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Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version)

Chin Med J (Engl). 2022 Jul 14. doi: 10.1097/CM9.0000000000002198. Online ahead of print.

ABSTRACT

Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’ social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.

PMID:35830261 | DOI:10.1097/CM9.0000000000002198

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The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study

J Clin Med. 2022 Jun 21;11(13):3576. doi: 10.3390/jcm11133576.

ABSTRACT

BACKGROUND: We aimed to investigate the impact of the COVID-19 pandemic on the degree of depression among hyperhidrosis patients and their quality of life.

METHODS: 222 patients were contacted through an online questionnaire. Patients reported quality of life (QoL), including treatment and changes in symptoms during the pandemic, and also responded to the Patient Health Questionnaire-9 (PHQ-9) to evaluate the severity of depression. Those were compared with the result from the general population. Spearman correlation and multiple linear regression were performed to identify the factors related to the PHQ-9 score.

RESULTS: Half of the patients were female. The mean PHQ-9 score (5.25) of hyperhidrosis patients was higher than the general population, and female patients displayed significantly higher PHQ-9 scores than males (p = 0.002). QoL was impaired more in females. About 10% of patients experienced worsening symptoms, and 30% had difficulties getting appropriate management. Significant negative correlations were found between the PHQ-9 and age or disease duration. Predictive factors for the PHQ-9 were female (p = 0.006) and facial hyperhidrosis (p = 0.024).

CONCLUSIONS: The level of depression among hyperhidrosis patients was higher than the general population during the COVID-19 pandemic; female and facial hyperhidrosis patients need much more psychiatric attention. Though hyperhidrosis is classified as benign and often neglected by clinicians, we need to give more awareness to the mental burden imposed by the COVID-19 pandemic.

PMID:35806865 | DOI:10.3390/jcm11133576

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Evaluation of blood perfusion using laser doppler flowmetry during endoscopic lumbar sympathectomy in patients with plantar hyperhidrosis: a retrospective observational study

Sci Rep. 2022 Jul 6;12(1):11456. doi: 10.1038/s41598-022-14778-7.

ABSTRACT

The purpose of this study is to evaluate whether monitoring the changes of skin blood flow may be effective in assessing blood perfusion during endoscopic lumbar sympathectomy (ELS) in patients with plantar hyperhidrosis. In this study, a total of 30 patients who underwent surgical treatment for plantar hyperhidrosis at the Department of Thoracic and Cardiovascular Surgery in Yonsei University Gangnam Severance Hospital, Seoul, Korea, between July 2020 and December 2020, were retrospectively analyzed. Sympathetic denervation was performed on the third lumbar ganglion, and intraoperative laser doppler flowmetry (LDF) was used to detect the lumbar sympathetic chain accurately. We observed an abrupt increase of peripheral blood flow after sympathetic denervation, and the median percent changes of perfusion unit were 173.27 (inter-quartile range, IQR 195.48) and 392.98 (IQR 597.27) for the left and right sympathectomies, respectively. This study demonstrated the efficacy of monitoring skin blood flow via LDF during ELS. This result suggests that exact detection of blood flow using LDF is essential for improving the accuracy of ELS by checking the perfusion site on the sole in patients with plantar hyperhidrosis.

PMID:35794150 | DOI:10.1038/s41598-022-14778-7

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Efficacy of Percutaneous Radiofrequency Sympathectomy Versus Percutaneous Ethanol Sympatholysis in the Treatment of Primary Hyperhidrosis

Pain Physician. 2022 Jul;25(4):E689-E695.

ABSTRACT

BACKGROUND: At present, there are many surgical treatments for primary hyperhidrosis (PH), but their medium- and long-term effects remain unclear.

OBJECTIVES: To evaluate and compare the efficacy of radiofrequency sympathectomy (RFS) and percutaneous ethanol sympatholysis (PES) in the treatment of PH.

STUDY DESIGN: A retrospective study.

SETTING: This study was performed at the Affiliated Hospital of Jiaxing University, China.

METHODS: Patients who underwent RFS and PES at The First Affiliated Hospital of Jiaxing University for PH were retrospectively reviewed from January 2016 through December 2018 and were divided into an RFS group and a PES group. The Hyperhidrosis Disease Severity Scale was evaluated at the following time points: before the operation, immediately after the operation, 12 months and 24 months after the operation. The effective rate, patient satisfaction, and compensatory hyperhidrosis were also evaluated.

RESULTS: A total of 94 patients diagnosed with primary hyperhidrosis were included (RFS group, n = 45; PES group, n = 49). RFS yielded a postprocedure 24-month effective rate of 53.33% in treating hyperhidrosis compared to PES (24.49%, P < 0.05). There were no significant differences between the 2 groups regarding patient satisfaction (P = 0.927) and compensatory hyperhidrosis (P = 0.711).

