Category: Hyperhidrosis

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Dermoscopy of Pitted Keratolysis.

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Dermoscopy of Pitted Keratolysis.

Case Rep Dermatol. 2010 Aug 19;2(2):146-148

Authors: Lockwood LL, Gehrke S, Navarini AA

Abstract
Irritated hyperhidrotic soles with multiple small pits are pathognomonic for pitted keratolysis (PK). Here we show the dermatoscopic view of typical pits that can ensure the diagnosis. PK is a plantar infection caused by Gram-positive bacteria, particularly Corynebacterium. Increases in skin surface pH, hyperhidrosis, and prolonged occlusion allow these bacteria to proliferate. The diagnosis is fundamentally clinical and treatment generally consists of a combination of hygienic measures, correcting plantar hyperhidrosis and topical antimicrobials.

PMID: 21076687 [PubMed – as supplied by publisher]

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Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.

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Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.

World J Surg. 2011 Jan;35(1):49-53

Authors: Rieger R, Loureiro Mde P, Pedevilla S, de Oliveira RA

Abstract
BACKGROUND: Palmoplantar hyperhidrosis is a common disease that leads to significant psychosocial strain for the affected person. Although the treatment of palmar symptoms with endoscopic thoracic sympathectomy (ETS) is clinically established, there are few data on the efficacy of an endoscopic lumbar sympathectomy (ELS) for the elimination of plantar symptoms. Especially the occurrence of unwanted side effects associated with sequential ETS and ELS has not been examined sufficiently.
METHODS: The study includes 130 patients, 8 men and 122 women, with severe palmoplantar hyperhidrosis who were already previously treated with ETS. An average of 28 months after the ETS, bilateral ELS was performed on all patients due to persistent severe plantar hyperhidrosis. After ELS the perioperative morbidity, elimination rate of the plantar hyperhidrosis, the frequency of unwanted side effects, and satisfaction with the result were evaluated. Follow-up examinations were carried out on 96 patients (74%) with a mean follow-up of 37 months (3-90 months).
RESULTS: A total of 260 lumbar sympathectomies were successfully carried out endoscopically. Mortality was zero, intraoperative complications occurred in three (2.3%) patients and postoperative complications in six (4.6%). Plantar hyperhidrosis was eliminated in 93 patients (97%), 3 (3%) patients developed a one-sided recurrence. Seven patients (7%) developed minor compensatory sweating, and in 17 patients (18%) compensatory sweating that existed before the ELS was slightly increased. Transient postsympathectomy neuralgia was observed in 18 patients (19%), and none of the patients showed a sexual function disorder. Altogether, 77 patients (80%) were very satisfied with the postoperative result, and 16 (17%) were partially satisfied.
CONCLUSIONS: The sesequential performance of ELS after ETS appears to be a safe, effective therapy option for patients with severe palmoplantar hyperhidrosis. However, more experience with a larger number of patients and longer follow-up investigations are necessary to confirm the safety of four-limb sympathectomy.

PMID: 20862474 [PubMed – indexed for MEDLINE]

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[Botulinum toxin type A for the treatment of primary hyperhidrosis: a prospective study of 52 patients].

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[Botulinum toxin type A for the treatment of primary hyperhidrosis: a prospective study of 52 patients].

Actas Dermosifiliogr. 2010 Sep;101(7):614-21

Authors: Martí N, Ramón D, Gámez L, Reig I, García-Pérez MA, Alonso V, Jordá E

Abstract
BACKGROUND AND OBJECTIVES: Primary hyperhidrosis is characterized by excessive sweating in a defined region of the body. It should not be considered a purely cosmetic problem as it has a significant impact on the social and professional relationships of affected individuals. The aim of this study was to determine the clinical profile of patients with primary hyperhidrosis and assess the results obtained with the use of botulinum toxin type A (BTX-A) in clinical practice.
MATERIAL AND METHODS: The study included 52 patients (39 women and 13 men) with a diagnosis of primary hyperhidrosis treated for the first time with BTX-A. All patients completed a questionnaire that included the following information: age; sex; profession; age at onset, family history, and site of hyperhidrosis; accompanying signs and symptoms, and previous treatment; time to effect of BTX-A; local or systemic side effects; and severity of hyperhidrosis before and after BTX-A treatment.
RESULTS AND CONCLUSIONS: Primary hyperhidrosis began during puberty in 61.5% of the patients included in the study, 75% were women, and the mean age was 29.9 years. In 36.5% of patients, first-degree relatives also had primary hyperhidrosis. Hyperhidrosis was classified as palmar in 61.5% of cases, plantar in 53.8%, and axillary in 59.6%. Other sites were affected less frequently. The most common accompanying symptoms were facial erythema (32.7%), palpitations (30.7%), muscle tension (28.8%), shivering (23%), and headache (17.3%). Treatment with BTX-A was well tolerated and there was a highly significant reduction in the severity of hyperhidrosis 2 months after performing the treatment (P<0.001).

