Axillary – Page 18 – Hyperhidrosis Research . org

November 11, 2018

Thoracoscopic sympathectomy for palmar hyperhidrosis in children: 21 years of experience at a tertiary care center.

Thoracoscopic sympathectomy for palmar hyperhidrosis in children: 21 years of experience at a tertiary care center.

Eur J Pediatr Surg. 2013 Dec;23(6):486-9

Authors: Sinha CK, Kiely E

Abstract
PURPOSE: The aim of this study was to find out the outcome of “thoracoscopic sympathectomy” (TS) for palmar hyperhidrosis (PH) in children. To our knowledge, this is the largest experience of TS from the United Kingdom.
METHOD: All patients who underwent TS for PH during the past 21 years were studied retrospectively.
RESULTS: A total of 85 procedures were done in 44 children. Ratio of female to male was 4:1. Median age at operation was 12.8 years. Types of operations performed were as follows: bilateral T2-T3 sympathectomy in 87% (38/44), bilateral T2-T5 sympathectomy in 9% (4/44), and right-sided thoracoscopic (left-sided done open) in 1% (0.5/44); operation was not possible in 3% (1.5/44) of cases. No chest drains were used. Median postoperative stay was 2 days (range 1 to 5). Median follow-up time was 1.3 years (range 0.2 to 4.7 years). Only problematic patients were followed up for longer. During follow-up, 21% (9/44) developed severe hyperhidrosis of other parts of body. Seven percent (3/44) of patients developed severe axillary hyperhidrosis (AH) and required T4-T5 sympathectomy later on at a median age of 14.4 years (range 11 to 16 years). Another 9% (4/44) patients developed severe plantar hyperhidrosis. Severe hyperhidrosis of the whole body was seen in 5% (2/44) of the patients. Postoperative complications were seen in 47% (21/44) of the patients. They were as follows: postoperative pain (needing > 48 hours hospital stay) in 18% (8/44); transient Horner syndrome in 18% (8/44-right 5, left 3); and recurrence of PH in 11% (5/44) of cases. In the recurrence group, 7% (3/44) were unilateral (right 2, left 1) and 5% (2/44) were bilateral. Redo operations were performed in 11% (5/44) of cases. Median time to redo was 2.6 years (range 8 months to 4.2 years). All three unilateral recurrent patients underwent respective sided redo. In the bilateral recurrence group (2/44), one patient had bilateral redo (remained dry), whereas the other patient underwent only right-sided operation (remained dry), as that sided operation was difficult and so the other side was not tried. FINAL OUTCOMES: The final outcomes were recurrence 3.5% (3/85-right 2, left 1) and technically failed operation 3.5% (3/85-both sides 1, one side 1). Success rate for thoracoscopic sympathetectomy was 93% (79/85) overall.
CONCLUSION: TS for PH is a safe and feasible operation in children. It is successful in the majority; however, the procedure is not trouble free.

PMID: 23460464 [PubMed – indexed for MEDLINE]

November 11, 2018

Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system.

Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system.

J Neurol. 2013 Mar;260(3):701-13

Authors: Dressler D

Abstract
Botulinum toxin (BoNT) has gained widespread use for the treatment of overactive muscles, overactive exocrine glands and, most recently, non-muscular pain conditions. Autonomic conditions treated with BoNT include achalasia, gastroparesis, sphincter of Oddi spasms, and unspecific esophageal spasms in gastroenterology and prostate disorders in urology. BoNT’s use for autonomic conditions related to neurology includes various forms of bladder dysfunction (detrusor sphincter dyssynergia, idiopathic detrusor overactivity, neurogenic detrusor overactivity, urinary retention and bladder pain syndrome), pelvic floor disorders (pelvic floor spasms and anal fissures), hyperhidrosis (axillary, palmar, and plantar hyperhidrosis, diffuse sweating, Frey’s syndrome) and hypersalivation (hypersalivation in Parkinsonian syndromes, motor neuron disease, neuroleptic use, and cerebral palsy). Hyperhidrosis, hypersalivation, some forms of bladder dysfunction and pelvic floor disorders can easily be treated by neurologists. Most bladder dysfunctions require cooperation with urology departments.

PMID: 22878428 [PubMed – indexed for MEDLINE]

November 11, 2018

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

J Vasc Surg. 2012 Jun;55(6):1696-700

Authors: Wolosker N, de Campos JR, Kauffman P, Puech-Leão P

Abstract
INTRODUCTION: Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects.
OBJECTIVE: This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis.
METHODS: This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life.
RESULTS: Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
CONCLUSIONS: Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life.

PMID: 22341836 [PubMed – indexed for MEDLINE]

November 11, 2018

Treatment of hyperhidrosis with botulinum toxin.

