Palmar – Page 12 – Hyperhidrosis Research . org

August 13, 2020

Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

J Am Acad Dermatol. 2020 Aug 08;:

Authors: Galadari H, Galadari I, Smit R, Prygova I, Redaelli A

Abstract
BACKGROUND: Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis.
OBJECTIVE: To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis.
METHODS: Embase, MEDLINE and the Cochrane Library were searched for relevant observational studies (OSs), randomized controlled trials (RCTs) and non-RCTs. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted.
RESULTS: Of 191 unique articles identified, 23 were considered relevant (3 OSs, 10 non-RCTs and 10 RCTs). These articles provided data on axillary (13), palmar (7) and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey’s syndrome (1) and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed following aboBoNT-A treatment.
LIMITATIONS: Variability in the injection technique when comparing data across studies.
CONCLUSION: This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

PMID: 32781184 [PubMed – as supplied by publisher]

August 1, 2020

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia.

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia.

F1000Res. 2018;7:670

Authors: Musa AF, Gandhi VP, Dillon J, Nordin RB

Abstract
Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1 st January 2011 until 31 st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.

PMID: 32724556 [PubMed]

July 25, 2020

[Thoracoscopic Sympathectomy for Palmar and Axillary Hyperhidrosis].

[Thoracoscopic Sympathectomy for Palmar and Axillary Hyperhidrosis].

Zentralbl Chir. 2020 Jul 23;:

Authors: Rohleder S, Münsterer O, Gödeke J

Abstract
OBJECTIVE: This video is a step-by-step description of thoracoscopic sympathectomy.
INDICATION: Sweating is essential for thermoregulation. Hyperhidrosis is a condition of excess sweating from the eccrine glands and is associated with severe suffering for patients of all ages. It often worsens during adolescence. A generalised and focal type of hyperhidrosis which affects mainly the face, armpits, hands and feet can be distinguished from the focal variant. Thoracic sympathectomy has become the standard treatment for palmar and axillary hyperhidrosis worldwide.
METHODS: The procedure is performed in the supine position with the upper body elevated about 30° in an adolescent patient. Both arms are abducted at 90° and single tube endotracheal ventilation is employed. A 3 mm trocar is placed in the anterior axillary line for a 3 mm 30° optic. A 5 mm trocar placed on the anterior axillary line (or breast fold in female patients) of the 4th or 5th intercostal space is used for the bipolar forceps. The sympathetic trunk and ganglia T 2 - 4 are identified and coagulated over the heads of ribs.
CONCLUSION: The thoracoscopic approach to focal palmar and axillary hyperhidrosis allows clear identification of the sympathetic structures on each side. Under direct vision, selective ablation of the ganglia and sympathetic trunk provides long-term benefit for patients.

PMID: 32702765 [PubMed – as supplied by publisher]

July 23, 2020

Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

Dermatol Ther. 2020 Jul 21;:e14039

Authors: Campanati A, Gregoriou S, Consales V, Rizzetto G, Bobyr I, Diotallevi F, Martina E, Kontochristopoulos G, Platsidaki E, Offidani A

Abstract
Oxybutynin chloride and Botulinum Toxin type A (BTX-A) have demonstrated to be effective treatments for primary palmar hyperhidrosis, however both of them are not completely free from local and/or generalized side effects. Primary aim of this study is to compare efficacy and safety of a therapeutic approach based on in sequence administration of oral oxybutynin chloride following BTX-A injections versus oral oxybutynin chloride in monotherapy in patients with primary palmar hyperhidrosis. Secondary aim of the study is to evaluate if the sequencing approach can allow the control of hyperhidrosis with lower dose of oral oxybutynin, thus reducing the related side effects. Patients with primary focal palmar hyperhidrosis receiving sequencing treatment with BTX-A injections followed by oral oxybutynin chloride administration and patients in monotherapy with oral oxybutynin chloride were compared for short and long term efficacy and safety of treatments. Effectiveness was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS), and the Dermatology Quality of Life Index (DLQI) score; safety was assessed through collection of the adverse events (AEs) reported by patients both at baseline, at 24 weeks and 52 weeks after starting the treatments in both groups. Patients receiving sequencing treatment showed significant greater improvement than patients receiving oxybutynin chloride alone at T24 (HDSS p=0.0076 and DLQI p=0.0139) and T52 (HDSS p=0.0387 and DLQI p=0.0087). The dose of oxybutynin chloride useful to control hyperhidrosis was lower, and retention rate to the treatment was higher in patients receiving sequencing treatment (p=0.001), than patients receiving monotherapy with oxybutynin chloride alone (p=0.04). A sequencing therapeutic approach to palmar hyperhidrosis provides good clinical results, increasing both efficacy and safety compared with the use of oral oxybutynin chloride alone, and allows clinicians to keep lower dosage of oxybutynin chloride reducing generalized side effects and increasing the retention rate to the treatment. This article is protected by copyright. All rights reserved.