PMID: 20858387 [PubMed – indexed for MEDLINE]

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Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method.

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Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method.

Surg Laparosc Endosc Percutan Tech. 2010 Aug;20(4):231-6

Authors: Reisfeld R

Abstract
Surgical treatment for focal plantar hyperhidrosis is not yet well studied. Bilateral endoscopic lumbar sympathectomy (ELS), using the clamping method, was performed in 63 patients with focal plantar hyperhidrosis. Clamps were placed at L3 (46.0%) or L4 (52.4%), with one case at L2. All patients had improvement in foot sweating, with 96.6% achieving total anhidrosis. Five early cases had to be converted to an open surgical method. Complications were rare. No sexual problems were reported by the male patients. Compensatory sweating, already present in those with prior thoracic sympathectomy (n=56), remained unchanged in 91.1% and no severe compensatory sweating occurred in those who had only ELS. Postoperative pain was minimal. ELS is a viable option in the treatment of plantar hyperhidrosis, whether after a thoracic sympathectomy or in primary cases of plantar hyperhidrosis. Use of the clamping method provides good results with minimal postoperative pain or other complications.

PMID: 20729691 [PubMed – indexed for MEDLINE]

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Botulinum Toxin Type A for the Treatment of Primary Hyperhidrosis: A Prospective Study of 52 Patients.

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Botulinum Toxin Type A for the Treatment of Primary Hyperhidrosis: A Prospective Study of 52 Patients.

Actas Dermosifiliogr. 2010 Sep;101(7):614-621

Authors: Martí N, Ramón D, Gámez L, Reig I, García-Pérez MÁ, Alonso V, Jordá E

Abstract
BACKGROUND AND OBJECTIVES: Primary hyperhidrosis is characterized by excessive sweating in a defined region of the body. It should not be considered a purely cosmetic problem as it has a significant impact on the social and professional relationships of affected individuals. The aim of this study was to determine the clinical profile of patients with primary hyperhidrosis and assess the results obtained with the use of botulinum toxin type A (BTX-A) in clinical practice.
MATERIAL AND METHODS: The study included 52 patients (39 women and 13 men) with a diagnosis of primary hyperhidrosis treated for the first time with BTX-A. All patients completed a questionnaire that included the following information: age; sex; profession; age at onset, family history, and site of hyperhidrosis; accompanying signs and symptoms, and previous treatment; time to effect of BTX-A; local or systemic side effects; and severity of hyperhidrosis before and after BTX-A treatment.
RESULTS AND CONCLUSIONS: Primary hyperhidrosis began during puberty in 61.5% of the patients included in the study, 75% were women, and the mean age was 29.9 years. In 36.5% of patients, first-degree relatives also had primary hyperhidrosis. Hyperhidrosis was classified as palmar in 61.5% of cases, plantar in 53.8%, and axillary in 59.6%. Other sites were affected less frequently. The most common accompanying symptoms were facial erythema (32.7%), palpitations (30.7%), muscle tension (28.8%), shivering (23%), and headache (17.3%). Treatment with BTX-A was well tolerated and there was a highly significant reduction in the severity of hyperhidrosis 2 months after performing the treatment (P<0.001).

PMID: 28709543 [PubMed]

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Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis.

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Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis.

