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November 11, 2018

Randomized trial – oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy.

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Randomized trial – oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy.

Clinics (Sao Paulo). 2014 Feb;69(2):101-5

Authors: Costa Ada S, Leão LE, Succi JE, Perfeito JA, Filho Castelo A, Rymkiewicz E, Filho Aurelio Marchetti M

Abstract
OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy.
METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015.
RESULTS: Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p=0.001). The placebo group showed modest improvement (p=0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p=0.95), whereas the oxybutynin group revealed a significant decrease (p=0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p=0.001).
CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy.

PMID: 24519200 [PubMed – indexed for MEDLINE]

November 11, 2018

Influence of thoracoscopic sympathectomy on tendency to cry – case-controlled study.

Influence of thoracoscopic sympathectomy on tendency to cry – case-controlled study.

Wideochir Inne Tech Maloinwazyjne. 2013 Dec;8(4):315-20

Authors: Stefaniak T, Cwigoń M, Vingerhoets AJ, Dobosz L, Kaczor M, Cwaliński T, Lankiewicz M, Wrukowska I

Abstract
INTRODUCTION: Primary hyperhidrosis (PHH) is a disease that is mainly characterized by increased palmar and plantar sweating that significantly affects the everyday functioning. It is not clear to what extent this surgical intervention has an effect on one’s further emotional functioning.
AIM: To evaluate the impact of endoscopic thoracic sympathectomy (ETS) on crying tendency in PHH patients.
MATERIAL AND METHODS: Eighty-six patients qualified for ETS due to PHH took part in the study. All patients completed the Adult Crying Inventory (ACI) and the Functional Assessment of Chronic Illness Therapy (FACIT) questionnaires before and 3 months after sympathectomy. The ACI questionnaire was additionally completed by a group of 60 volunteers.
RESULTS: In females, the number of crying episodes increased after ETS, though it was still lower than the number observed in the control group (1.19 vs. 2.36 vs. 3.83; p < 0.05). In males the number of crying episodes dropped insignificantly to the number observed in the control group (0.87 vs. 0.27 vs. 0.14; p = NS). The tendency to cry in females decreased compared to the level prior to surgery, but it was lower than the level observed in the control group (respectively, 4.5 vs. 3.5 vs. 5.63; p < 0.05). In males the differences were not statistically significant (1.03 vs. 1.5 vs. 1.77; p = NS). There was no impact of emotional status on crying, either before or after the treatment.
CONCLUSIONS: Endoscopic thoracic sympathectomy decreases the subjective tendency to cry though it increases the number of crying episodes in women, but does not change crying behaviours in men.

PMID: 24501601 [PubMed]

November 11, 2018

Using 80% trichloroacetic acid in the treatment of ingrown toenails.

Using 80% trichloroacetic acid in the treatment of ingrown toenails.

An Bras Dermatol. 2013 Nov-Dec;88(6):889-93

Authors: Barreiros H, Matos D, Goulão J, Serrano P, João A, Brandão FM

Abstract
BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times.
OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail.
METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery.
RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery.
CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.

PMID: 24474095 [PubMed – indexed for MEDLINE]

November 11, 2018

[Irreversible Horner’s syndrome after bilateral thoracoscopic sympathectomy].

[Irreversible Horner’s syndrome after bilateral thoracoscopic sympathectomy].

Arch Soc Esp Oftalmol. 2014 Feb;89(2):79-81

Authors: Vicente P, Canelles E, Díaz A, Fons A

Abstract
CASE REPORT: A 19 year-old boy who developed a right Horner’s syndrome after a bilateral sympathectomy as a treatment for palmoplantar hyperhidrosis.
DISCUSSION: Horner’s syndrome is defined by the occurrence of miosis, ptosis and enophthalmos as a result of involvement of sympathetic innervation. This is quite rare, but identification is very important because it may also be an ominous sign secondary to a neoplasm, neurological diseases, or surgery of the sympathetic chain, as in our case.

PMID: 24269401 [PubMed – indexed for MEDLINE]

November 11, 2018

CT-assisted sympathicolysis as an additional minimally invasive therapeutic option in primary focal plantar hyperhidrosis.

CT-assisted sympathicolysis as an additional minimally invasive therapeutic option in primary focal plantar hyperhidrosis.

Cardiovasc Intervent Radiol. 2014 Dec;37(6):1554-8

Authors: Scheer F, Wiggermann P, Kamusella P, Wissgott C, Andresen R

Abstract
PURPOSE: The purpose of this retrospective study was to evaluate the benefit of lumbar computed tomography-assisted sympathicolysis (CTSy) in patients with primary focal hyperhidrosis of the feet.
METHODS: A lumbar CTSy was conducted on 35 patients (mean age 36.6 ± 11.9 years) with primary focal hyperhidrosis of the feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients evaluated the severity of their symptoms before the intervention, 2 days after the intervention, and 6 and 12 months after the intervention on the basis of a Dermatology Quality of Life Index(©) (DLQI) and side effects experienced.
RESULTS: The interventions performed led to a statistically significant decrease in the preinterventional severity of symptoms 2 days after the intervention, and 6 and 12 months after CTSy (p < 0.05). No major complications occurred. As the most common side effect, 12 of the patients reported compensatory sweating.
CONCLUSIONS: After conservative measures have been exhausted or as a complement to the existing therapy regimen, CT-assisted sympathicolysis represents a therapeutic option low in side effects that provides a marked benefit to patients with primary, focal hyperhidrosis.

