-reported or hospital-diagnosed hyperhidrosis. The study included blood donors from the Danish Blood Donor Study for the period 2010-2019. Registry data were collected from Statistics Denmark. Overall, 2,794 of 30,808 blood donors (9.21%; 95% confidence interval (95% CI) 8.75-9.40) had self- reported hyperhidrosis and 284 of 122,225 (0.23%; 95% CI 0.21-0.26) had hospital-diagnosed hyperhidrosis. Self-reported hyperhidrosis was associated with smoking (odds ratio (OR) 1.17; 95% CI 1.05-1.31), overweight (OR 1.72; 95% CI 1.58-1.87), “unemployed” (OR 1.60; 95% CI 1.24-2.08), “short education” (OR 0.76; 95% CI 0.64-0.90), and lower income (beta-coefficient -26,121; 95% CI -37,931, -14,311). Hospital-diagnosed hyperhidrosis did not differ from controls. Thus, self-reported hyperhidrosis was associated with potential hyperhidrosis risk factors (smoking, overweight) and disease implications (unemployment, low education level and income).

PMID:33734420 | DOI:10.2340/00015555-3790

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Effects of lower thoracic sympathicotomy on plantar hyperhidrosis

J Thorac Dis. 2021 Feb;13(2):664-670. doi: 10.21037/jtd-20-2437.

ABSTRACT

BACKGROUND: The purpose of this study was to investigate whether performing lower thoracic sympathicotomy (LTS) from T10 to T12 affects plantar hyperhidrosis in patients with palmo-plantar (PP) or palmo-axillary-plantar (PAP) hyperhidrosis.

METHODS: Between January 2015 and January 2020, all consecutive patients with primary hyperhidrosis who underwent bilateral thoracoscopic sympathicotomy and met the inclusion criteria were included. Sympathicotomy was performed using one of the following two methods: the conventional upper thoracic vs. expanded thoracic sympathicotomy. In the expanded thoracic sympathicotomy, we expanded the level of sympathicotomy ranging from R5 to R12 in addition to the conventional upper thoracic sympathicotomy (R3 or R4). In cases of the expanded thoracic sympathicotomy, we defined the LTS as a sympathicotomy of the levels ranging from R10 to R12, which are related to plantar hyperhidrosis.

RESULTS: A total of 103 subjects with PP (71 cases) or PAP (32 cases) hyperhidrosis were included. Palmar or axillary hyperhidrosis in all patients were alleviated after sympathicotomy. There was no difference in sweating decrease or CH according to the hyperhidrosis types or sympathicotomy techniques. In addition, no-LTS was performed in 77 cases and LTS was performed in 26 cases. In the no-LTS group, there were 65 and 12 cases of low and high degrees of CH, respectively. In the LTS group, there were 22 and four cases of low and high degrees of CH, respectively. There was no significant difference in CH between the no-LTS and LTS groups (P=0.981). Improvement in plantar hyperhidrosis in the no-LTS group was observed in 29 of 77 cases, while improvement in plantar hyperhidrosis in the LTS group was observed in 16 of 26 cases. The addition of LTS lead to significant improvement in plantar hyperhidrosis (P=0.034).

CONCLUSIONS: Performing LTS is a safe and feasible procedure that improved plantar sweating more so than it did in cases that did not undergo LTS. Therefore, we cautiously suggest that adding LTS helps in the treatment of plantar hyperhidrosis combined with palmar hyperhidrosis. Further studies on LTS are needed to validate these findings and will be helpful in establishing management guidelines.

PMID:33717539 | PMC:PMC7947522 | DOI:10.21037/jtd-20-2437

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Long-Term Efficacy of T3 Versus T3+T4 Thoracoscopic Sympathectomy for Concurrent Palmar and Plantar Hyperhidrosis

J Surg Res. 2021 Mar 7;263:224-229. doi: 10.1016/j.jss.2020.11.064. Online ahead of print.

ABSTRACT

BACKGROUND: More than 50% of patients with palmar hyperhidrosis (PAH) also have plantar hyperhidrosis (PLH). We compared the long-term results of T3 sympathectomy with those of combined T3+T4 sympathectomy among patients with concurrent PAH and PLH.

MATERIALS AND METHODS: We retrospectively analyzed the records of patients with concurrent PAH and PLH who underwent T3 alone or T3+T4 sympathectomy from January 1, 2012, to December 31, 2017. Preoperative and postoperative sweating (hyperhidrosis index) was evaluated through questionnaires, physical examination, and outpatient follow-up. The relief rates and hyperhidrosis index were used as outcome measures to compare the efficacy of the two approaches. Patients’ satisfaction and side effects were also evaluated.

RESULTS: Of the 220 eligible patients, 60 underwent T3 sympathectomy (T3 group), and 160 underwent T3+T4 sympathectomy (T3+T4 group). Compared with the T3 group, the T3+T4 group showed higher symptom relief rates both for PAH (98.75% versus 93.33%, P = 0.048) and PLH (65.63% versus 46.67%, P = 0.01), and a greater postoperative decrease in both hyperhidrosis indices. The rate of severe compensatory hyperhidrosis also increased (10% versus 5%, P = 0.197), although the rates of overall satisfaction were comparable between the groups. The incidence of postoperative pneumothorax requiring chest tube placement and postoperative neuralgia was also similar. There were no cases of perioperative death, secondary operation, wound infection, or Horner syndrome in either group.

CONCLUSIONS: Compared with T3 alone, T3+T4 sympathectomy achieved a higher symptom relief rate and a lower hyperhidrosis index. T3+T4 sympathectomy may be a choice for the treatment of concurrent PAH and PLH; however, patients need to be informed that this kind of surgery may increase the risk of compensatory sweating.

PMID:33691245 | DOI:10.1016/j.jss.2020.11.064

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Primary hyperhidrosis in children: A review of therapeutics

Pediatr Dermatol. 2021 Mar 4. doi: 10.1111/pde.14551. Online ahead of print.

ABSTRACT

Primary hyperhidrosis, an idiopathic disease that commonly affects the palms, soles, axillae, or craniofacial region, is characterized by perspiration in excess of what is required for physiologic cooling. This disease begins in childhood or adolescence and negatively impacts emotional, physical, and psychologic well-being. This review explores current therapeutic options for primary hyperhidrosis in the pediatric population, including topical therapies, oral therapies, non-surgical and procedural interventions, and adjunctive therapies. In addition, this review identifies new and emerging treatments and highlights the need for further research and therapeutic options for this impactful disease.

PMID:33660889 | DOI:10.1111/pde.14551