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November 11, 2018

Plantar hyperhidrosis: A review of current management.

Plantar hyperhidrosis: A review of current management.

J Dermatolog Treat. 2016 Nov;27(6):556-561

Authors: Singh S, Kaur S, Wilson P

Abstract
AIM: To critically appraise current literature regarding the management of plantar hyperhidrosis in the form of a structured review.
METHOD: A literature search was conducted using various databases and search criteria.
DISCUSSION: The literature reports the use of conservative, medical and surgical treatment modalities for the management of plantar hyperhidrosis. However, long-term follow-up data are rare and some treatment modalities currently available are not fully understood.
CONCLUSION: There is a considerable dearth in the literature on the management of plantar hyperhidrosis. Further study in larger populations with longer follow-up times is critical to access the long-term effects of treatment. Nonetheless, iontophoresis, botulinum toxin injection and lumbar sympathectomy are promising treatment modalities for this disorder.

PMID: 27053510 [PubMed – indexed for MEDLINE]

November 11, 2018

[Effect of T4 thoracoscopic sympathectomy on  plantar hyperhidrosis in patients with  primary palmoplantar hyperhidrosis].

[Effect of T4 thoracoscopic sympathectomy on  plantar hyperhidrosis in patients with  primary palmoplantar hyperhidrosis].

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Mar 28;41(3):300-4

Authors: Xiao P, Liu A, Liu W

Abstract
OBJECTIVE: To evaluate the effect of video-assisted thoracoscopic sympathectomy at the T4 level on plantar hyperhidrosis in the treatment of palmoplantar hyperhidrosis. 
METHODS: The clinical data of 28 patients with primary palmoplantar hyperhidrosis, who were admited in our hospital from June 2009 to May 2014, was analyzed. All patients were qualified to bilateral thoracoscopic transaction of the sympathetic chain at the thoracic level T4. Patients completed a self-administered hyperhidrosis questionnaire and scoring before and after procedure. Follow-up data were obtained at 1 and 6 months after the surgery. 
RESULTS: Endoscopic thoracic sympathectomy at the thoracic level T4 was performed successfully for all cases. Palmar hyperhidrosis was completely alleviated after the operation and no recurrence was observed during follow-up. The ratio for initial improvement of plantar hyperhidrosis was 28.6% (8/28) at 1 month after the surgery followed by a recurrence of plantar hyperhidrosis. No case continued to show the improvement of palmoplantar hyperhidrosis at 6 months after the sympathectomy. Twenty-seven patients (96.4%) were very satisfied with the outcome of the operation, 1 patient (3.6%) satisfied and no patient regretted the surgical procedure. 
CONCLUSION: T4 thoracoscopic sympathectomy could initialliy alleviate plantar hyperhidrosis in some patients with palmoplantar hyperhidrosis, but the improvement was not sustained over a long period. It could not be used to treat plantar hyperhidrosis.

PMID: 27033795 [PubMed – indexed for MEDLINE]

November 11, 2018

Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases.

Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases.