PMID: 24430535 [PubMed – indexed for MEDLINE]

November 11, 2018

Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis.

Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis.

J Dermatol. 2013 Nov;40(11):886-90

Authors: Fujimoto T, Kawahara K, Yokozeki H

Abstract
Primary hyperhidrosis is a disorder of excessive, bilateral and relatively symmetrical sweating occurring in the palms, soles and axillae regions without obvious etiology. There have been some reports of the epidemiology of primary hyperhidrosis abroad so far, but there has never been any research performed in Japan. We performed a questionnaire survey for people aged 5-64 years who agreed with the purpose of this study at 20 companies or schools, and received 5807 valid responses. From this survey, each prevalence could broken down into 5.33% for primary palm hyperhidrosis, 2.79% for primary plantar hyperhidrosis, 5.75% for primary axillae hyperhidrosis and 4.7% for primary head hyperhidrosis. Patients with severe symptoms were estimated to be approximately 616,000 for primary palmar hyperhidrosis and 2,239,000 for primary axillae hyperhidrosis in Japan. These findings reveal that many patients feel a decreased quality of life because of symptoms of hyperhidrosis every day. However, only 6.2% of the patients had visited medical institutions. Moreover, few patients take appropriate treatment even after visiting the hospital.

PMID: 24106874 [PubMed – indexed for MEDLINE]

November 11, 2018

A novel approach to the lumbar sympathetic chain: lateral access.

A novel approach to the lumbar sympathetic chain: lateral access.

Neurosurg Focus. 2013 Jul;35(2 Suppl):Video 12

Authors: Rodgers SD, Engler JA, Perin NL

Abstract
Plantar hyperhydrosis is a disabling condition of excessive, symmetric, focal sweating of the feet with social, psychological, and medical implications. Treatment options include topical agents, iontophoresis, botulinum toxin injection, and surgical disruption of the lumbar sympathetic chain. Surgical corridors include transperitoneal and retroperitoneal approaches. We report our technique with a novel minimally invasive lateral retroperitoneal approach commonly used for lateral interbody fusions. The lateral approach for sectioning of the sympathetic chain in the treatment of hyperhydrosis appears safe. The approach may be advantageous for the patient and surgeons familiar with lateral interbody fusion. Further studies may elucidate the long term efficacy and safety of the lateral approach. The video can be found here: http://youtu.be/Q82SGpmAXng.

PMID: 23829842 [PubMed – indexed for MEDLINE]

November 11, 2018

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Pol Przegl Chir. 2013 May;85(5):247-52

Authors: Stefaniak TJ, Ćwigoń M

Abstract
UNLABELLED: The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating. The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation.
MATERIAL AND METHODS: Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0–no sweating; 10–maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%.
RESULTS: There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months.
CONCLUSIONS: Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.

PMID: 23770524 [PubMed – indexed for MEDLINE]

November 11, 2018

The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime.

The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime.

Dermatol Online J. 2013 Mar 15;19(3):14

Authors: Siah TW, Hampton PJ

Abstract
Primary focal hyperhidrosis is a benign condition of unknown etiology. Tap water iontophoresis has long been known to inhibit sweat production. The mechanism of reduced hyperhidrosis by iontophoresis is not completely clear. For operational convenience, our patients received their treatments at different intervals to those recommended by the manufacturer of the iontophoresis unit. We performed a retrospective audit to evaluate the effectiveness of tap water iontophoresis using this regimen. This new treatment regimen was effective at controlling palmoplantar hyperhidrosis. Minimal undesirable effects such as mild skin irritation and erythema were noted but none were severe enough to necessitate discontinuation of treatment. In conclusion, tap water iontophoresis is a safe and effective treatment of palmar and plantar hyperhidrosis when used on Monday, Wednesday, and Friday for 4 weeks. Continued treatment is needed to maintain the effect and many patients go on to purchase their own machines. This technique should be considered prior to systemic or aggressive surgical intervention.

PMID: 23552011 [PubMed – indexed for MEDLINE]

November 11, 2018

Use of oxybutynin for treating plantar hyperhidrosis.

Use of oxybutynin for treating plantar hyperhidrosis.

Int J Dermatol. 2013 May;52(5):620-3

Authors: Wolosker N, de Campos JR, Kauffman P, Yazbek G, Neves S, Puech-Leao P

Abstract
BACKGROUND: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin at low doses for treating plantar hyperhidrosis.
METHODS: From January 2007 to December 2010, 35 consecutive patients with plantar hyperhidrosis were treated with oxybutynin. Data were collected from 30 patients (five patients were lost to follow-up). During the first week, patients received 2.5 mg of oxybutynin once a day, 2.5 mg twice a day from the eighth to the 42nd day, and from the 43rd day to the end of the 12th week, 5 mg twice a day. All of the patients underwent two evaluations: before and after the oxybutynin treatment, using a clinical questionnaire, and a clinical protocol for quality of life.
RESULTS: More than 70% of patients experienced an improvement in plantar hyperhidrosis. Most of the patients showed improvements in quality of life (66.6%). The side effects were minor, the most frequent being dry mouth (76.7%).
CONCLUSION: Treatment of plantar hyperhidrosis with oxybutynin presents good results and improves quality of life. We believe that this therapeutic alternative is an excellent choice for the initial treatment of plantar hyperhidrosis.

PMID: 23590378 [PubMed – indexed for MEDLINE]