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Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production.

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Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production.

Dermatol Surg. 2010 Apr;36(4):496-8

Authors: Gregoriou S, Rigopoulos D, Makris M, Liakou A, Agiosofitou E, Stefanaki C, Kontochristopoulos G

Abstract
BACKGROUND: Patients with focal hyperhidrosis in multiple areas often report improvement of plantar hyperhidrosis after botulinum toxin A (BTX-A) therapy for palmar hyperhidrosis.
OBJECTIVE: To assess sweat production from the soles in patients receiving BTX-A treatment for their palmar hyperhidrosis.
PATIENTS AND METHODS: Thirty-six patients with both palmar and plantar hyperhidrosis received 100 U of BTX-A per palm. Sweat production of palms and soles was assessed using a starch iodine test and gravimetry at baseline and 1, 3, and 8 months after treatment. Patients were subjectively assessed using a percentile scale.
RESULTS: All patients had significant improvement in their palmar hyperhidrosis that lasted for 6.2 +/- 1.8 months. Gravimetry revealed marginal improvement of plantar hyperhidrosis in 12 patients (from 39.7 +/- 21.3 to 31.5 +/- 18.0 mg/min; p=.01) and statistically significant worsening in 24 patients (from 71.6 +/- 70.60 to 109.94 +/- 82.93 mg/min, p<.001).
CONCLUSION: Treatment of palmar hyperhidrosis with BTX-A increased plantar sweating in many patients affected by both palmar and plantar hyperhidrosis in the population under study. Regardless, patients reported satisfaction with the results and were willing to repeat treatment.

PMID: 20180837 [PubMed – indexed for MEDLINE]

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Chemical lumbar sympathectomy in plantar hyperhidrosis.

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Chemical lumbar sympathectomy in plantar hyperhidrosis.

Clin Auton Res. 2010 Apr;20(2):113-5

Authors: Yoshida WB, Cataneo DC, Bomfim GA, Hasimoto E, Cataneo AJ

Abstract
Plantar hyperhidrosis can cause great changes to an individual’s quality of life. We described a case successfully treated by the minimally invasive method of percutaneous injection of 7.0% phenolic solution into the lumbar sympathetic chains.

PMID: 20012143 [PubMed – indexed for MEDLINE]

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Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperhidrosis in women.

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Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperhidrosis in women.

J Laparoendosc Adv Surg Tech A. 2010 Feb;20(1):1-6

Authors: Coelho M, Kondo W, Stunitz LC, Branco Filho AJ, Branco AW

Abstract
OBJECTIVES: Primary focal hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating occurring in the axillae, palms, soles, or craniofacial region. Armpits are affected in 51% of patients, feet in 29%, palms in 25%, and the face in 20%. There is a wide range of nonsurgical and surgical treatments available for patients with focal hyperhidrosis. Surgical treatments for plantar hyperhidrosis include thoracic and/or lumbar sympathectomy. In this article, we report on a new technique of bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperidrosis.
MATERIALS AND METHODS: The sample consisted of female patients who presented with plantar hyperhidrosis at the time of surgery and received bilateral retroperitoneoscopic lumbar sympathectomy by a unilateral access technique at our hospital. All patients had already been submitted to a previous thoracic sympathectomy with no improvement of the plantar hyperhidrosis.
RESULTS: Five procedures were performed successfully from January through March 2009. Mean operative time and mean estimated blood loss were 59 minutes and 54 cc, respectively. We had no intraoperative complications, and patients were discharged home 12.8 hours after surgery. Immediate warming of the feet was observed at the end of all procedures. On follow-up consultations, all patients referred a complete resolution of the plantar hyperhidrosis and 1 case of compensative hyperhidrosis on the back.
CONCLUSIONS: Retroperitoneoscopic lumbar sympathectomy by unilateral access seems to be feasible when performed by a surgeon with experience on advanced laparoscopy. Larger series comparing unilateral to bilateral access are necessary to establish the real benefits and potential disadvantages of this new technique.

PMID: 19943777 [PubMed – indexed for MEDLINE]

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Endoscopic lumbar sympathectomy for plantar hyperhidrosis.

