Category: Treatment

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[Thoracoscopic Sympathectomy for Palmar and Axillary Hyperhidrosis].

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[Thoracoscopic Sympathectomy for Palmar and Axillary Hyperhidrosis].

Zentralbl Chir. 2020 Jul 23;:

Authors: Rohleder S, Münsterer O, Gödeke J

Abstract
OBJECTIVE: This video is a step-by-step description of thoracoscopic sympathectomy.
INDICATION: Sweating is essential for thermoregulation. Hyperhidrosis is a condition of excess sweating from the eccrine glands and is associated with severe suffering for patients of all ages. It often worsens during adolescence. A generalised and focal type of hyperhidrosis which affects mainly the face, armpits, hands and feet can be distinguished from the focal variant. Thoracic sympathectomy has become the standard treatment for palmar and axillary hyperhidrosis worldwide.
METHODS: The procedure is performed in the supine position with the upper body elevated about 30° in an adolescent patient. Both arms are abducted at 90° and single tube endotracheal ventilation is employed. A 3 mm trocar is placed in the anterior axillary line for a 3 mm 30° optic. A 5 mm trocar placed on the anterior axillary line (or breast fold in female patients) of the 4th or 5th intercostal space is used for the bipolar forceps. The sympathetic trunk and ganglia T 2 - 4 are identified and coagulated over the heads of ribs.
CONCLUSION: The thoracoscopic approach to focal palmar and axillary hyperhidrosis allows clear identification of the sympathetic structures on each side. Under direct vision, selective ablation of the ganglia and sympathetic trunk provides long-term benefit for patients.

PMID: 32702765 [PubMed – as supplied by publisher]

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Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

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Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

Dermatol Ther. 2020 Jul 21;:e14039

Authors: Campanati A, Gregoriou S, Consales V, Rizzetto G, Bobyr I, Diotallevi F, Martina E, Kontochristopoulos G, Platsidaki E, Offidani A

Abstract
Oxybutynin chloride and Botulinum Toxin type A (BTX-A) have demonstrated to be effective treatments for primary palmar hyperhidrosis, however both of them are not completely free from local and/or generalized side effects. Primary aim of this study is to compare efficacy and safety of a therapeutic approach based on in sequence administration of oral oxybutynin chloride following BTX-A injections versus oral oxybutynin chloride in monotherapy in patients with primary palmar hyperhidrosis. Secondary aim of the study is to evaluate if the sequencing approach can allow the control of hyperhidrosis with lower dose of oral oxybutynin, thus reducing the related side effects. Patients with primary focal palmar hyperhidrosis receiving sequencing treatment with BTX-A injections followed by oral oxybutynin chloride administration and patients in monotherapy with oral oxybutynin chloride were compared for short and long term efficacy and safety of treatments. Effectiveness was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS), and the Dermatology Quality of Life Index (DLQI) score; safety was assessed through collection of the adverse events (AEs) reported by patients both at baseline, at 24 weeks and 52 weeks after starting the treatments in both groups. Patients receiving sequencing treatment showed significant greater improvement than patients receiving oxybutynin chloride alone at T24 (HDSS p=0.0076 and DLQI p=0.0139) and T52 (HDSS p=0.0387 and DLQI p=0.0087). The dose of oxybutynin chloride useful to control hyperhidrosis was lower, and retention rate to the treatment was higher in patients receiving sequencing treatment (p=0.001), than patients receiving monotherapy with oxybutynin chloride alone (p=0.04). A sequencing therapeutic approach to palmar hyperhidrosis provides good clinical results, increasing both efficacy and safety compared with the use of oral oxybutynin chloride alone, and allows clinicians to keep lower dosage of oxybutynin chloride reducing generalized side effects and increasing the retention rate to the treatment. This article is protected by copyright. All rights reserved.

PMID: 32691938 [PubMed – as supplied by publisher]

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Modified R5-R8 thoracic sympathectomy for severe compensatory hyperhidrosis: How to Do It.

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Modified R5-R8 thoracic sympathectomy for severe compensatory hyperhidrosis: How to Do It.

Ann Thorac Surg. 2020 Jul 17;:

Authors: Vasconcelos CFM, Aguiar WS, Cordeiro GG, Silveira KC, Moreira RS, Lisboa DL, Ferraz ÁAB

Abstract
Compensatory hyperhidrosis (CH) is the most frequent complication after thoracic sympathectomy (TS) applied in the treatment of localized hyperhidrosis. It affects the quality of life in patients, especially in social, professional and affective spheres. The present study aims to describe the operative technique of bilateral TS from R5 to R8 by videothoracoscopy as an optimized resolution of CH. R5-R8 technique allows shorter surgical time, better ergonomics, more satisfactory aesthetic outcome and reduction of postoperative morbidity. Severe CH treatment remains a challenge.

