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Shapiro’s syndrome: episodic hypothermic hyperhidrosis

BMJ Case Rep. 2024 Jul 29;17(7):e260998. doi: 10.1136/bcr-2024-260998.

ABSTRACT

SummaryShapiro’s syndrome is a rare neurological disease. The triad of Shapiro’s syndrome includes episodes of hyperhidrosis, hypothermia and complete/partial agenesis of the corpus callosum. We report a case of a young male who had episodic chills, increased sweating and fatigue. During these episodes, he was found to have bradycardia, hypotension and hypothermia. Clinical and neurological examinations were unremarkable. The MRI of the brain revealed agenesis of the corpus callosum. There was a good response to carbamazepine therapy.

PMID:39074946 | DOI:10.1136/bcr-2024-260998

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Hyperhidrosis and Neurofibromatosis Type 1: A Case Report

Cureus. 2024 Jun 24;16(6):e63021. doi: 10.7759/cureus.63021. eCollection 2024 Jun.

ABSTRACT

In this report, we present the case of a 20-year-old male with childhood-onset hyperhidrosis affecting his fingers and palm flexor surfaces. Dermatological examination revealed café-au-lait macules, palm and sole involvement, and axillary freckling. A starch-iodine test confirmed localized sweating. Neuroimaging identified neurofibromatosis type 1 (NF1) with subcutaneous nodules and dural ectasia in the thoracic spine. The patient was diagnosed with hyperhidrosis and NF1 based on diagnostic criteria, and he responded well to 20% aluminum chloride for treatment of hyperhidrosis. This case represents a unique occurrence of hyperhidrosis with NF1 in Saudi Arabia. Comprehensive evaluation, including systemic assessment, radiology, and starch-iodine testing, aids in diagnosis and understanding of the underlying mechanisms of this disorder, which remains unexplained.

PMID:39050311 | PMC:PMC11267592 | DOI:10.7759/cureus.63021

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Treatment of Primary Axillary Hyperhidrosis with Two Doses of Botulinum Toxin A-Observational Study

Toxins (Basel). 2024 Jul 16;16(7):320. doi: 10.3390/toxins16070320.

ABSTRACT

Hyperhidrosis (HH) is defined as the production of more sweat than is necessary for its thermoregulatory function, negatively affecting patients’ quality of life and interfering with their social, work and family life. In this context, the aim of thisstudy was to evaluate the efficacy of two different doses of botulinum toxin type A (50 or 100 units) in each axilla in severe primary axillary hyperhidrosis. A descriptive, observational, cross-sectional and post-authorisation study was conducted onpatients referred to our department.Thirty-one patients with severe primary axillary hyperhidrosis were included, some of whom received more than one infiltration during the follow-up period, performing a total of 82 procedures. They were assigned by simple random sampling to two types of treatment: infiltration of 50 or 100 units (U) of botulinum toxin A per axilla.Hyperhidrosis severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Onabotulinum toxin A infiltration reduced the severity of hyperhidrosis and improved the quality of life of the treated patients, with no significant differences between the two groups.

PMID:39057960 | DOI:10.3390/toxins16070320

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Internalized stigma, disease severity, quality of life, anxiety and depression in axillary hyperhidrosis

Ann Dermatol Venereol. 2024 Jul 15;151(3):103291. doi: 10.1016/j.annder.2024.103291. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary hyperhidrosis (AH) is characterized by excessive underarm sweating. It is a chronic autonomic disorder that can lead to social embarrassment, impaired quality of life (QoL), anxiety and depression. Internalized stigma (IS), defined as the acceptance of negative societal attitudes and stereotypes about an individual’s illness, has not been previously studied in AH. The aim of this study was to evaluate the level of IS in patients with AH and the relationships between IS, disease severity, quality of life, anxiety, and depression.

PATIENTS AND METHODS: One hundred and four patients with AH were included in the study. Demographic and clinical characteristics of the patients were recorded. The Hyperhidrosis Disease Severity Scale (HDSS) was used to define disease severity. Assessment was made using the Internalized Stigma Scale (ISS) (between 29 and 116, the higher the score the greater the stigma), Hospital Anxiety and Depression Scale (HADS) and Dermatology Life Quality Index (DLQI).

RESULTS: The mean age of the patients was 34.1 ± 10.9 years. The HDSS grade was mostly moderate to severe. The mean ISS score was 57.5 ± 6.5. Median HADS scores were 7 [interquartile range (IQR) 2-12] and 5 [IQR 2-10], respectively. HADS scores ≥ 8 were observed respectively in 39.4% and 8.7% of patients. The median DLQI score was 14 [IQR 4-24]. A DLQI score ≥ 11 was observed in 75% of patients. Significant correlation was found between ISS score and HDSS (r = 0.445, p < 0.001), HADS-A (r = 0.455, p < 0.001), DLQI (r = 0.478, p < 0.001) scores and symptom duration (r = 0.207, p = 0.035). The relationship between ISS and HADS depression scores was not statistically significant.

CONCLUSION: IS is common in patients with AH. Disease severity, symptom duration and anxiety increased IS. Patient’s quality of life is reduced in AH.

PMID:39013257 | DOI:10.1016/j.annder.2024.103291

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Incidence and Severity of Compensatory Hyperhidrosis Following Bilateral Sympathectomy

Ann Vasc Surg. 2024 Jul 11:S0890-5096(24)00390-X. doi: 10.1016/j.avsg.2024.05.013. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis is a condition caused by an excessive stimulation of sweat glands, leading to a decline in both quality of life and social wellbeing. Thoracic sympathectomy surgery provides a relief of the initial symptoms but poses a risk for developing compensatory hyperhidrosis in various degrees.

