Category: Treatment

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Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey

Gen Thorac Cardiovasc Surg. 2024 Apr 27. doi: 10.1007/s11748-024-02034-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. However, compensatory hyperhidrosis occurs frequently as a postoperative complication of the procedure. The goal of this study was to elucidate the clinical significance of thoracoscopic sympathectomy using our surgical procedure.

METHODS: Consecutive 151 patients who underwent thoracoscopic sympathectomy for palmar hyperhidrosis were studied. In addition, to investigate patients’ satisfaction and long-term quality of life, 111 patients were asked to complete a mailing questionnaire survey, and 84 responded (response rate of 75.7%).

RESULTS: All of the 151 patients reported a reduction in palmar sweating during the immediate postoperative period. None of the patients had pneumothorax, hemothorax, Horner’s syndrome, or worsening of bradycardia. Based on the questionnaire, the surgical success rate was 98.8%. None of the patients had a recurrence of palmar hyperhidrosis during the long-term postoperative period. However, compensatory hyperhidrosis was reported in 82 patients (97.6%). In total, 94.0% of patients had high levels of postoperative satisfaction.

CONCLUSIONS: Thoracoscopic sympathectomy is an effective surgical treatment for palmar hyperhidrosis. By contrast, the careful preoperative explanation of compensatory hyperhidrosis is considered to be very important.

PMID:38676901 | DOI:10.1007/s11748-024-02034-w

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Anisocoria in patients with hyperhidrosis: A case series for the primary care physician

J Family Med Prim Care. 2024 Feb;13(2):797-799. doi: 10.4103/jfmpc.jfmpc_698_23. Epub 2024 Mar 6.

ABSTRACT

The differential diagnosis for anisocoria is broad and ranges from benign to life-threatening causes. Often, patients with new onset anisocoria present to their primary care physician, an urgent care center, or an emergency room. As such, it is important for non-ophthalmologist physicians to be familiar with its common causes. We present two cases of pharmacologic anisocoria from Qbrexza (glycopyronnium), a wipe used in the treatment of hyperhidrosis. Identifying this medication as a cause of anisocoria in patients with hyperhidrosis can reduce costs and unnecessary testing. Furthermore, physician education about safer usage can be provided.

PMID:38605781 | PMC:PMC11006025 | DOI:10.4103/jfmpc.jfmpc_698_23

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Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis

Sci Rep. 2024 Apr 1;14(1):7620. doi: 10.1038/s41598-024-57834-0.

ABSTRACT

Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21-0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38-0.92; p = 0.020), postoperative pain (95% CI 0.13-0.33; p < 0.001), and surgery-related complications (95% CI 0.19-0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84-3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx .

PMID:38556580 | DOI:10.1038/s41598-024-57834-0

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Botulinum toxin A versus microwave thermolysis for primary axillary hyperhidrosis: A randomized controlled trial

JAAD Int. 2024 Jan 23;15:91-99. doi: 10.1016/j.jdin.2023.12.011. eCollection 2024 Jun.

ABSTRACT

BACKGROUND: Botulinum toxin A (BTX) and microwave thermolysis (MWT) represent 2 treatment modalities for axillary hyperhidrosis with different procedural and efficacy profiles.

OBJECTIVE: To compare long-term outcomes following BTX vs MWT treatment of axillary hyperhidrosis.

METHODS: A prospective, randomized, within-patient, controlled trial, treating axillary hyperhidrosis with contralateral BTX and MWT. Objective sweat measurement and patient-reported outcome measures for sweat and odor were collected at baseline, 6-month and 1-year follow-up (6M/1YFU). Hair reduction and patient treatment preference was also assessed.

RESULTS: Sweat reduction was significant (all P <.01) for both interventions throughout the study. Objectively, sweat reduction was equal at 1-year FU (ΔP =.4282), but greater for BTX than MWT at 6-month FU (ΔP =.0053). Subjective sweat assessment presented comparable efficacy (6MFU: ΔP =.4142, 1YFU: ΔP =.1025). Odor reduction was significant (all P <.01) following both interventions, whereas only sustaining for MWT (6MFU: ΔP =.6826, 1YFU: ΔP =.0098). Long-term, hair reduction was visible after MWT, but not BTX (ΔP ≤.0001), and MWT was preferred by the majority of patients (76%).

LIMITATIONS: The intrinsic challenges in efficacy assessment.

CONCLUSION: This study exhibited BTX and MWT with similar sweat reduction, but distinguishable odor and hair reduction at 1-year FU. These findings support individualized treatment approaches for axillary hyperhidrosis based on patient-specific symptoms and preferences.

PMID:38495540 | PMC:PMC10940128 | DOI:10.1016/j.jdin.2023.12.011

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Botulinum Toxin A and B for Palmoplantar Hyperhidrosis

Dermatol Ther (Heidelb). 2024 Mar 1. doi: 10.1007/s13555-024-01113-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL.

METHODS: A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100-550) units BTX-A and a median dose (low to high) of 200 (200-500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475-1000) units BTX-B was injected.

RESULTS: At follow-up 2 weeks post-treatment, patients’ Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001).

CONCLUSION: We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.

PMID:38424385 | DOI:10.1007/s13555-024-01113-3

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Primary hyperhidrosis: From a genetics point of view

J Family Med Prim Care. 2023 Dec;12(12):3028-3032. doi: 10.4103/jfmpc.jfmpc_1568_22. Epub 2023 Dec 21.