PMID: 32691938 [PubMed – as supplied by publisher]

July 19, 2020

Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates.

Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates.

Pediatr Dermatol. 2020 Jul 16;:

Authors: Verhaegh AJFP, Kuijpers M, Boon M, DeJongste MJL, Bouma W, Mariani MA, Klinkenberg TJ

Abstract
BACKGROUND: Treatment of palmar and axillary primary focal hyperhidrosis (PFH) in children up to 16 years using thoracoscopic sympathicotomy is supported by scarce evidence. Therefore, this study aimed to summarize the results of our standardized bilateral, one-stage, single-port sympathicotomy (BOSS) in children up to 16 years of age.
METHODS: Consecutive children (n = 14) up to 16 years of age undergoing BOSS between October 2011 and June 2015 in our institution were included in this retrospective study.
RESULTS: Recurrence of primary hyperhidrosis was noted in seven patients (50.0%), of whom five patients (35.7%) underwent reoperation. Reoperations were associated with placement of additional thoracoscopic ports (n = 1; 12.5%), intraoperative placement of pleural drains (n = 2; 25%), and prolonged air leak (n = 1; 12.5%). Despite the high recurrence and reoperation rates, overall patient satisfaction was high with a median satisfaction score of 7.5 (interquartile range of 1.75; range: 4-9).
CONCLUSION: Although the overall patient satisfaction score in our cohort was good, BOSS for the treatment of intolerable palmar and axillary PFH in children up to 16 years of age is associated with a high recurrence and reoperation rate.

PMID: 32677080 [PubMed – as supplied by publisher]

July 11, 2020

Over a decade of single-center experience with thoracoscopic sympathicolysis for primary palmar hyperhidrosis: a case series.

Over a decade of single-center experience with thoracoscopic sympathicolysis for primary palmar hyperhidrosis: a case series.

Surg Endosc. 2020 Jul 08;:

Authors: Mol A, Muensterer OJ

Abstract
BACKGROUND: Primary palmar hyperhidrosis is a severely debilitating condition that can affect patients of any age. We report our experience with thoracoscopic sympathicolysis in a large cohort of children less than 14 years of age.
METHODS: All children who underwent thoracoscopic sympathicolysis from April 2005 through January 2017 were evaluated retrospectively. The procedure entailed bilateral bipolar fulguration of the second and third thoracic ganglia with transverse disruption of collateral nerve fibers along the third and fourth rib. Demographic information, as well as postoperative outcome, complications, and satisfaction were analyzed.
RESULTS: Over the 12 year study interval, a total of 102 children underwent thoracoscopic sympathicolysis for palmar hyperhidrosis. Complete follow-up was available for 98 patients (median age 12 [range 5-14] years; 38 boys [39%]). Median follow-up was 4 [range 2-12] years. Complete palmar dryness was achieved in 93 (95%) cases. One patient suffered postoperative unilateral ptosis, 6 reported gustatory sweating, and 65 experienced compensatory sweating. Average postoperative rating on a 1 (lowest) to 10 (highest) rating scale was 9, with 97 (99%) patients saying that they would undergo the procedure again.
CONCLUSION: Our technique of thoracoscopic sympathicolysis in children was associated with very high postoperative satisfaction, despite a high rate of compensatory sweating and occasional autonomic gustatory sweating. Other more severe complications in this age group were rare.

PMID: 32642844 [PubMed – as supplied by publisher]

June 28, 2020

Association between Reflux Esophagitis Incidence and Palmar Hyperhidrosis.

Association between Reflux Esophagitis Incidence and Palmar Hyperhidrosis.