PMID: 32687829 [PubMed – as supplied by publisher]

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Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates.

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Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates.

Pediatr Dermatol. 2020 Jul 16;:

Authors: Verhaegh AJFP, Kuijpers M, Boon M, DeJongste MJL, Bouma W, Mariani MA, Klinkenberg TJ

Abstract
BACKGROUND: Treatment of palmar and axillary primary focal hyperhidrosis (PFH) in children up to 16 years using thoracoscopic sympathicotomy is supported by scarce evidence. Therefore, this study aimed to summarize the results of our standardized bilateral, one-stage, single-port sympathicotomy (BOSS) in children up to 16 years of age.
METHODS: Consecutive children (n = 14) up to 16 years of age undergoing BOSS between October 2011 and June 2015 in our institution were included in this retrospective study.
RESULTS: Recurrence of primary hyperhidrosis was noted in seven patients (50.0%), of whom five patients (35.7%) underwent reoperation. Reoperations were associated with placement of additional thoracoscopic ports (n = 1; 12.5%), intraoperative placement of pleural drains (n = 2; 25%), and prolonged air leak (n = 1; 12.5%). Despite the high recurrence and reoperation rates, overall patient satisfaction was high with a median satisfaction score of 7.5 (interquartile range of 1.75; range: 4-9).
CONCLUSION: Although the overall patient satisfaction score in our cohort was good, BOSS for the treatment of intolerable palmar and axillary PFH in children up to 16 years of age is associated with a high recurrence and reoperation rate.

PMID: 32677080 [PubMed – as supplied by publisher]

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The impact of adolescents’ everyday life experiences on their primary hyperhidrosis treatment- a qualitative study.

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The impact of adolescents’ everyday life experiences on their primary hyperhidrosis treatment- a qualitative study.

J Dermatolog Treat. 2020 Jul 06;:1-27

Authors: Trettin B, Hansen J, Bygum A

Abstract
Introduction: Hyperhidrosis is a disease affecting around 5% of the western population. The qualitative field within hyperhidrosis among adolescents has been sparsely investigated. The aim of this study was to investigate the impact of adolescent hyperhidrosis patients’ everyday life experiences on their hyperhidrosis treatment.Methods: Qualitative, semi-structured interviews were carried out. In total, 10 adolescents, aged 12-18 years, participated in the study. Data were analyzed using a set of inseparable activities as described by Van Manen.Results: Three main themes were identified to represent common shared experiences across participants. The first theme was related to the impact of hyperhidrosis on the physical and psychological dimensions of life as it negatively affected both physical abilities and one’s self-concept. Having hyperhidrosis was experienced as living a life in secrecy, characterized by individual routines for concealment and isolation in order to protect social identity.Conclusion: The large negative impact of hyperhidrosis on adolescents is a strong justification for treatment of the disease. The substantial emotional distress suggests that treatment may need to include psychological support.

PMID: 32628056 [PubMed – as supplied by publisher]

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Stepwise treatment of primary focal hyperhidrosis with aluminium chloride hexahydrate lotion (20%) and oral glycopyrrolate: a retrospective study from a tertiary care centre

Abstract

Background
Primary focal hyperhidrosis is a common reason for dermatology outpatient visit and has significant impact on patient’s social and professional activities. The study describes the clinical profile of those patients and response with aluminum chloride hexahydrate lotion (ACH 20%) and oral glycopyrrolate (OGP).

Methods
A retrospective study was carried out at a tertiary care centre between the year 2016‐18. Details of history, baseline assessment, treatment response recorded in specially designed proformas were analysed. Initially the patients received topical ACH daily at night. Non‐responders were advised OGP 1 mg BD and increased to 2 mg BD if they didn’t respond. Response was measured according to patient global assessment and objective evaluation of sweating.

Results
Among total 69 patients 57 had onset

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Bilateral R5-R8 sympathectomy for compensatory hyperhidrosis: complications and patient satisfaction.

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Bilateral R5-R8 sympathectomy for compensatory hyperhidrosis: complications and patient satisfaction.