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Treatment of hyperhidrosis with botulinum toxin.

Aesthet Surg J. 2012 Feb;32(2):238-44

Authors: Doft MA, Hardy KL, Ascherman JA

Abstract
Botulinum toxin type A is a safe and effective method for treating focal hyperhidrosis, providing longer-lasting results than topical treatments without the necessity of invasive surgical procedures. Although more useful for axillary hyperhidrosis, botulinum toxin injections can also be effective in treating palmar and plantar disease. The effects of botulinum toxin last for six to nine months on average, and treatment is associated with a high satisfaction rate among patients. In this article, the authors discuss their preferred methods for treating axillary, palmar, and plantar hyperhidrosis. This article serves as guide for pretreatment evaluation, injection techniques, and posttreatment care.

PMID: 22328694 [PubMed – indexed for MEDLINE]

November 11, 2018

Evaluation of trace elements, calcium, and magnesium levels in the plasma and erythrocytes of patients with essential hyperhidrosis.

Evaluation of trace elements, calcium, and magnesium levels in the plasma and erythrocytes of patients with essential hyperhidrosis.

Int J Dermatol. 2011 Sep;50(9):1071-4

Authors: Güder H, Karaca S, Cemek M, Kulaç M, Güder S

Abstract
BACKGROUND: Essential hyperhidrosis is a disease that expresses itself with excessive sweating in palmar, plantar, axillary, and craniofacial regions. The etiopathogenesis of the disease, which has particular importance because of leading to psychosocial morbidity, could have not been completely elucidated. In previous studies, it has been shown that oxidative stress might play a role in the pathogenesis.
AIMS: Assessing the levels of trace elements such as Se, Zn, Cu, Fe, and Mg that have an important role in oxidative stress, as well as Ca and Mg that have an important role in membrane physiology, in patients with essential hyperhidrosis.
MATERIALS AND METHODS: Blood samples taken from the patient group with essential hyperhidrosis (42) and the control group (37) were separated into plasma and erythrocytes, and the levels of the bioelements were measured by use of ICP-OES device.
RESULTS: Erythrocyte levels of Se, Fe, Cu, Zn, Ca, and Mg were detected significantly higher in patients with essential hyperhidrosis. Furthermore, plasma levels of Cu, Ca, and Mg were significantly lower in patients with essential hyperhidrosis. Plasma levels of Se, Fe, and Zn showed no statistical difference between two groups.
DISCUSSION: It was thought that the high levels of Cu and Fe in erythrocytes may play a role in increased intracellular oxidative stress, whereas the increase in Se and Zn levels may be secondary to increased oxidative stress. Low extracellular concentrations of Ca and Mg raise the thought that they play a role either enhancing the membrane excitability of eccrine sweat glands or influencing the autonomic nerve system.
CONCLUSION: The levels of trace elements, which were determined to be different from the control group, may play a role in the pathogenesis of essential hyperhidrosis either in direct relation with or without oxidative mechanisms.

PMID: 22126867 [PubMed – indexed for MEDLINE]

November 11, 2018

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis.

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis.

Exp Dermatol. 2011 Dec;20(12):1017-20

Authors: Bovell DL, MacDonald A, Meyer BA, Corbett AD, MacLaren WM, Holmes SL, Harker M

Abstract
Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.

PMID: 21995840 [PubMed – indexed for MEDLINE]

November 11, 2018

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.

Mayo Clin Proc. 2011 Aug;86(8):721-9

Authors: Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ

Abstract
OBJECTIVE: To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
PATIENTS AND METHODS: We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.
RESULTS: Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).
CONCLUSION: In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

PMID: 21803954 [PubMed – indexed for MEDLINE]

November 11, 2018

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

Thorac Cardiovasc Surg. 2011 Sep;59(6):357-9

Authors: Gorur R, Yiyit N, Yildizhan A, Candas F, Turut H, Sen H, Isitmangil T

Abstract
OBJECTIVE: Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations.
MATERIALS AND METHODS: Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis.
RESULTS: The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B.
CONCLUSIONS: Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

PMID: 21766277 [PubMed – indexed for MEDLINE]

November 11, 2018

Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

J Eur Acad Dermatol Venereol. 2012 Jan;26(1):1-8

Authors: Hoorens I, Ongenae K

Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).

PMID: 21749468 [PubMed – indexed for MEDLINE]

November 11, 2018

Treatment options for hyperhidrosis.

Treatment options for hyperhidrosis.

Am J Clin Dermatol. 2011 Oct 01;12(5):285-95

Authors: Walling HW, Swick BL

Abstract
Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.

PMID: 21714579 [PubMed – indexed for MEDLINE]