Indian J Surg. 2015 Aug;77(4):270-5

Authors: Shi H, Shu Y, Shi W, Lu S, Sun C

Abstract
The objective of this study is to investigate the feasibility and safety of single-port microthoracoscopic thoracic sympathicotomy for the treatment of palmar hyperhidrosis. Between January 2008 and March 2013, 56 patients (36 male, 20 female; mean age 25.6 years, age range 16-39 years) underwent single-port microthoracoscopic thoracic sympathicotomy for palmar hyperhidrosis. Nineteen patients (33.9 %) had moderate palmar hyperhidrosis that could thoroughly wet a handkerchief, and 37 (66.1 %) had severe palmar hyperhidrosis with sweat dripping from the palm. Eight patients (14.3 %) had a positive family history, 34 (60.7 %) had plantar hyperhidrosis, 22 (39.3 %) had axillary hyperhidrosis, and 20 (35.7 %) had both plantar and axillary hyperhidrosis. In addition, 21 patients (37.5 %) had palmar pompholyx, five (8.9 %) had keratolysis exfoliativa, 10 (17.9 %) had chilblains, and nine (16.1 %) had palmar rhagades. A single 10-mm skin incision was made in the third intercostal space at the anterior axillary line, posterior to the pectoralis muscle. A 5-mm microthoracoscope and a 3-mm microelectrocautery hook were inserted through a single port into the thoracic cavity. The third and fourth ribs were identified, and the sympathetic chain was cut using the microelectrocautery hook. The bypassing nerve fibers, such as the Kuntz nerve fiber bundle, were ablated for 2-3 cm along the surface of the rib. The palmar temperature was recorded before and after sympathicotomy. All 56 procedures were completed using single-port microthoracoscopy. No postoperative complications such as hemorrhage, wound infection, hemopneumothorax, bradycardia, or Horner’s syndrome were observed. Bilateral procedures were completed in 20-56 min (mean 30 min). The palmar temperature increased by 2.2 ± 0.3 °C after surgery. The postoperative hospital stay was 1-4 days (mean 2.5 days). Mild compensatory sweating of the back and thigh occurred in five patients (8.9 %) at 2-3 days after surgery and disappeared at 7-15 days. The patients were followed up for 28.5 months (range 1-62 months). Hyperhidrosis resolved in both hands after surgery, and the previously wet, cold hands became dry and warm. The efficacy rate was 100 %. Plantar hyperhidrosis was also significantly reduced in 33 of the 34 patients with this condition (remission rate 97.1 %), and axillary hyperhidrosis was significantly reduced in 19 of 22 patients (remission rate 86.4 %). Eighteen of the 20 patients (90.0 %) with both plantar and axillary hyperhidrosis experienced significant alleviation of their symptoms. Single-port microthoracoscopic thoracic sympathicotomy is a safe, convenient, and effective method of treating palmar hyperhidrosis. This procedure can accurately locate the sympathetic chain with a small incision, minimal invasiveness, and good cosmetic results. The procedure is suitable for extensive clinical use.

PMID: 26702233 [PubMed]

November 11, 2018

Early experience with endoscopic lumbar sympathectomy for plantar hyperhidrosis.

Early experience with endoscopic lumbar sympathectomy for plantar hyperhidrosis.

Asian J Endosc Surg. 2016 May;9(2):128-34

Authors: Singh S, Kaur S, Wilson P

Abstract
OBJECTIVE: We describe our endoscopic lumbar sympathectomy technique and our early experience using it to treat plantar hyperhidrosis.
METHODS: We reviewed 20 lumbar sympathectomies performed in our vascular unit for plantar hyperhidrosis in 10 patients from 2011 and 2014. Demographics and outcomes were analyzed and a review of the literature conducted.
RESULTS: All procedures were carried out endoscopically with no intraoperative or postoperative morbidity. Plantar anhidrosis was achieved in all the patients, although two patients (20%) suffered a relapse. Unwanted side-effects occurred in the form of compensatory sweating in three patients (30%) and post-sympathectomy neuralgia in two patients (20%). None of the patients experienced sexual dysfunction.
CONCLUSION: Management of plantar hyperhidrosis may be based upon a therapeutic ladder starting with conservative measures and working up to surgery depending on the severity of the disease. Minimally invasive (endoscopic) sympathectomy for the thoracic chain is well established, but minimally invasive sympathectomy for the lumbar chain is a relatively new technique. Endoscopic lumbar sympathectomy provides an effective, minimally invasive method of surgical management, but long-term data are lacking.

PMID: 26822187 [PubMed – indexed for MEDLINE]

November 11, 2018

Post-traumatic unilateral plantar hyperhidrosis.

Post-traumatic unilateral plantar hyperhidrosis.

Clin Auton Res. 2016 Feb;26(1):75-7

Authors: Eren Y, Yavasoglu NG, Comoglu SS

Abstract
Localized unilateral hyperhidrosis is rare and poorly understood, sometimes stemming from trauma. Feet, quite vulnerable to trauma are affected by disease-mediated plantar hyperhidrosis, usually bilaterally. This report describes partial hyperhidrosis developing post-traumatically on the left plantar region of a 52-year-old male.

PMID: 26691636 [PubMed – indexed for MEDLINE]

November 11, 2018

Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases.

Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases.

Dermatol Ther. 2016 Jan-Feb;29(1):32-6

Authors: González-Ramos J, Sendagorta-Cudós E, González-López G, Mayor-Ibarguren A, Feltes-Ochoa R, Herranz-Pinto P

Abstract
Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six-month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.

PMID: 26445325 [PubMed – indexed for MEDLINE]

November 11, 2018

Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil.

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Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil.

An Bras Dermatol. 2015 Sep-Oct;90(5):661-5

Authors: Lima SO, Aragão JF, Machado Neto J, Almeida KB, Menezes LM, Santana VR

Abstract
BACKGROUND: Hyperhidrosis or excessive sweat production occurs at 2.9-9% of the population.
OBJECTIVE: To estimate the prevalence and disorders due to primary hyperhidrosis (HP) in medicine students in the state of Sergipe.
METHODS: Cross-sectional study using individual interviews.
RESULTS: Hyperhidrosis was found in 14.76% of subjects, the most affected regions were palmar, plantar and axillary, causing prejudice in daily activities. Family history occurred in 45% and 22.72% was diagnosed by a physician.
CONCLUSION: The prevalence of hyperhidrosis in medicine students of Sergipe was high, with strong family and a small portion of diagnoses made by medical professionals.

