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November 11, 2018

Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis.

Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis.

J Dermatol. 2013 Nov;40(11):886-90

Authors: Fujimoto T, Kawahara K, Yokozeki H

Abstract
Primary hyperhidrosis is a disorder of excessive, bilateral and relatively symmetrical sweating occurring in the palms, soles and axillae regions without obvious etiology. There have been some reports of the epidemiology of primary hyperhidrosis abroad so far, but there has never been any research performed in Japan. We performed a questionnaire survey for people aged 5-64 years who agreed with the purpose of this study at 20 companies or schools, and received 5807 valid responses. From this survey, each prevalence could broken down into 5.33% for primary palm hyperhidrosis, 2.79% for primary plantar hyperhidrosis, 5.75% for primary axillae hyperhidrosis and 4.7% for primary head hyperhidrosis. Patients with severe symptoms were estimated to be approximately 616,000 for primary palmar hyperhidrosis and 2,239,000 for primary axillae hyperhidrosis in Japan. These findings reveal that many patients feel a decreased quality of life because of symptoms of hyperhidrosis every day. However, only 6.2% of the patients had visited medical institutions. Moreover, few patients take appropriate treatment even after visiting the hospital.

PMID: 24106874 [PubMed – indexed for MEDLINE]

November 11, 2018

A novel approach to the lumbar sympathetic chain: lateral access.

A novel approach to the lumbar sympathetic chain: lateral access.

Neurosurg Focus. 2013 Jul;35(2 Suppl):Video 12

Authors: Rodgers SD, Engler JA, Perin NL

Abstract
Plantar hyperhydrosis is a disabling condition of excessive, symmetric, focal sweating of the feet with social, psychological, and medical implications. Treatment options include topical agents, iontophoresis, botulinum toxin injection, and surgical disruption of the lumbar sympathetic chain. Surgical corridors include transperitoneal and retroperitoneal approaches. We report our technique with a novel minimally invasive lateral retroperitoneal approach commonly used for lateral interbody fusions. The lateral approach for sectioning of the sympathetic chain in the treatment of hyperhydrosis appears safe. The approach may be advantageous for the patient and surgeons familiar with lateral interbody fusion. Further studies may elucidate the long term efficacy and safety of the lateral approach. The video can be found here: http://youtu.be/Q82SGpmAXng.

PMID: 23829842 [PubMed – indexed for MEDLINE]

November 11, 2018

Severe plantar hyperhidrosis: an effective surgical solution.

Severe plantar hyperhidrosis: an effective surgical solution.

Am Surg. 2013 Aug;79(8):845-53

Authors: Reisfeld R, Pasternack GA, Daniels PD, Basseri E, Nishi GK, Berliner KI

Abstract
Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life.

PMID: 23896256 [PubMed – indexed for MEDLINE]

November 11, 2018

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Pol Przegl Chir. 2013 May;85(5):247-52

Authors: Stefaniak TJ, Ćwigoń M

Abstract
UNLABELLED: The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating. The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation.
MATERIAL AND METHODS: Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0–no sweating; 10–maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%.
RESULTS: There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months.
CONCLUSIONS: Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.

PMID: 23770524 [PubMed – indexed for MEDLINE]

November 11, 2018

Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.

Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.

Clin Auton Res. 2013 Aug;23(4):197-200

Authors: Stefaniak TJ, Proczko M

Abstract
OBJECTIVE: Though hyperhidrosis is generally considered a subjectively perceived disease, it seems more and more doubtful that merely subjective evaluation is sufficient to qualify the patient to surgery. The aim of this study was to develop further gravimetry as a method of evaluation of sweating intensity and determination of the applicability of it in post-operative follow-up of primary hyperhidrosis (PHH) patients.
METHODS: Total of 1,485 gravimetry assays has been performed in 343 patients treated for hyperhidrosis and in 220 healthy volunteers. In all of the subjects the measurements were taken from four localizations (face, hands, armpits and trunk) and normalized by body surface of the participant. The measurements were taken twice for every participant to obtain test-retest correlations. Mean values and standard deviations (SD) have been evaluated and on that basis reference values were quantified. Thresholds for diagnosis of hyperhidrosis were quantified on the basis of normal distribution theory as healthy population mean +2 SD.
RESULTS: In healthy volunteers, mean value of gravimetrically evaluated intensity of sweating were: facial: 19.15 ± 14.97 mg/min/m(2), palmar: 18.49 ± 14.06 mg/min/m(2), axillary: 42.39 ± 47.08 mg/min/m(2) and plantar: 15.77 ± 16.87 mg/min/m(2). Thresholds for diagnosis of hyperhidrosis were quantified, respectively as: 49, 46, 136 and 50 mg/min/m(2). The overall test-retest correlation was 0.71.
INTERPRETATION: Gravimetry is easy, reproducible and fast method of evaluation of sweating. The reference values are stable and can serve as a qualifying and follow-up tool for evaluation of the patients with PHH in any localization.