OBJECTIVE: The aim of this study was to assess the occurrence and characteristics of compensatory hyperhidrosis post thoracic sympathectomy.

METHODS: A retrospective cohort study of patients who underwent video-assisted thoracic sympathectomy surgery at level T2-T3 between 2016 and 2022 was conducted. Patients’ data was retrieved from medical records and through a telephone interview.

RESULTS: A total of 50 patients (32 males and 18 females) were operated on with a mean ± SD age of 25.9 ± 7.4 years at the time of surgery for palmoplantar hyperhidrosis. Initial symptoms started in childhood at a mean ± SD age of 11.4 ± 3.3 years. Postoperatively, 39 patients (78%) developed compensatory hyperhidrosis, more prevalent in males (64.1%) compared to females (35.8%). This compensatory hyperhidrosis mainly affected the back and abdomen (100%), followed by the groin and thighs (28.2%), and, to a lesser extent, the craniofacial area (15.3%). Onset of symptoms occurred within one week after surgery in 71.7% of cases, with 71.7% reporting mild to moderate symptoms. Compensatory hyperhidrosis was significantly associated with higher age at the time of surgery, smoking status, and a longer time lapse in the surgery operation (p value <0.05).

CONCLUSIONS: Thoracic sympathectomy is an effective procedure with a high success rate. Despite a relatively higher occurrence of compensatory hyperhidrosis, most patients experience milder symptoms and express satisfaction, noting that their expectations were met following the surgery.

PMID:39002894 | DOI:10.1016/j.avsg.2024.05.013

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Long-term efficacy of fractional microneedle radiofrequency versus botulinum toxin-A in primary axillary hyperhidrosis: a randomized controlled trial

Lasers Med Sci. 2024 Jul 10;39(1):177. doi: 10.1007/s10103-024-04115-x.

ABSTRACT

Primary axillary hyperhidrosis is an idiopathic disorder that creates severe psycho-social burden due to excessive uncontrolled sweating. Various therapeutic agents have been described, but each has its own limitations. The use of fractional microneedling radiofrequency has emerged lately with promising results. This study aimed to determine the efficacy and safety of fractional microneedle radiofrequency in comparison to Botulinum toxin-A (BT-A) in patients with primary axillary hyperhidrosis. In this randomized controlled clinical trial, 20 patients (40 sides) were randomized to either fractional microneedle radiofrequency (4 sessions at 3-week intervals) or BT-A (single session), where each side received one of the treatment modalities. Efficacy was measured at 3, 6 and 12 months using Minor’s starch iodine test, HDSS score, Hqol questionnaire, and patient satisfaction. Fractional microneedle radiofrequency, although showed moderate efficacy, is inferior to BT-A regarding longitudinal efficacy at 12 months, as well as patients’ satisfaction. Both treatment modalities showed to be equally safe, but fractional microneedle radiofrequency procedure was substantially more painful. In conclusion, fractional microneedle radiofrequency does not offer a better substitute to BT-A in primary axillary hyperhidrosis. BT-A shows higher efficacy, is less painful, less expensive, and needs a smaller number of sessions.

PMID:38981914 | DOI:10.1007/s10103-024-04115-x

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Evaluation of the clinical efficacy of ultra-fast track anesthesia for endoscopic thoracic sympathectomy of palmar hyperhidrosis

J Cosmet Dermatol. 2024 Jun 19. doi: 10.1111/jocd.16425. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study, we investigated the safety and practicability of ultra-fast track anesthesia (UFTA) for endoscopic thoracic sympathectomy (ETS).

METHODS: A total of 72 patients with palmar hyperhidrosis undergoing ETS were randomly divided into three groups: the UFTA group (group I), the group undergoing single-lumen tracheal intubation with local infiltration anesthesia technique (group II), and the group undergoing single-lumen tracheal intubation with routine anesthesia (group III). Mean arterial pressure (MAP) and heart rate (HR) were recorded for all three groups at the following six time points: Before anesthetics administration (T0), the time of intubating or inserting laryngeal mask airway (T1), the time of incising skin (T2), the time of disconnecting of the right sympathetic nerve (T3), the time of disconnecting of the left sympathetic nerve (T4), the time of withdrawing the tracheal tube or laryngeal mask airway (T5), and the time of transferring the patient to a post-anesthesia care unit (PACU) (T6). The three groups were compared from the following perspectives: surgery duration; anesthesia recovery duration, that is, the duration from discontinuation of anesthesia to extubating the tracheal tube; the dose of propofol and remifentanil per kilogram body mass per unit time interval (the time at the end of the procedure, which lasted from anesthesia induction to incision suturing); and the visual analog scale (VAS) in the resting state in the PACU.

RESULTS: Based on pairwise comparisons, the average HR and average MAP values of the three groups differed significantly from T2 to T6 (p < 0.05). As demonstrated by the correlation analysis between remifentanil and propofol with HR and MAP, the doses of the total amount of remifentanil and propofol were lower, and group I used less remifentanil and propofol than group II. No patient in group I experienced throat discomfort following surgery. Patients in groups II and III experienced a range of postoperative discomfort. The VAS scores of groups I and II were significantly lower than those of group III, with group I lower than group II.

CONCLUSION: When utilized in ETS, UFTA can provide effective anesthesia for minor traumas. It is safe, effective, and consistent with the enhanced recovery philosophy of fast-track surgery departments.

PMID:38895860 | DOI:10.1111/jocd.16425