Category: Treatment

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Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

BMC Surg. 2021 Nov 12;21(1):397. doi: 10.1186/s12893-021-01393-y.

ABSTRACT

BACKGROUND: Primary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH.

METHODS: RLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months.

RESULTS: Mean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed.

CONCLUSIONS: RLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

PMID:34772374 | DOI:10.1186/s12893-021-01393-y

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Techniques to Relieve Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis

Dermatol Surg. 2021 Oct 19. doi: 10.1097/DSS.0000000000003182. Online ahead of print.

ABSTRACT

BACKGROUND: Palmar and plantar hyperhidrosis (HH) is a common condition characterized by excessive sweating of the palms and soles. Botulinum neurotoxin (BTX) is a very effective and safe treatment. However, the associated intense injection pain is a major limiting factor deterring patients from selecting this treatment.

OBJECTIVE: The aim of this study was to review the numerous techniques used to minimize pain accompanying injections for palmoplantar HH. Additionally, the advantages and limitations of each modality will be discussed.

MATERIALS AND METHODS: The authors performed a comprehensive literature search in PubMed/MEDLINE, Embase, Cochrane Central, and Google Scholar on randomized controlled trials, cohort studies, and case series on techniques to relieve pain of BTX injections for treatment of palmar and plantar HH.

RESULTS: Current available techniques in reducing botulinum injection with merits and drawbacks are nerve blocks, Bier blocks, cryoanalgesia, needle-free anesthesia, topical anesthetics, and vibration anesthesia.

CONCLUSION: Topical anesthesia, ice, and vibration are the safest and most convenient noninvasive available methods to relieve pain associated with botulinum injection. Nerve blocks, Bier block, and needle-free anesthesia provide better anesthesia but are limited by the need for training and equipment.

PMID:34743126 | DOI:10.1097/DSS.0000000000003182

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Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation

Prosthet Orthot Int. 2021 Oct 28. doi: 10.1097/PXR.0000000000000040. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss.

OBJECTIVES: To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem.

STUDY DESIGN: Narrative Literature Review.

METHODS: A literature review focused on the assessment and treatment of excessive sweating of residual limbs.

RESULTS: There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation.

CONCLUSIONS: Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.

PMID:34723907 | DOI:10.1097/PXR.0000000000000040

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The treatment of palmar hyperhidrosis – a systematic review

Int J Dermatol. 2021 Oct 15. doi: 10.1111/ijd.15937. Online ahead of print.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual’s quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management.

METHODS: A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017.

RESULTS: Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients’ symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement.

CONCLUSION: There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.

PMID:34653261 | DOI:10.1111/ijd.15937

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Topical glycopyrronium tosylate in Japanese patients with primary axillary hyperhidrosis: A randomized, double-blind, vehicle-controlled study

J Dermatol. 2021 Oct 11. doi: 10.1111/1346-8138.16188. Online ahead of print.

ABSTRACT

Glycopyrronium tosylate cloth, an anticholinergic drug, has been approved for the topical treatment of primary axillary hyperhidrosis in the USA, but its effects in Japanese patients have not been previously investigated. This 4-week, randomized, double-blind, vehicle-controlled, multicenter study was conducted to evaluate the efficacy and safety of glycopyrronium tosylate cloth for primary axillary hyperhidrosis patients in Japan. Eligible patients, who were ≥9 years of age and had primary axillary hyperhidrosis ≥6 months, with gravimetrically-measured sweat production ≥50 mg/5 min, and Hyperhidrosis Disease Severity Scale ≥3 (moderate) were randomized 1:1:1 to once daily topical glycopyrronium tosylate 3.75%, 2.5%, or vehicle. Overall, 497 patients (163 in the glycopyrronium tosylate 3.75% group, 168 in the glycopyrronium tosylate 2.5% group, and 166 in the vehicle group, hereinafter in this order) were randomized. Statistically higher proportions of patients in the glycopyrronium tosylate groups achieved ≥2-point improvement in Hyperhidrosis Disease Severity Scale and ≥50% reduction in sweat production from baseline versus vehicle at week 4 (51.6%, 41.1%, and 16.4%, respectively; p < 0.001 in both cases). Higher responder rates in the glycopyrronium tosylate groups compared with the vehicle group occurred as early as week 1. The most common treatment-emergent adverse events in patients treated with glycopyrronium tosylate were photophobia, mydriasis, thirst, and dysuria. Most treatment-emergent adverse events were mild as determined by the investigators. The incidence of treatment-emergent adverse events leading to treatment modification was low in the three groups. The 4-week use of topical glycopyrronium tosylate improved the patient-reported outcome measure Hyperhidrosis Disease Severity Scale and objectively-evaluated sweat production with a favorable benefit/risk profile.

PMID:34636057 | DOI:10.1111/1346-8138.16188

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Perianal Hyperhidrosis Successfully Treated with Botulinum Toxin A

Skin Appendage Disord. 2021 Aug;7(5):404-407. doi: 10.1159/000515492. Epub 2021 Apr 28.

ABSTRACT

Perianal hyperhidrosis (HH) is a rare form of primary focal HH and may become a major problem for the patient with a significant psychosocial burden and negative impact on the quality of life. Botulinum toxin injections are widely used as a second-line treatment option for axillary, palmar, and plantar HH with a good safety profile. Herein, we pre-sent a case of primary perianal HH successfully treated with Botulinum toxin A at a dose higher than that previously reported in literature, with a longer response, a higher degree of satisfaction, and no adverse effects. Moreover, we review the main aspects of the perianal anatomy that are essential to carry out the technique correctly and make dermatologists achieve expertise with the procedure.