PMID: 23761115 [PubMed – indexed for MEDLINE]

November 11, 2018

Objective evaluation of plantar hyperhidrosis after sympathectomy.

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Objective evaluation of plantar hyperhidrosis after sympathectomy.

Clinics (Sao Paulo). 2013;68(3):311-5

Authors: Wolosker N, Ishy A, Yazbek G, Campos JR, Kauffman P, Puech-Leão P, Jatene FB

Abstract
OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter).
METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years).
RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution.
CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

PMID: 23644849 [PubMed – indexed for MEDLINE]

November 11, 2018

The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime.

The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime.

Dermatol Online J. 2013 Mar 15;19(3):14

Authors: Siah TW, Hampton PJ

Abstract
Primary focal hyperhidrosis is a benign condition of unknown etiology. Tap water iontophoresis has long been known to inhibit sweat production. The mechanism of reduced hyperhidrosis by iontophoresis is not completely clear. For operational convenience, our patients received their treatments at different intervals to those recommended by the manufacturer of the iontophoresis unit. We performed a retrospective audit to evaluate the effectiveness of tap water iontophoresis using this regimen. This new treatment regimen was effective at controlling palmoplantar hyperhidrosis. Minimal undesirable effects such as mild skin irritation and erythema were noted but none were severe enough to necessitate discontinuation of treatment. In conclusion, tap water iontophoresis is a safe and effective treatment of palmar and plantar hyperhidrosis when used on Monday, Wednesday, and Friday for 4 weeks. Continued treatment is needed to maintain the effect and many patients go on to purchase their own machines. This technique should be considered prior to systemic or aggressive surgical intervention.

PMID: 23552011 [PubMed – indexed for MEDLINE]

November 11, 2018

Use of oxybutynin for treating plantar hyperhidrosis.

Use of oxybutynin for treating plantar hyperhidrosis.

Int J Dermatol. 2013 May;52(5):620-3

Authors: Wolosker N, de Campos JR, Kauffman P, Yazbek G, Neves S, Puech-Leao P

Abstract
BACKGROUND: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin at low doses for treating plantar hyperhidrosis.
METHODS: From January 2007 to December 2010, 35 consecutive patients with plantar hyperhidrosis were treated with oxybutynin. Data were collected from 30 patients (five patients were lost to follow-up). During the first week, patients received 2.5 mg of oxybutynin once a day, 2.5 mg twice a day from the eighth to the 42nd day, and from the 43rd day to the end of the 12th week, 5 mg twice a day. All of the patients underwent two evaluations: before and after the oxybutynin treatment, using a clinical questionnaire, and a clinical protocol for quality of life.
RESULTS: More than 70% of patients experienced an improvement in plantar hyperhidrosis. Most of the patients showed improvements in quality of life (66.6%). The side effects were minor, the most frequent being dry mouth (76.7%).
CONCLUSION: Treatment of plantar hyperhidrosis with oxybutynin presents good results and improves quality of life. We believe that this therapeutic alternative is an excellent choice for the initial treatment of plantar hyperhidrosis.

PMID: 23590378 [PubMed – indexed for MEDLINE]

November 11, 2018

Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis.

Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis.

J Bras Pneumol. 2012 Sep-Oct;38(5):573-8

Authors: Sakiyama BY, Monteiro TV, Ishy A, Campos JR, Kauffman P, Wolosker N

Abstract
OBJECTIVE: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating.
METHODS: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm². Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24ºC). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet.
RESULTS: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m²/h and 71.8 ± 40.3 g/m²/h, respectively, compared with 37.9 ± 18.4 g/m²/h and 27.6 ± 14.3 g/m²/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet).
CONCLUSIONS: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

PMID: 23147049 [PubMed – indexed for MEDLINE]

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]