ABSTRACT

Primary hyperhidrosis is a disorder of profuse sweating which negatively influences a patient’s quality of life and is caused because of over-activation of the sympathetic nervous system. It was believed that hyperhidrosis is a condition limited to only anxious individuals; however, this hypothesis is discredited now. It has been found that people with a positive family history of primary hyperhidrosis are likely to suffer from this condition, suggesting a strong genetic basis. Genetic analysis has revealed a dominant autosomal pattern of inheritance with a variable degree of penetrance and is a sex-independent trait. It is a heterogeneous condition both genetically and clinically as different studies revealed variable genetics and clinical factors. There are no proper criteria for diagnosis as it is not treated as disease by most affected persons. Various studies revealed opposing results in localizing disease gene loci, so further genetic research is needed to pinpoint genes responsible for causing this debilitating condition. Gene expression profiling of human anxiety-causing genes in hyperhidrotic sufferers will also help to devise new treatment modalities. This review highlights the current genetic studies on hyperhidrosis, which may prove to be helpful in understanding the molecular mechanism governing hyperhidrosis.

PMID:38361865 | PMC:PMC10866286 | DOI:10.4103/jfmpc.jfmpc_1568_22

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The Efficacy of Botulinum Toxin A in Treating Palmar Hyperhidrosis – a Literature Review

Maedica (Bucur). 2023 Dec;18(4):712-717. doi: 10.26574/maedica.2023.18.4.712.

ABSTRACT

Background:Palmar hyperhidrosis, a condition characterized by excessive sweating in the palms, considerably impacts the quality of life (QoL). Although various treatment modalities are available, the efficacy and safety of Botulinum toxin type A (BTX-A) needed further investigation. Methods:We conducted a literature review, with open-label, controlled trial, double-blind placebo-controlled and observational designs being eligible for inclusion, according to the PRISMA guidelines. Results:All the six selected studies consistently reported the efficacy of BTX-A in reducing symptoms of hyperhidrosis, without significant side effects. Botulinum toxin type A treatment was found to improve the QoL significantly, to reduce sweat rate and production and to have no detrimental effect on grip strength. The duration of the antisudorific effect also indicated the potential for long-term management of palmar hyperhidrosis with BTX-A. Conclusions:Our findings corroborated the effectiveness and safety of BTX-A in managing palmar hyperhidrosis across diverse patient outcomes and experiences. Botulinum toxin type A emerged as a promising treatment modality for this condition, capable of improving the QoL, reducing symptoms and offering long-term relief without significant side effects.

PMID:38348073 | PMC:PMC10859206 | DOI:10.26574/maedica.2023.18.4.712

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The Efficacy of Long-Pulsed, 1064-nm Nd:YAG Laser Versus Aluminum Chloride 20% Solution in the Treatment of Axillary Hyperhidrosis

J Lasers Med Sci. 2023 Dec 29;14:e71. doi: 10.34172/jlms.2023.71. eCollection 2023.

ABSTRACT

Introduction: Hyperhidrosis (HH) refers to uncontrollable excessive sweating that has a significant negative impact on the quality of life. The aim of this study was to compare the efficacy and safety of the long-pulsed, 1064-nm Nd:YAG laser and aluminum chloride (ALCL3 ) 20% solution in axillary HH treatment. Methods: In this single-center, within-patient comparison clinical trial, 12 patients with axillary HH were treated monthly for 3 to 4 consecutive sessions with the long-pulsed, 1064-nm Nd:YAG laser system on one axilla, while the contralateral axilla was treated with ALCL3 20 % by the patient. Treatment response was evaluated by comparing the area of sweating at the end of each session and 6 months after treatment termination using the iodine starch test. Results: Both treatments led to the reduction of HH from baseline with the mean area of sweating reduced from 109.3±36.6 to 38.3±19.8 and from 92.5±31.6 to 35.6±17.1 in laser- and ALCL3-treated axilla respectively (Both P<0.001). In the 6-month follow-up, the area of sweating was 60.6±29.2 in the laser-treated armpit and 78.3±23.6 in the ALCL3-treated side, which were 45% and 14.4% lower compared to the baseline respectively. Adverse events were temporary, and none caused each of the treatments to be discontinued. Conclusion: The long-pulsed, 1064-nm Nd:YAG laser with hair reduction setting can stand as a potential therapeutic option for axillary HH since it is as effective as ALCL3. The therapeutic effect is superior in the long term for the laser; nevertheless, the beneficial effect of both treatments may lessen the following treatment cessation.

PMID:38318217 | PMC:PMC10843241 | DOI:10.34172/jlms.2023.71

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Treatment of Palmar Hyperhidrosis with Radiofrequency Microneedling-Based on Ultrasound Measurements

J Ultrasound Med. 2023 Dec 27. doi: 10.1002/jum.16402. Online ahead of print.

ABSTRACT

This study addresses the treatment of palmar hyperhidrosis, which has been difficult to manage. A new treatment has been developed using radiofrequency microneedling to reduce sweating non-surgically by ablating sweat glands. Based on ultrasound measurements of the dermis and precise microneedling damage, effective energy was applied to locate the sweat glands and disabled their function. Radiofrequency microneedling with ultrasound can safely and effectively treat hyperhidrosis in a minimally invasive way.

PMID:38149371 | DOI:10.1002/jum.16402