Category: Palmar

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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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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]

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Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production.

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Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production.

Dermatol Surg. 2010 Apr;36(4):496-8

Authors: Gregoriou S, Rigopoulos D, Makris M, Liakou A, Agiosofitou E, Stefanaki C, Kontochristopoulos G

Abstract
BACKGROUND: Patients with focal hyperhidrosis in multiple areas often report improvement of plantar hyperhidrosis after botulinum toxin A (BTX-A) therapy for palmar hyperhidrosis.
OBJECTIVE: To assess sweat production from the soles in patients receiving BTX-A treatment for their palmar hyperhidrosis.
PATIENTS AND METHODS: Thirty-six patients with both palmar and plantar hyperhidrosis received 100 U of BTX-A per palm. Sweat production of palms and soles was assessed using a starch iodine test and gravimetry at baseline and 1, 3, and 8 months after treatment. Patients were subjectively assessed using a percentile scale.
RESULTS: All patients had significant improvement in their palmar hyperhidrosis that lasted for 6.2 +/- 1.8 months. Gravimetry revealed marginal improvement of plantar hyperhidrosis in 12 patients (from 39.7 +/- 21.3 to 31.5 +/- 18.0 mg/min; p=.01) and statistically significant worsening in 24 patients (from 71.6 +/- 70.60 to 109.94 +/- 82.93 mg/min, p<.001).
CONCLUSION: Treatment of palmar hyperhidrosis with BTX-A increased plantar sweating in many patients affected by both palmar and plantar hyperhidrosis in the population under study. Regardless, patients reported satisfaction with the results and were willing to repeat treatment.

PMID: 20180837 [PubMed – indexed for MEDLINE]

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Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet.

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Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet.

J Cutan Med Surg. 2009 Sep-Oct;13(5):253-6

Authors: Richards RN

Abstract
BACKGROUND: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use.
OBJECTIVE: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort.
METHODS: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection.
RESULTS: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay.
CONCLUSION: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.

PMID: 19769833 [PubMed – indexed for MEDLINE]

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[Botulinum toxin in disabling dermatological diseases].

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[Botulinum toxin in disabling dermatological diseases].

Ann Dermatol Venereol. 2009 May;136 Suppl 4:S129-36

Authors: Messikh R, Atallah L, Aubin F, Humbert P

Abstract
Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin.

PMID: 19576479 [PubMed – indexed for MEDLINE]

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What stands in the way of treating palmar hyperhidrosis as effectively as axillary hyperhidrosis with botulinum toxin type A.

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What stands in the way of treating palmar hyperhidrosis as effectively as axillary hyperhidrosis with botulinum toxin type A.

Dermatol Online J. 2009 Apr 15;15(4):12

Authors: Benohanian A

Abstract
Botulinum Toxin type A (BTX-A) has revolutionized the treatment of focal hyperhidrosis (HH) in recent years and has dramatically reduced the invasive surgical techniques that have been performed in the past to control severe focal HH unresponsive to topical therapies. Whereas BTX-A injections are easily performed to control axillary HH with little or no analgesia, pain management is a must during the injection of palmar and plantar HH with BTX-A because of the intense pain generated with the 30 to 40 needle punctures needed on each hand or foot through the densely innervated skin present in those areas. For that reason, many physicians who contentedly treat axillary HH with BTX-A injections, refuse to do so for palmar and plantar HH. Although pain is the major stumbling block deterring patients and physicians from choosing this treatment option, it is not the only one. Many other factors may play a role in deciding whether or not to treat palmar and plantar HH with BTX-A injections. This article reviews these factors and presents some personal data from patients who have already been treated with BTX-A injections on the palms and soles and who came back once or more for repeat treatments when the effect of BTX-A started to fade away. “Jet Anesthesia” was the pain management method used in this group.

PMID: 19450405 [PubMed – indexed for MEDLINE]

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[Management of axillary hyperhidrosis].

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[Management of axillary hyperhidrosis].

Ann Dermatol Venereol. 2009 May;136 Suppl 4:S125-8

Authors: Pomarède N

Abstract
Hyperhidrosis is considered as an handicap which affects around of 2.8% of the population. It is linked to an extreme, permanent and symetric production of sweating because of an hyperactivity of sweat glands independant of thermo regulation process. The treatment by botulinum toxin has completely changed the treatment of axillary hyperhidrosis. It is an easy, quick, efficient treatment which improved quality of life of these patients. This treatment can also be used for palmar and plantar hyperhidrosis but it requires regional anesthetic technics, so it is done to the hospital.

PMID: 19576478 [PubMed – indexed for MEDLINE]

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An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.

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An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.

Eur J Cardiothorac Surg. 2009 Aug;36(2):360-3

Authors: Ureña A, Ramos R, Masuet C, Macia I, Rivas F, Escobar I, Villalonga R, Moya J

Abstract
BACKGROUND: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine plantar hyperhidrosis before and after EBTS.
METHODS: A total of 198 patients with primary hyperhidrosis underwent 396 thoracoscopic sympathicolysis of ganglia T2-T3 in a prospective study. All completed a preoperative questionnaire, followed by a second questionnaire 12 months after the operation. The questionnaires evaluated sweating in the different body areas. Only the zones of anhydrosis were considered in delimiting the cutaneous expression of sympathetic ganglia T2-T3.
RESULTS: Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001).
CONCLUSIONS: EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.

PMID: 19410478 [PubMed – indexed for MEDLINE]