Int J Environ Res Public Health. 2020 Jun 23;17(12):

Authors: Cheng CG, Chien WC, Yu CP, Chung CH, Cheng CA

Abstract
The autonomic dysfunction in palmar hyperhidrosis (PH) includes not only sympathetic overactivity but also parasympathetic impairment. A decrease of parasympathetic tone has been noted in gastroesophageal reflux disease of neonates and adults. Patients with reflux esophagitis have a defective anti-reflux barrier. The association between reflux esophagitis and PH is deliberated in this article. The National Health Insurance Database in Taiwan was used. At first-time visits, PH patients were identified by the International Classification of Disease, 9th Revision, Clinical Modification disease code of 780.8 without endoscopic thoracic sympathectomy. Patients were matched by age and gender as control groups. The reflux esophagitis incidence was assessed using disease codes 530.11, 530.81, and 530.85. The factors related to reflux esophagitis were established by the Cox proportional regression model. The risk of reflux esophagitis in PH patients had a hazard ratio of 3.457 (95% confidence interval: 3.043-3.928) after adjustment of the other factors. We confirmed the association between reflux esophagitis and PH. Health care providers must be alerted to this relationship and other risk factors of reflux esophagitis to support suitable treatments to improve the quality of life of patients.

PMID: 32585882 [PubMed – in process]

June 21, 2020

Fractional CO2 laser-assisted Botulinum toxin type A delivery for the treatment of primary palmar hyperhidrosis.

Fractional CO2 laser-assisted Botulinum toxin type A delivery for the treatment of primary palmar hyperhidrosis.

Lasers Med Sci. 2020 Jun 17;:

Authors: Junsuwan N, Manuskiatti W, Phothong W, Wanitphakdeedecha R

Abstract
Intradermal injections of botulinum toxin type A (BTX-A) have been used successfully to treat patients with primary palmoplantar hyperhidrosis (PPH). However, problems with local injections of BTX-A for palmar hyperhidrosis include injection pain and reduced palmar muscle strength. This case series describes three patients with PPH. Patients were followed up for 3 months and assessed using the minor iodine starch test and the visual analog scale (VAS). Over two sessions within a 2-week interval, all patients received treatment on one palm, while the other palm served as the untreated control. Treated palms received fractional CO2 laser therapy and immediate post-operative topical application of BTX-A solution for a total of 50 units. Sweat production was assessed based on the size of the sweat-producing area (measured by the minor iodine starch test) and subjective assessment of sweat production using the visual analog scale (VAS) at baseline, 2 weeks after the first treatment, and 1, 2, and 3 months after the second treatment. In the BTX-A-treated palm, the decrease in the mean sweat production was 51.6% at 2 weeks after the first treatment, and 88.5%, 67.8%, and 52.9%, at 1, 2, and 3 months after the final treatment when compared to the baseline. In the untreated palms, the decrease in the mean sweat production was 2% on all follow-ups when compared to the baseline. No adverse effect was observed in any patient. Fractional CO2 laser is a safe technique for BTX-A delivery on the palm area and is demonstrated to be safe and effective in decreasing sweat secretion of hyperhidrosis palm.

PMID: 32557001 [PubMed – as supplied by publisher]

May 28, 2020

Correction to: The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis.

Correction to: The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis.

Clin Auton Res. 2020 May 25;:

Authors: Hirakawa N, Higashimoto I, Takamori A, Tsukamoto E, Uemura Y

Abstract
Unfortunately, the 3rd coauthor name has been published incorrectly in the original publication.

PMID: 32451754 [PubMed – as supplied by publisher]

May 17, 2020

Anatomic variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus

Abstract

Introduction
This study investigated morphological variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus based on the existence of the intrathoracic nerves and the rami communicantes.

Materials and Methods
Fifty thoracic sympathetic trunks from 26 Korean adult cadavers were used.

Results
The first intrathoracic nerve connecting the first and second thoracic nerves was observed on 36 sides (72%), and the second intrathoracic nerve connecting the second and third thoracic nerves was found on 3 sides (6%). There were either one (62%) or two (10%) first intrathoracic nerves, and only one second intrathoracic nerve (6%). The neural connections of the second and third thoracic sympathetic ganglia to the first thoracic nerve were classified into three types based on the existence of the intrathoracic nerves: type I (68%) had only the first intrathoracic nerve, type II (26%) had no intrathoracic nerve, and type III (6%) had both the first and second intrathoracic nerves. Types I, II, and III were further subdivided into ten, six, and three types, respectively, according to the types of the rami communicantes arising from the second and third thoracic sympathetic ganglia.

Conclusions
Improved knowledge of the variations in intrathoracic nerves and upper thoracic sympathetic ganglia will be helpful to thoracic surgeons when they are disrupting the sympathetic supply to the hand for treating palmar hyperhidrosis, and contribute to successful diagnoses and treatments.