Rev Col Bras Cir. 2020;47:e20202398

Authors: Vasconcelos CFM, Aguiar WS, Tavares RM, Barbosa A, Cordeiro GG, Oliveira FSC, Ferraz ÁAB

Abstract
OBJECTIVE: The purpose of this study was to assess the quality of life of patients who had undergone bilateral thoracic sympathectomy from R5 to R8 as a treatment for severe and debilitating compensatory hyperhidrosis (CH).
METHODS: Twelve patients with severe and debilitating compensatory hyperhidrosis underwent extended sympathectomy (R5-R8) from September 2016 to May 2019 at the Hospital das Clínicas, Federal University of Pernambuco, Brazil. Outcomes such as the level of patient satisfaction with the operation, quality of life scores as well as postoperative complications were assessed.
RESULTS: There has been a substantial improvement in the quality of life score of 66% of the sample. In all four domains, a statistical significant difference was seen, regarding the relief of compensatory hyperhidrosis symptoms.
CONCLUSIONS: Extended sympathectomy from R5 to R8 was shown to be quite effective in most cases, leading us to believe that this approach could be a therapeutic option for severe compensatory hyperhidrosis.

PMID: 32555962 [PubMed – in process]

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Fractional CO2 laser-assisted Botulinum toxin type A delivery for the treatment of primary palmar hyperhidrosis.

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Fractional CO2 laser-assisted Botulinum toxin type A delivery for the treatment of primary palmar hyperhidrosis.

Lasers Med Sci. 2020 Jun 17;:

Authors: Junsuwan N, Manuskiatti W, Phothong W, Wanitphakdeedecha R

Abstract
Intradermal injections of botulinum toxin type A (BTX-A) have been used successfully to treat patients with primary palmoplantar hyperhidrosis (PPH). However, problems with local injections of BTX-A for palmar hyperhidrosis include injection pain and reduced palmar muscle strength. This case series describes three patients with PPH. Patients were followed up for 3 months and assessed using the minor iodine starch test and the visual analog scale (VAS). Over two sessions within a 2-week interval, all patients received treatment on one palm, while the other palm served as the untreated control. Treated palms received fractional CO2 laser therapy and immediate post-operative topical application of BTX-A solution for a total of 50 units. Sweat production was assessed based on the size of the sweat-producing area (measured by the minor iodine starch test) and subjective assessment of sweat production using the visual analog scale (VAS) at baseline, 2 weeks after the first treatment, and 1, 2, and 3 months after the second treatment. In the BTX-A-treated palm, the decrease in the mean sweat production was 51.6% at 2 weeks after the first treatment, and 88.5%, 67.8%, and 52.9%, at 1, 2, and 3 months after the final treatment when compared to the baseline. In the untreated palms, the decrease in the mean sweat production was 2% on all follow-ups when compared to the baseline. No adverse effect was observed in any patient. Fractional CO2 laser is a safe technique for BTX-A delivery on the palm area and is demonstrated to be safe and effective in decreasing sweat secretion of hyperhidrosis palm.

PMID: 32557001 [PubMed – as supplied by publisher]

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Something to Sweat About: Two Cases of Dupilumab-Induced Hyperhidrosis and Bromhidrosis.

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Something to Sweat About: Two Cases of Dupilumab-Induced Hyperhidrosis and Bromhidrosis.

Allergy Rhinol (Providence). 2020 Jan-Dec;11:2152656720927703

Authors: Rowane M, Valencia R, Schend J, Jhaveri D, Hostoffer R

Abstract
Introduction: Atopic dermatitis (AD, eczema) is familial chronic inflammatory skin disease of complex etiology and increasing prevalence. Dupilumab is an IL-4 receptor subunit alpha (IL-4Rα) antagonist that is the first Food and Drug Administration-approved biological therapy for moderate-to-severe adult AD inadequately controlled with topical therapies. Adverse effects reported in the literature include injection site reactions, conjunctivitis, headache, and nasopharyngitis.
Objective: We report the first cases of hyperhidrosis and bromhidrosis as side effects from dupilumab (Dupixent®) for the treatment of AD.
Case Reports: Case 1 is a 20-year-old woman with controlled allergic rhinitis and severe AD reported axillary hyperhidrosis with bromhidrosis, comparable to sweat from high-intensity exercise, with no relief from several different over-the-counter antiperspirants. Case 2 is a 61-year-old woman with history of chronic asthma, allergic contact dermatitis, allergic rhinitis, and AD noticed markedly increased sweating with bromhidrosis that was reminiscent of her menopausal symptomology, about 3 months after initiating dupilimab.
Discussion: Traditional immunosuppressive agents and corticosteroids have limited efficacy, numerous side effects, and increased risk of infection. The safety profile and efficacy of the newly approved IL-4Rα antagonist dupilumab may be favorable to oral immunosuppressants, but its use remains limited to severe recalcitrant cases, due to financial implications and lack of long-term safety data and comparative head-to-head trials.
Conclusion: We report improved outcomes with dupilumab, in addition to unpublished cases of bromhidrosis and hyperhidrosis in 2 patients with AD. This report of additional complications may inspire further clinical research and assist clinicians in considering the option of dupilumab for uncontrolled AD, despite aggressive traditional treatment.

PMID: 32489715 [PubMed]