PMID: 26560211 [PubMed – indexed for MEDLINE]

November 11, 2018

Papillon-Lefevre Syndrome In An Adolescent Female: A Case Study.

Papillon-Lefevre Syndrome In An Adolescent Female: A Case Study.

J Clin Diagn Res. 2015 May;9(5):ZD23-5

Authors: Jijin MJ, Jaishankar HP, Narayaran VS, Rangaswamy K, Puthaswamy KA

Abstract
Papillon-Lefevre Syndrome (PLS) is a rare inherited autosomal-recessive condition with one-third of the patients’ showing consanguinity of the parents. Lesions are characterised by palmar-plantar hyperkeratosis and hyperhidrosis. Early onset of periodonditis, severe periodontal destruction in both primary and permanent dentitions, and calcification of the duramater form the three important features of this disease. Here, we present a case of a 14-year-old female who presented to the Department of Oral Medicine and Radiology with a complaint of mobility of the teeth since four months. Oral examination of the patient showed generalised mobility of the teeth. General physical examination of the patient showed dry scaly skin on dorsum of bilateral feet, hands, and knee. The patient had familial history positive for consanguinity. The patient was medically diagnosed as positive for PLS. The patients with PLS show combination of dermatological and dental lesions and it requires the dentist to assume a more prominent role in early treatment and rehabilitation. There is a need for symbiotic and synergetic approach between the two specialties for effective management of this rare disease.

PMID: 26155583 [PubMed]

November 11, 2018

Unilateral sequential endoscopic thoracic sympathectomy for palmar hyperhidrosis: a proposed technique to overcome compensatory hyperhidrosis and improve plantar hyperhidrosis.

Unilateral sequential endoscopic thoracic sympathectomy for palmar hyperhidrosis: a proposed technique to overcome compensatory hyperhidrosis and improve plantar hyperhidrosis.

J Laparoendosc Adv Surg Tech A. 2015 May;25(5):370-4

Authors: Youssef T, Soliman M

Abstract
BACKGROUND: Although endoscopic thoracic sympathectomy (ETS) offers permanent cure of palmar hyperhidrosis (PH), compensatory hyperhidrosis (CH) often complicates the procedure. We analyzed the outcomes of a 2-month interval for unilateral sequential ETS (S-ETS) in comparison with simultaneous bilateral ETS (B-ETS), notably regarding CH and associated plantar hyperhidrosis, in treating patients with PH.
PATIENTS AND METHODS: Four hundred seven patients with intractable PH were randomly assigned into two groups: the B-ETS group (204 patients) and the S-ETS group (203 patients).
RESULTS: Three hundred sixty-four patients completed the study. Complication rates were comparable for both groups. No patient died perioperatively, and no conversion was necessary. Treatment success on follow-up was 97.2% for S-ETS and 96.7% for B-ETS. The incidence of CH was decreased substantially from 131 (71.1%) patients in the B-ETS group to 22 (12.2%) patients in the S-ETS group (P<.001), with no patient suffering severe CH in the S-ETS group compared with 33 (25.5%) patients in the B-ETS group. Eighty-four (58.3%) patients in the S-ETS group had simultaneous disappearance or decreased perspiration on the soles. All patients in the S-ETS group were satisfied, whereas 37.9% of B-ETS patients were unsatisfied with their operation, mostly because of CH and recurrences.
CONCLUSIONS: Although both sympathectomies were effective, safe, and minimally invasive methods for treatment of PH, unilateral sequential ETS appeared to be a more optimal technique in terms of reduction of CH to a minimum and improvement of associated plantar hyperhidrosis.

PMID: 25768057 [PubMed – indexed for MEDLINE]

November 11, 2018

[Image-guided pain therapy. Sympathicolysis].

[Image-guided pain therapy. Sympathicolysis].

Radiologe. 2015 Jun;55(6):462-9

Authors: Burbelko M, Wagner HJ, Gutberlet M, Grothoff M

Abstract
BACKGROUND: In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome.
METHODS: The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added.
RESULTS: The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome.
CONCLUSION: After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar SL.

PMID: 26063075 [PubMed – indexed for MEDLINE]