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November 11, 2018

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

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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]

November 11, 2018

Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel.

Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel.

J Eur Acad Dermatol Venereol. 2013 Sep;27(9):1120-6

Authors: van der Snoek EM, Ekkelenkamp MB, Suykerbuyk JC

Abstract
BACKGROUND: Pitted keratolysis (PK) is a common plantar skin manifestation in army personnel, farmers and athletes. Due to pain while walking and marching, the condition can cause reduced operational deployability (in case of army personnel).
OBJECTIVE: We used a questionnaire to investigate currently used treatment options of PK and perceptions on perceived efficacy of these treatments among Royal Netherlands Armed Forces primary health care physicians.
METHODS: A cross-sectional anonymous postal questionnaire survey was conducted among all Royal Netherlands Armed Forces primary health care physicians. In addition to question about prescription behaviour on the treatment of PK by topical and oral therapies and given non-pharmacological treatment, several questions assessed perceived efficacy of these therapies.
RESULTS: Of the 164 eligible primary health care physicians, 51 (31.1%) completed the questionnaire. Half of physicians had seen less than five patients with PK in the preceding year. Two-thirds of physicians reported problems with operational deployability in less than 10% of army personnel with PK. PK was treated mostly with topical and non-pharmacological treatments. Oral therapy was seldom prescribed. For hyperhidrosis, aluminium chloride hexahydrate was used in most cases.
CONCLUSION: PK and related reduced operational deployability were less often reported than expected in this study. Dutch physicians prefer combined topical antibiotic therapy with non-pharmacological treatments and perceive the efficacy of topical antibiotic therapy superior to non-pharmacological treatments. Preventive measures, topical antibiotic therapy and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with PK.

PMID: 22882561 [PubMed – indexed for MEDLINE]

November 11, 2018

[Clinical importance of CT-assisted sympathicolysis in primary, focal plantar and palmar hyperhidrosis].

[Clinical importance of CT-assisted sympathicolysis in primary, focal plantar and palmar hyperhidrosis].

Rofo. 2012 Jul;184(7):624-8

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

Abstract
PURPOSE: The objective of this study was to evaluate the benefit of thoracic and lumbar computed tomographic-assisted sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis.
MATERIALS AND METHODS: Thoracic and/or lumbar CTSy was conducted on 101 patients (average age 37.5 ± 15.5 years) with primary, focal hyperhidrosis of the hands and/or feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients were divided into groups with palmar, palmoplantar and plantar hyperhidrosis. The patients evaluated the severity of their symptoms prior to the intervention and 2 days, 6 months and 12 months after the intervention using a Dermatology Quality of Life Index (DLQI) and side effects.
RESULTS: The performed interventions led to a statistically significant decrease in the preinterventional severity of symptoms after the intervention (2 days), and 6 and 12 months after CTSy in the palmar, palmoplantar and plantar (p < 0.01) group. The technical success rate of CTSy was 100 %. No major complications occurred. Patients reported compensatory perspiration over the course of treatment, neuralgia and paraesthesia as side effects. The differentiated assessment of the strength of perspiration of the hands and feet showed statistically significant differences between the foot and hand region, whereby the decrease in sweat secretion of the feet was more significant and more lasting (p < 0.02).
CONCLUSION: After conservative measures have been exhausted, CT-assisted sympathicolysis represents a therapeutic option with minimal side effects for patients with primary, focal hyperhidrosis.

PMID: 22661390 [PubMed – indexed for MEDLINE]