Clin Auton Res. 2011 Feb;21(1):11-7

Authors: Schmidt JE, Wehrwein EA, Gronbach LA, Atkinson JL, Fealey RD, Charkoudian N, Eisenach JH

Abstract
PURPOSE: Primary palmar-plantar hyperhidrosis is the condition of excessive sweating of the hands and feet. For severe and medically refractory cases, endoscopic thoracic sympathotomy (ETS) is a bilateral ganglion-sparing disconnection between the stellate and T2 ganglion in an effort to minimize compensatory hyperhidrosis. The purpose of this study was to determine the effect of ETS on cardiac autonomic function.
METHODS: Participants in this study were 22 otherwise healthy hyperhidrosis patients with 17 returning 1-12 months after surgery. Heart rate (HR) and blood pressure were collected at rest and during sequential nitroprusside/phenylephrine infusion (modified Oxford). To determine change in cardiac autonomic function, heart rate variability indices of RMSSD, LF and HF (log, nu) power were calculated. Sequential baroreflex sensitivity was also calculated.
RESULTS: After surgery, resting HR on standardized ECG tended to be lower and reached significance during the modified Oxford baseline (p < 0.001). HRV changed significantly between assessments with an increase in HF (nu) and decrease in LF (nu) and LF (log) spectral ranges (p < 0.05), while the increase in RMSSD was marginally significant (p < 0.06). Compared with matched controls, HRV indices were significantly different before surgery, but similar after surgery. No change was detected in resting sequential baroreflex sensitivity, baroslope obtained by modified Oxford or QTc interval.
CONCLUSIONS: We conclude that ETS changes cardiac autonomic modulation of HR to levels similar to controls. Despite the minimally destructive nature of ETS, effects on HRV are consistent with previously reported post-sympathectomy blunting of exaggerated sympathetic control associated with hyperhidrosis. No significant changes in the baroreflex indices suggest that ETS did not significantly affect blood pressure regulation.

PMID: 20700640 [PubMed – indexed for MEDLINE]

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Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita.

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Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita.

Br J Dermatol. 2010 Nov;163(5):1072-6

Authors: Swartling C, Karlqvist M, Hymnelius K, Weis J, Vahlquist A

Abstract
BACKGROUND: Painful foot blistering is a common problem in patients with epidermolysis bullosa simplex (EBS) and pachyonychia congenita (PC). Hyperhidrosis, a condition which can be effectively blocked by plantar injections of botulinum toxin (Btx), often exacerbates the blistering.
OBJECTIVES: A retrospective evaluation of the effects of Btx injections in 14 patients with EBS and PC with foot blisters and painful callosities.
METHODS: After informed consent, patients with EBS (n = 6) and PC (n = 8), aged 7-66 years, who had received Btx therapy at our centre since 2003, were included. The treatment consisted of multiple plantar injections of Btx A or Btx B after prior regional or general anaesthesia. Patients were interviewed about the treatment effect and were asked to score the improvement from 0 to 5, where 5 is ‘excellent’. One patient with PC with painful callosities was studied by magnetic resonance (MR) spectroscopic microimaging before and after Btx injections to disclose any underlying blisters.
RESULTS: In total, 76 treatments were evaluated (one to 19 sessions per patient). Thirteen patients (93%) reported reduced plantar blistering and pain; the improvement score was ≥ 4 in four of six patients with EBS and six of eight patients with PC. The mean effect duration was 3 months. No adverse events, apart from mild anticholinergic side-effects in two patients, were noted. MR spectroscopic microimaging showed disappearance of intraepidermal blistering after Btx therapy.
CONCLUSIONS: Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.

PMID: 20618323 [PubMed – indexed for MEDLINE]

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Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents.

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Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents.

J Neurosurg Pediatr. 2010 Aug;6(2):183-7

Authors: Wait SD, Killory BD, Lekovic GP, Dickman CA

Abstract
OBJECT: Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author.
METHODS: A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire.
RESULTS: Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10-17 years). Average follow-up was 42 weeks (range 0.2-143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%.
CONCLUSIONS: Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.

PMID: 20672941 [PubMed – indexed for MEDLINE]

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An epidemiological study of hyperhidrosis patients visiting the Ajou University Hospital hyperhidrosis center in Korea.

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An epidemiological study of hyperhidrosis patients visiting the Ajou University Hospital hyperhidrosis center in Korea.

J Korean Med Sci. 2010 May;25(5):772-5

Authors: Park EJ, Han KR, Choi H, Kim DW, Kim C

Abstract
Hyperhidrosis is a disorder of perspiration in excess of the body’s physiologic need and significantly impacts one’s occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21+/-5.80 yr vs. 16.04+/-9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history.

PMID: 20436716 [PubMed – indexed for MEDLINE]