PMID:34604333 | PMC:PMC8436621 | DOI:10.1159/000515492

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Retrospective analysis of the efficacy and duration of botulinum toxin A injections in 30 patients with palmar hyperhidrosis

Intern Med J. 2021 Sep;51(9):1517-1521. doi: 10.1111/imj.15489.

ABSTRACT

Palmar hyperhidrosis is a common disorder characterised by excessive sweating due to hyperfunction of the sweat glands. It can be classified as primary disease, or secondary to other causes. It has a high morbidity, and a range of treatment options. Botulinum toxin injections inhibit the release of acetylcholine from the presynaptic receptors. It is an effective treatment; however, it is infrequently selected as only axillary hyperhidrosis currently attracts a Medicare subsidy. We conducted a retrospective review of 30 patients at a Sydney dermatology clinic who received botulinum toxin injections for palmar hyperhidrosis within the past 5 years. This study has the largest patient cohort with this condition in Australia. There was evidence for a median reduction in the Hyperhidrosis Disease Severity Scale, a qualitative self-reported score, as well as an increasing duration of efficacy with repeated injections. There were minimal side-effects of weakness and numbness. There is also an association between treatment of palmar disease and improvement in plantar disease, which suggests that treatment of palmar hyperhidrosis should be considered earlier and more frequently.

PMID:34541778 | DOI:10.1111/imj.15489

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The efficacy and safety of a fractional microneedle radiofrequency device for the treatment of axillary hyperhidrosis: clinical prospective pilot study

Lasers Med Sci. 2021 Aug 28. doi: 10.1007/s10103-021-03404-z. Online ahead of print.

ABSTRACT

We aimed to evaluate the efficacy and safety of a fractional microneedle radiofrequency device (FMRD) for the treatment of primary axillary hyperhidrosis (PAH). The FMRD adopted insulated microneedles, which could be located at a depth of up to 4.5 mm and deliver a radiofrequency current in a fractional manner. Also, the device could automatically regulate the amount of the delivered energy. Sixteen Korean patients with PAH received two FMRD treatment sessions at a 3-week interval and were followed-up until week 15. The primary outcome was Patient Satisfaction Scale (PSS) score at each visit. Hyperhidrosis Disease Severity Scale (HDSS) and Global Aesthetic Improvement Scale (GAIS) were also assessed. The area and amount of sweat produced were evaluated by specific tests. Mean PSS score significantly improved from 1.6 at week 3 to 2.5 at week 15 by 56%. More than a 50% improvement in sweating assessed by the PSS score was seen in 63% and 50% of patients at weeks 11 and 15, respectively. Mean HDSS score significantly decreased by week 3 and further decreased by week 7. Mean GAIS scores improved from the first follow-up visit at week 3 and improved again at week 7. The mean hyperhidrosis area assessed by starch-iodine test significantly decreased by 36% at week 15 compared with baseline. Mean transepidermal water loss level significantly decreased by 42% at week 15 compared with baseline. No patients experienced any serious adverse events. FMRD can be an effective and safe treatment modality for PAH.

PMID:34453655 | DOI:10.1007/s10103-021-03404-z

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Endoscopic thoracic sympathotomy for primary hyperhidrosis: predictors of outcome over a 10-year period

Surg Endosc. 2021 Aug 23. doi: 10.1007/s00464-021-08684-8. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic thoracic sympathectomy/sympathotomy is gold standard of treatment for primary hyperhidrosis. Compensatory hyperhidrosis following surgery and partial response to surgery in some patients can significantly affect surgery outcome and patient satisfaction. In this study we investigated predictors of success rate, side effects, and satisfaction of our patients following ETS over a 10-year period.

METHODS: We retrospectively reviewed result of 200 Endoscopic thoracic sympathotomy surgeries that was performed in a single center to treat craniofacial, palmar, or axillary primary hyperhidrosis over a 10-year period. Patients were asked to report success of surgery to resolve their primary hyperhidrosis, development of compensatory hyperhidrosis, its severity, and their overall satisfaction with surgery.

RESULTS: Palmar hyperhidrosis was resolved in 167 (94%) patients. Craniofacial hyperhidrosis was resolved in 66 (84%) patients. Axillary hyperhidrosis was resolved in 68 (50%) patients. Compensatory hyperhidrosis developed in 176 (88%) patients. 44 (22%) patients had mild CHH, 79 (40%) patients developed moderate CHH, and 52 (26%) patients experienced severe CHH. A total of 173 (87%) patients were satisfied with surgery. 19 (9%) patients were not satisfied with ETS and 8 (4%) patients regretted ETS. Lower body mass index and grade IV primary hyperhidrosis were found to be independent predictors of patient satisfaction. Pure axillary primary hyperhidrosis was a negative predictor of patient satisfaction.

CONCLUSION: Best results of ETS are achieved in patients with grade IV PHH and lower body mass indexes. Outcome of ETS for treating axillary PHH is not favorable.

PMID:34426874 | DOI:10.1007/s00464-021-08684-8

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Nationwide Cross-Sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis over 12 years in Brazil: Epidemiology, Costs and Mortality

Ann Surg. 2021 Aug 19. doi: 10.1097/SLA.0000000000005178. Online ahead of print.

ABSTRACT

OBJECTIVE: to analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements and the in-hospital mortality rates.

BACKGROUND: Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate.

MATERIALS AND METHODS: Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 millions inhabitants.

RESULTS: 13,201 endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with and average of U$ 512.68 per patient.

CONCLUSIONS: We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis’ treatment per 10 million inhabitants per year. The in-hospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths following endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.

PMID:34417365 | DOI:10.1097/SLA.0000000000005178