LIMITATIONS: This was a single-center study.

CONCLUSION: This is the first clinical study to evaluate the efficacy of RFS and compare it with PES in treating primary hyperhidrosis. RFS significantly decreased hyperhidrosis and had a higher 2-year effective rate compared to PES.

PMID:35793193

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Treatment of Hyperhidrosis: An Update

Am J Clin Dermatol. 2022 Jul 1. doi: 10.1007/s40257-022-00707-x. Online ahead of print.

ABSTRACT

Hyperhidrosis is a dermatosis presenting as pathologically excessive focal or generalized sweating. The stigmatizing nature of hyperhidrosis may cause patients to feel embarrassment and apprehension about their symptoms and experience a significant decrease in well-being. Severe cases of hyperhidrosis can also increase the risk of developing psychiatric and somatic comorbidities. Conventional non-surgical treatments of hyperhidrosis include aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium. In recent years, new topical anticholinergic medications and devices have emerged that may improve the patients’ symptoms and even prevent the development of comorbidities. The treatment of hyperhidrosis can be a complex matter and may require the combination of several therapies. The purpose of this paper was to firstly review the literature on existing non-surgical treatment options for hyperhidrosis, and secondly provide a stepwise approach to investigating and treating patients with hyperhidrosis.

PMID:35773437 | DOI:10.1007/s40257-022-00707-x

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Questionnaire-based epidemiological survey of primary focal hyperhidrosis and survey on current medical management of primary axillary hyperhidrosis in Japan

Arch Dermatol Res. 2022 Jun 29. doi: 10.1007/s00403-022-02365-9. Online ahead of print.

ABSTRACT

To obtain current epidemiological information on primary focal hyperhidrosis in Japan, a large epidemiological survey was conducted using a web-based questionnaire. The prevalence of primary focal hyperhidrosis was 10.0% and the site-specific prevalence was highest for primary axillary hyperhidrosis (5.9%). The proportion of respondents with primary focal hyperhidrosis who had consulted a physician was 4.6%, which was similar to the low prevalence reported previously in 2013 in Japan. A questionnaire survey for physicians and individuals with primary axillary hyperhidrosis on the current medical management of primary axillary hyperhidrosis showed that physicians recognized the existence of patients who were very worried about hyperhidrosis, but failed to provide active treatment. Regarding the information provided by patients to physicians at presentation, it was found that patients failed to provide sufficient information to the physicians about their worries in daily life. Among individuals who had sought medical care with primary axillary hyperhidrosis, 62.3% reported that they were not currently receiving treatment, highlighting a challenge to be addressed regarding continued treatment. Frequently chosen options leading to willingness to receive treatment were less expensive treatment and highly effective treatment as well as feeling free to consult a physician, suggesting a desire for an improved medical environment.

PMID:35768620 | DOI:10.1007/s00403-022-02365-9

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Botulinum Toxin Type A for Treatment of Forehead Hyperhidrosis: Multicenter Clinical Experience and Review from Literature

Toxins (Basel). 2022 May 27;14(6):372. doi: 10.3390/toxins14060372.

ABSTRACT

Among the forms of idiopathic hyperhidrosis, those involving the forehead have the greatest impact on patients’ quality of life, as symptoms are not very controllable and are difficult to mask for patients. Although the local injection therapy with Incobotulinum toxin type A (IncoBTX-A therapy) can be considered a rational treatment, data from the literature describing both efficacy and safety of the treatment over the long term are poor. The aim of this report is to describe the single-center experience of five patients seeking treatment, for forehead hyperhidrosis with IncoBTX-A. To evaluate the benefits, safety profile and duration of anhidrosis, patients were treated following a standardized procedure and then followed until clinical relapse. The amount of sweating was measured by gravimetric testing, the extension of hyperhidrosis area was measured through Minor’s iodine starch test, and response to the treatment was evaluated using the Hyperhidrosis Disease Severity Scale (HDSS) and the Dermatology Life Quality Index (DLQI). In all treated patients, a significant anhidrotic effect was observed 4 weeks after the treatment and lasted for approximately 36 weeks. The reduction in sweat production was associated with significant amelioration of symptoms and quality of life for all treated patients. No serious side effects occurred; one patient complained of a mild transient bilateral ptosis. Although further wider studies are required, our preliminary results seem to encourage the use of IncoBTX-A in forehead hyperhidrosis.

PMID:35737033 | DOI:10.3390/toxins14060372

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The temporal association of hyperhidrosis and its co-morbidities – a nationwide hospital-based cohort study

J Eur Acad Dermatol Venereol. 2022 Jun 23. doi: 10.1111/jdv.18351. Online ahead of print.

