Category: Palmar

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Therapeutic Effectiveness of Needle Injection Versus Needle-Free Jet Injector System for Botulinum Toxin Type a in Palmar Hyperhidrosis

J Cutan Med Surg. 2023 Aug 3:12034754231191062. doi: 10.1177/12034754231191062. Online ahead of print.

ABSTRACT

BACKGROUND: The most important problem with local injections of botulinum toxin type A (BTX-A) in palmar hyperhidrosis is pain during the injections.

OBJECTIVES: We evaluated therapeutic effectiveness and pain of local injections of BTX-A using needle-free direct administration system.

METHODS: We performed BTX-A local injection therapy using a conventional injection needle in the left hand and a needle-free direct administration system in the right hand.

RESULTS: A reduction in the quantity of perspiration was observed 4 weeks after administration of both Needle and Needle-free BTX-A, and reduction was maintained throughout 28 weeks observation period. Both hyperhidrosis Disease Severity Scale scores and Dermatology Life Quality Index for hands treated with Needle BTX-A and hands treated with Needle-free BTX-A had decreased significantly by 4 weeks after treatment. Pain visual analog scale scores and the degree of pain were significantly lower in hands treated with Needle-free BTX-A than in hands treated with Needle BTX-A.

CONCLUSIONS: When the trigger of the pressurized needle-free injector device is activated, the gas powered driving pressure propels BTX-A through an orifice (0.13 mm) about four times narrower than a 30 G needle at very high speed. As most pain occurs during the needle prick itself, the advantage of a small orifice coupled with high-speed penetration of BTX-A through the pressurized device results in reduced pain during administration. The needle-free direct administration system administers the injectate under the skin without a visible needle.

PMID:37537972 | DOI:10.1177/12034754231191062

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Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin

Surg Radiol Anat. 2023 Jul 20. doi: 10.1007/s00276-023-03199-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment.

METHODS: This study, involving 52 Korean cadaver arms (mean age 73.5 years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites.

RESULTS: In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43 mm and 29.39 ± 6.43 mm from the transverse line at the pisiform level.

DISCUSSION: To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4 cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.

PMID:37468725 | DOI:10.1007/s00276-023-03199-4

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Rhomboid intercostal block versus serratus block for postoperative analgesia after thoracoscopic sympathectomy for primary palmar hyperhidrosis: a randomized controlled trial

BMC Anesthesiol. 2023 Jul 19;23(1):241. doi: 10.1186/s12871-023-02203-z.

ABSTRACT

BACKGROUND: Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and serratus anterior plane block (SABP) are recent techniques used for pain control after such procedures. Herein, we compared RIB and SAPB regarding pain control in patients undergoing thoracoscopic sympathectomy for palmar hyperhidrosis.

PATIENTS AND METHODS: Three groups were enrolled in this prospective randomized study (71 patients in each group); Group S received SAPB, Group R received RIB and Group C as controls. The block procedures were performed after general anesthesia and prior to the skin incision.

RESULTS: The three groups showed comparable demographics and operative time (P ˃ 0.05). Pain scores showed a significant decline with the two block procedures compared to controls during the first day following surgery (both P ˂ 0.05), but Group R had better scores compared to Group S. Both block techniques were associated with a significant prolongation of the time to first rescue analgesic and less fentanyl consumption compared to controls (both P ˂ 0.05). However, both parameters were improved with RIB rather than SAPB (both P ˂ 0.05). Both blocks led to a significant improvement in patient satisfaction than in the control group (both P ˂ 0.05), but it was comparable between the two approaches (P ˃ 0.05).

CONCLUSION: Both RIB and SAPB are safe and effective in pain reduction after thoracoscopic sympathectomy procedures in patients with hyperhidrosis. Moreover, RIB is superior to SAPB as it is associated with better analgesic outcomes.

TRIAL REGISTRATION: Pan African Trial Registry PACTR202203766891354. https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=21522.

PMID:37468840 | DOI:10.1186/s12871-023-02203-z

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A comparative evaluation of aluminum chloride hexahydrate gel iontophoresis versus tap water iontophoresis in people with primary palmar hyperhidrosis: A randomized clinical trial

Indian J Dermatol Venereol Leprol. 2023 Jun 30:1-7. doi: 10.25259/IJDVL_975_2022. Online ahead of print.

