Category: Palmar

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Transfersomal eosin topical delivery assisted by fractional CO2 laser for photodynamic treatment of palmar hyperhidrosis: case study

Drug Deliv Transl Res. 2022 Apr 20. doi: 10.1007/s13346-022-01164-z. Online ahead of print.

ABSTRACT

Hyperhidrosis is a condition in which the cholinergic receptors on the eccrine glands are overstimulated, resulting in excessive sweating. It is considered a serious cosmetic and psychological problem that affects the patient’s quality of life. Searching for novel treatment modalities is required to minimize the side effects and to attain better patient satisfaction.Photodynamic therapy (PDT), using eosin as a photosensitizer, is developed as a promising modality of the treatment of palmar and axillary hyperhidrosis. In this study, we treated six cases suffering palmar hyperhidrosis by applying the fractional CO2 laser prior to PDT session. For PDT, a hydrogel of eosin loaded in a transfersomes as a nano-delivery carrier was applied for 5 min, followed by irradiation by intense pulsed light (IPL). The prepared transfersomes loaded by eosin were spherical in shape with encapsulation efficiency of 33 ± 3.5%, particle size 305.5 ± 5.7 nm, average zeta potential of – 54 ± 7.6 mV with 80 ± 4% of the loaded eosin was released after 3 h. Two cases achieved 90% improvement after four sessions, three patients needed six sessions to show 75% improvement, while one patient showed only 25% improvement after six sessions. This resulted in shortening the time of PS application and decreasing the number of sessions required to achieve acceptable improvement. More clinical studies on large number of patients are required to optimize the results.

PMID:35441986 | DOI:10.1007/s13346-022-01164-z

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A Practical Approach to the Diagnosis and Treatment of Palmar Hyperhidrosis

Plast Reconstr Surg Glob Open. 2022 Mar 7;10(3):e4172. doi: 10.1097/GOX.0000000000004172. eCollection 2022 Mar.

ABSTRACT

Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH.

METHOD: The authors reviewed the current literature specific to the diagnostic workup and treatment of PH.

RESULTS: In this article, we show a practical approach to managing patients presenting with PH, summarize its main nonsurgical and surgical treatment options, provide a suggested treatment ladder, and outline emerging therapeutic approaches. We suggest that, after diagnosing PH and classifying its severity, nonsurgical treatments (ie, topical antiperspirants, iontophoresis, botulinum toxin A injection, and topical/oral anticholinergics) should be utilized in a stepwise manner. In patients with severe palmar hyperhidrosis who do not respond to nonsurgical treatments, surgical intervention may be warranted, generally in the form of sympathetic denervation.

CONCLUSION: This article provides a clear overview of PH treatment options, stepwise guidelines for physicians, and educational video resources demonstrating botulinum toxin A injections with cryotherapy and nerve blocks.

PMID:35265447 | PMC:PMC8901220 | DOI:10.1097/GOX.0000000000004172

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Thoracoscopic resympathectomy for persistent or recurrent palmar hyperhidrosis: single-center experience

Gen Thorac Cardiovasc Surg. 2022 Feb 23. doi: 10.1007/s11748-022-01788-5. Online ahead of print.

ABSTRACT

BACKGROUND: In case of recurrence or persistent palmar hyperhidrosis, a sympathetic chain resection is suggested, however, many surgeons are still reluctant to offer further intervention because of the inability to predict the efficacy of such a procedure. We analyzed our large series of resympathectomy.

METHODS: Substantive retrospective analysis of 39 patients underwent a resympathectomy (minimally invasive bilaterally sympathetic chain Th2-3 resection). Patients referred from other hospitals or primarily operated at our institution for recurrence or persistence palmar hyperhidrosis were included in the study group.

RESULTS: No intraoperative complications were detected. Reoperation or chest tube positioning was necessary in 2 patients. Twenty-eight patients had a positive response (excellent or good results). Seven patients described a substantial, but not sufficient, reduction of the symptomatology. Four patients were very unsatisfied and regretted the operation.

CONCLUSIONS: Resympathectomy is highly effective procedure for patients who have persistent or recurrent symptoms. However, the indication of the operations should be more dissuasive as possible to avoid the risk of any undesirable psychologically side effects.

PMID:35195859 | DOI:10.1007/s11748-022-01788-5

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Cohort study on 20 years’ experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients

Sao Paulo Med J. 2022 Feb 21:S1516-31802022005004202. doi: 10.1590/1516-3180.2021.0078.R1.23072021. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation.