ABSTRACT

BACKGROUND: Research on hyperhidrosis comorbidities has documented the co-occurrence of diseases but has not provided information about temporal disease associations.

OBJECTIVE: To investigate the temporal disease trajectories of individuals with hospital diagnosed hyperhidrosis.

METHODS: This is a hospital-based nationwide cohort study including all patients with a hospital contact in Denmark between 1994 and 2018. International Classification of Diseases version-10 diagnoses assigned to inpatients, outpatients and emergency department patients were collected from the Danish National Patient Register. The main outcome was the temporal disease associations occurring in individuals with hyperhidrosis, which was assessed by identifying morbidities significantly associated with hyperhidrosis and then examining whether there was a significant order of these diagnoses using binomial tests.

RESULTS: Overall, 7,191,519 patients were included. Of these, 8,758 (0.12%) patients had localized hyperhidrosis (5,674 female sex [64.8%]; median age at first diagnosis 26.9 [interquartile range 21.3-36.1]) and 1,102 (0.015%) generalized hyperhidrosis (606 female sex [59.9%]; median age at first diagnosis 40.9 [interquartile range 26.4-60.7]). The disease trajectories comprised pain complaints, stress, epilepsy, respiratory and psychiatric diseases. The most diagnosed morbidities for localized hyperhidrosis were abdominal pain (relative risk [RR]=121.75; 95% Confidence Interval [CI] 121.14-122.35; p<0.001), soft tissue disorders (RR=151.19; 95% CI 149.58-152.80; p<0.001) and dorsalgia (RR=160.15; 95% CI 158.92-161.38); p<0.001). The most diagnosed morbidities for generalized hyperhidrosis were dorsalgia (RR=306.59; 95% CI 302.17-311.02; p<0.001), angina pectoris (RR=411.69; 95% CI 402.23-421.16; p<0.001) and depression (RR=207.92; 95% CI 202.21-213.62; p<0.001). All these morbidities were diagnosed before hyperhidrosis.

CONCLUSIONS: This paper ascertains which hospital-diagnosed morbidities precede hospital-diagnosed hyperhidrosis. As hyperhidrosis mainly is treated in the primary health care sector, the trajectories suggests that these morbidities may lead to a worse disease course of hyperhidrosis that necessitates treatment in hospitals. Treating these morbidities may improve the disease course of hyperhidrosis.

PMID:35735049 | DOI:10.1111/jdv.18351

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Clinical efficacy of microwave in the treatment of axillary osmidrosis and primary hyperhidrosis

Dermatol Ther. 2022 Jun 21:e15657. doi: 10.1111/dth.15657. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary osmidrosis(AO) and primary hyperhidrosis(PH) are common diseases, but there are still difficulties in treatment. Microwave therapy may become a new method.

OBJECTIVE: To evaluate long-time efficacy of patients with AO or PH treated by microwave. To discuss possible mechanism of microwave therapy by combining results of clinical and pathological.

METHODS: Ten AO or PH patients with moderate or severe level were selected as subjects, and each subject received microwave treatment of bilateral armpits. The follow-up period lasted two years,and the changes of perspiration and odor were evaluated in subjective and objective ways. Each subject took skin biopsy in the treatment area before and after treatment or each follow-up. HE and immunohistochemical staining were performed.

RESULTS: Both subjective and objective index reflected the significant improvement of AO and PH after treatment(P<0.05). Dermatology life quality index score decreased by 10.4±4.6(P<0.05). The number of apocrine glands decreased significantly after treatment, and most of them changed from secretory phase to quiescent phase.

CONCLUSIONS: Microwave therapy can destroy apocrine sweat glands, reduce number of functional glands, so as to improve symptoms of AO and PH and elevate quality of life, which is safe, effective and stable. This article is protected by copyright. All rights reserved.

PMID:35726636 | DOI:10.1111/dth.15657

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Hyperhidrosis in sleep disorders – A narrative review of mechanisms and clinical significance

J Sleep Res. 2022 Jun 15:e13660. doi: 10.1111/jsr.13660. Online ahead of print.

ABSTRACT

Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs that affects patients’ quality of life. It results from an excessive stimulation of eccrine sweat glands in the skin by the sympathetic nervous system. Hyperhidrosis may be primary or secondary to an underlying cause. Nocturnal hyperhidrosis is associated with different sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome/periodic limb movement during sleep and narcolepsy. The major cause of the hyperhidrosis is sympathetic overactivity and, in the case of narcolepsy type 1, orexin deficiency may also contribute. In this narrative review, we will provide an outline of the possible mechanisms underlying sudomotor dysfunction and the resulting nocturnal hyperhidrosis in these different sleep disorders and explore its clinical relevance.

PMID:35706374 | DOI:10.1111/jsr.13660