ABSTRACT

Background Primary palmar hyperhidrosis causes a lot of problems for patients and negatively affects their quality of life. Currently, iontophoresis with tap water and aluminum chloride hexahydrate is used for primary palmar hyperhidrosis. Yet, little evidence exists about iontophoresis with aluminum chloride hexahydrate in the form of gel. This study investigated the effect of aluminum chloride hexahydrate gel iontophoresis compared to tap water iontophoresis on primary palmar hyperhidrosis. Methods In this randomized controlled trial study, 32 patients with primary palmar hyperhidrosis were divided randomly into two groups (n = 16). Participants received 7 sessions of iontophoresis with aluminum chloride hexahydrate gel or tap water every other day on the dominant hand. The sweating rate was measured by gravimetry and iodine-starch tests before and after the last treatment session. Results Following the iontophoresis, the rate of sweating in both hands in the two groups was significantly reduced (P < 0.001). However, the sweating rate in the treated hand and the non-treated hand showed no significant difference. There was no significant difference observed in sweating rate reduction between both groups over time, but the larger effect size values observed in the aluminum chloride hexahydrate gel iontophoresis group may suggest the superiority of this gel over tap water in reducing the rate of sweating. Limitation Further investigations with longer follow-up are needed to confirm the hypothesis regarding the effectiveness of aluminum chloride hexahydrate gel iontophoresis over other types of iontophoresis. In addition, contraindications of iontophoresis such as pregnancy, pacemakers, and epilepsy should be considered. Conclusion The present study provides preliminary evidence suggesting that aluminum chloride hexahydrate gel iontophoresis is an effective alternative treatment to decrease sweating rate in extended areas with fewer side effects in patients with primary palmar hyperhidrosis.

PMID:37436009 | DOI:10.25259/IJDVL_975_2022

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Anatomical variation of sympathetic ganglia in R4+R5 sympathicotomy for primary palmar axillary hyperhidrosis

J Thorac Dis. 2023 Jun 30;15(6):3106-3114. doi: 10.21037/jtd-22-1782. Epub 2023 May 6.

ABSTRACT

BACKGROUND: R4+R5 sympathicotomy is one of the standard surgical treatments for primary palmar axillary hyperhidrosis (PAH), but the reported outcomes vary. Anatomical variation of sympathetic ganglia is hypothesized to be a cause for this phenomenon. The sympathetic ganglia could be visualized via near-infrared (NIR) fluorescent thoracoscopy, we utilize this novel technique to observe the anatomical variation of sympathetic ganglia T3 and T4 and investigate its relationship with surgical outcomes.

METHODS: This is a prospective multi-center cohort study. All patients received intravenous indocyanine green (ICG) infusion 24 hours preoperatively. Anatomical variation of sympathetic ganglia T3 and T4 was observed via fluorescent thoracoscopy. Standard R4+R5 sympathicotomy was performed regardless of anatomical variation. Patients were followed up for the therapeutic outcome.

RESULTS: One hundred and sixty-two patients in total were enrolled in this study and 134 patients with bilateral clearly visualized thoracic sympathetic ganglia (TSG) were included. The success rate of fluorescent imaging of thoracic sympathetic ganglion was 82.7%. The T3 ganglion was shifted downward on 32 sides (11.9%) and no upward-shifted ganglion was identified. The T4 ganglion was shifted downward on 52 sides (19.4%) and no upward-shifted ganglion was identified. All patients underwent R4+R5 sympathicotomy and no perioperative death or severe complication occurred. The total improvement rates on palmar sweating at short-term and long-term follow-up were 98.1% and 95.1%, respectively. There were significant differences between T3 normal and T3 variation subgroups both in short-term (P=0.049) and long-term (P=0.032) follow-ups. The total improvement rates on axillary sweating at short-term and long-term follow-ups were 97.0% and 89.6%, respectively. No significant difference was found between T4 normal and T4 variation subgroups both in short-term and long-term follow-ups. No significant difference was found between normal and variation subgroups on the degree of compensatory hyperhidrosis (CH).

CONCLUSIONS: NIR fluorescent thoracoscopy provides clear identification of anatomical variations of sympathetic ganglia during R4+R5 sympathicotomy. The improvement of palmar sweating was significantly affected by anatomical variation of T3 sympathetic ganglia.

PMID:37426141 | PMC:PMC10323581 | DOI:10.21037/jtd-22-1782

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Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

Front Surg. 2023 May 31;10:1126596. doi: 10.3389/fsurg.2023.1126596. eCollection 2023.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand’s exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient’s daily activities and quality of life.

OBJECTIVE: The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH.

METHODS: A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation.

RESULTS: Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05).

CONCLUSION: Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.

PMID:37325414 | PMC:PMC10264635 | DOI:10.3389/fsurg.2023.1126596

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Primary Palmar Hyperhidrosis (PPH) Accompanied With Nevus Flammeus: A Case Report

Cureus. 2023 May 8;15(5):e38723. doi: 10.7759/cureus.38723. eCollection 2023 May.