OBJECTIVE: To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series.

DESIGN AND SETTING: Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil.

METHODS: A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated.

RESULTS: All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample.

CONCLUSION: Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

PMID:35195234 | DOI:10.1590/1516-3180.2021.0078.R1.23072021

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Minimally Invasive Sympathicotomy for Palmar Hyperhidrosis and Facial Blushing: Current Status and the Hyperhidrosis Expert Center Approach

J Clin Med. 2022 Jan 31;11(3):786. doi: 10.3390/jcm11030786.

ABSTRACT

Hyperhidrosis, the medical term for excessive sweating beyond physiological need, is a condition with serious emotional and social consequences for affected patients. Symptoms usually appear in focal areas such as the feet, hands, axillae and face. Non-surgical treatment options such as topical antiperspirants or systemic medications are usually offered as a first step of treatment, although these therapies are often ineffective, especially in severe and intolerable cases of hyperhidrosis. In the treatment algorithm for patients suffering from hyperhidrosis, surgical thoracoscopic sympathicotomy offers a permanent solution, which is particularly effective in the treatment of palmar hyperhidrosis and facial blushing. In this review, we describe the current status of thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing. In addition, we share the specific treatment approach, technique and results of our Hyperhidrosis Expert Center. Last, we share recommendations to ensure an effective, reproducible and safe application of single-port thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing, based on our extensive experience.

PMID:35160238 | DOI:10.3390/jcm11030786

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Long-term follow-up in quality of life before and after endoscopic thoracic sympathicotomy in 367 patients with palmar hyperhidrosis

Ann Palliat Med. 2022 Jan 10:apm-21-2860. doi: 10.21037/apm-21-2860. Online ahead of print.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis (PH) hinders daily activities and deteriorates quality of life (QOL). Endoscopic thoracic sympathicotomy (ETS) is safe and efficient as the gold standard treatment for PH. So far, the long-term change of QOL after surgery has not been fully characterized, which is important to evaluate clinical benefits and helped to identify the true beneficiaries. In the current study, we aimed to investigate the long-term outcome of ETS by comparing their preoperative QOL with a follow-up QOL.

METHODS: This study enrolled 367 patients with PH who underwent ETS between March 2018 and March 2019. All patients were surveyed by a web-based questionnaire adapted from de Campos Quality-of-life Questionnaire for Evaluation of Hyperhidrosis, and compared to their preoperative results.

RESULTS: After a median follow-up of 14 months [interquartile range (IQR), 9-21 months], improvement in QOL was reported in 90.7% of patients. Compared to preoperative QOL [median (Md) =40, IQR, 37-45], postoperative QOL was significantly improved (Md =20, IQR, 13-23; P<0.001). A higher QOL score was noticed in patients with severer PH at diagnosis, whereas no significant difference was observed among postoperative QOL regarding the severity of PH. Subclinical compensatory hyperhidrosis (CH) occurred in 94.6% of post-ETS cases after long-term follow-up. The score of postoperative QOL was significantly positively correlated to the severity of CH (rs=0.14; P=0.009).

CONCLUSIONS: Improvement in QOL sustained for a long-term period after receiving ETS for PH. Almost all patients developed subclinical CH on other body sites in the long run, with an impairment in QOL correlating with the severity of CH. Further investigations on the developing patterns of CH and clinical coping strategy are warranted to improve the long-term outcome of ETS.

PMID:35016525 | DOI:10.21037/apm-21-2860

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Knowledge of surgical management of hyperhidrosis among primary care physicians and the general public

Interact Cardiovasc Thorac Surg. 2022 Jan 7:ivab371. doi: 10.1093/icvts/ivab371. Online ahead of print.

ABSTRACT

OBJECTIVES: Our study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public.

METHODS: An online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public’s perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey.

RESULTS: The majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery.

CONCLUSIONS: Neither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.

PMID:35015865 | DOI:10.1093/icvts/ivab371

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Palmar Hyperhidrosis Associated with the Azygos Lobe

Kyobu Geka. 2021 Dec;74(13):1086-1090.

ABSTRACT

A 66-year-old man visited our department because of palmar hyperhidrosis. Computed tomography had revealed division of the right upper lobe by a fissure and the azygos vein, and the presence of an azygos lobe had been diagnosed. Endoscopic thoracic sympathectomy (resection of T3 ganglion) was performed. Adhesion between the azygos lobe and parietal pleura was dissected to pulling out the azygos lobe and the sympathectomy was safely performed.

PMID:34876538