ABSTRACT

Palmar hyperhidrosis (PH) is a medical condition characterized by excessive sweating in the palms of the hands, which can result in significant distress and impairment in daily activities. Flammeus nevus, on the other hand, is a benign vascular lesion that appears as a red or purplish discoloration on the skin, commonly found on the face, neck, or trunk. In some cases, flammeus nevus can co-occur with PH, leading to increased sweating in the affected area. This condition can cause significant psychosocial impact, affecting an individual’s quality of life (QoL) and self-esteem. We present a case report of a patient presenting with PPH with flammeus nevus. There is currently limited information available on the relationship between PH and flammeus nevus, and more research is needed to better understand this phenomenon; here we have reported the presentation of a patient. In conclusion, PH accompanied with flammeus nevus is a condition that requires prompt attention and management to mitigate its adverse effects. We have used ChatGPT to aid in structuring and writing this case report.

PMID:37292575 | PMC:PMC10246863 | DOI:10.7759/cureus.38723

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Upregulation of ITGB6 in primary palmar hyperhidrosis

Adv Clin Exp Med. 2023 May 22. doi: 10.17219/acem/162178. Online ahead of print.

ABSTRACT

BACKGROUND: The regulatory effect of integrin β6 (ITGB6) on sweat gland cells in primary palmar hyperhidrosis (PPH) remains unclear.

OBJECTIVES: This study investigated the involvement of ITGB6 in the pathogenesis of PPH.

MATERIAL AND METHODS: Sweat gland tissues were collected from PPH patients and healthy volunteers. The expression levels of ITGB6 in sweat gland tissues were detected with quantitative polymerase chain reaction (qPCR), western blot and immunohistochemical staining. Sweat gland cells were extracted from PPH patients, and identified with immunofluorescence staining of CEA and CK7. The expression of aquaporin 5 (AQP5) and Na-K-Cl cotransporter 1 (NKCC1) in primary sweat gland cells that overexpress ITGB6 were also detected. Through a series of bioinformatic methods, differentially expressed genes in sweat gland tissues were examined and validated via comparing PPH samples and controls. The key proteins and biological functions enriched in PPH were determined using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses.

RESULTS: The ITGB6 was upregulated in sweat gland tissues of PPH patients compared to that of healthy volunteers. The CEA and CK7 were positively expressed in sweat gland cells extracted from PPH patients. The overexpression of ITGB6 upregulated AQP5 and NKCC1 protein expression in the sweat gland cells of PPH patients. A total of 562 differentially expressed mRNAs were identified using high-throughput sequencing (394 upregulated, 168 downregulated), which were mainly active in the chemokine and Wnt signaling pathways. After verification with qPCR and western blot, the overexpression of ITGB6 significantly upregulated CXCL3, CXCL5, CXCL10, and CXCL11, and downregulated Wnt2 mRNA and protein expression in sweat gland cells.

CONCLUSIONS: The ITGB6 is upregulated in PPH patients. It may be involved in the pathogenesis of PPH by upregulating AQP5, NKCC1, CXCL3, CXCL5, CXCL10, and CXCL11, and downregulating Wnt2 expression in sweat glands.

PMID:37212774 | DOI:10.17219/acem/162178

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Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS)

J Am Acad Dermatol. 2023 May;88(5):e197-e201. doi: 10.1016/j.jaad.2015.10.048.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (PH) affects young patients and may cause emotional distress and a negative quality of life (QOL).

OBJECTIVE: We sought to evaluate the QOL of children and adolescents with PH treated by endoscopic thoracic sympathectomy.

METHODS: A study of 220 patients was performed, based on submitted QOL questionnaires from their first consultation. Patients were evaluated within 1 week and 24 months after surgery.

RESULTS: Before endoscopic thoracic sympathectomy, the QOL in relation to PH was declared very poor by 141 patients, and poor by the remaining 79 (P = .552). Postoperative cure was reported in 100% of palmar and axillary PH cases, and in 91.7% of facial PH. After 24 months, the QOL was described as much better by 212 patients, a little better by 6 patients, and 2 patients reported no change.

LIMITATIONS: Convenience sampling was used and patients were taken from private practice only, raising the possibility of bias in gathering the data.

CONCLUSION: Onset of PH symptoms was mainly before the age of 10 years and substantially affected daily activities. Endoscopic thoracic sympathectomy cured PH and promoted significant improvement in the QOL of these young patients.

PMID:37069802 | DOI:10.1016/j.jaad.2015.10.048