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Endoscopic lumbar sympathectomy for plantar hyperhidrosis.

Br J Surg. 2009 Dec;96(12):1422-8

Authors: Rieger R, Pedevilla S, Pöchlauer S

Abstract
BACKGROUND: The aim of this study was to evaluate the results of endoscopic lumbar sympathectomy for plantar hyperhidrosis.
METHODS: A total of 178 endoscopic resections of the lower sympathetic lumbar trunk were carried out in 90 patients (59 men, 31 women) with severe plantar hyperhidrosis. The clinical results, including morbidity and satisfaction rates, were evaluated. Follow-up examination was carried out for all patients after a mean follow-up of 24 (range 3-45) months.
RESULTS: All procedures were carried out endoscopically. There were no deaths and only three patients had a postoperative complication. All patients had evidence of postoperative sympathetic denervation of the feet. In 87 patients (97 per cent) hyperhidrosis was eliminated, but in three (3 per cent) it recurred. Compensatory sweating occurred in 40 patients (44 per cent), postsympathectomy neuralgia in 38 (42 per cent) and one man suffered temporary loss of ejaculation. A total of 86 patients (96 per cent) were very, or partly, satisfied with the result, and 83 (92 per cent) would have the procedure repeated if required.
CONCLUSION: Endoscopic lumbar sympathectomy was a safe and effective option for patients with severe plantar hyperhidrosis.

PMID: 19918855 [PubMed – indexed for MEDLINE]

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Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet.

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Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet.

J Cutan Med Surg. 2009 Sep-Oct;13(5):253-6

Authors: Richards RN

Abstract
BACKGROUND: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use.
OBJECTIVE: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort.
METHODS: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection.
RESULTS: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay.
CONCLUSION: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.

PMID: 19769833 [PubMed – indexed for MEDLINE]

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[Botulinum toxin in disabling dermatological diseases].

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[Botulinum toxin in disabling dermatological diseases].

Ann Dermatol Venereol. 2009 May;136 Suppl 4:S129-36

Authors: Messikh R, Atallah L, Aubin F, Humbert P

Abstract
Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin.

PMID: 19576479 [PubMed – indexed for MEDLINE]

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[Management of axillary hyperhidrosis].

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[Management of axillary hyperhidrosis].

Ann Dermatol Venereol. 2009 May;136 Suppl 4:S125-8

Authors: Pomarède N

Abstract
Hyperhidrosis is considered as an handicap which affects around of 2.8% of the population. It is linked to an extreme, permanent and symetric production of sweating because of an hyperactivity of sweat glands independant of thermo regulation process. The treatment by botulinum toxin has completely changed the treatment of axillary hyperhidrosis. It is an easy, quick, efficient treatment which improved quality of life of these patients. This treatment can also be used for palmar and plantar hyperhidrosis but it requires regional anesthetic technics, so it is done to the hospital.

PMID: 19576478 [PubMed – indexed for MEDLINE]

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What stands in the way of treating palmar hyperhidrosis as effectively as axillary hyperhidrosis with botulinum toxin type A.

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What stands in the way of treating palmar hyperhidrosis as effectively as axillary hyperhidrosis with botulinum toxin type A.

Dermatol Online J. 2009 Apr 15;15(4):12

Authors: Benohanian A

Abstract
Botulinum Toxin type A (BTX-A) has revolutionized the treatment of focal hyperhidrosis (HH) in recent years and has dramatically reduced the invasive surgical techniques that have been performed in the past to control severe focal HH unresponsive to topical therapies. Whereas BTX-A injections are easily performed to control axillary HH with little or no analgesia, pain management is a must during the injection of palmar and plantar HH with BTX-A because of the intense pain generated with the 30 to 40 needle punctures needed on each hand or foot through the densely innervated skin present in those areas. For that reason, many physicians who contentedly treat axillary HH with BTX-A injections, refuse to do so for palmar and plantar HH. Although pain is the major stumbling block deterring patients and physicians from choosing this treatment option, it is not the only one. Many other factors may play a role in deciding whether or not to treat palmar and plantar HH with BTX-A injections. This article reviews these factors and presents some personal data from patients who have already been treated with BTX-A injections on the palms and soles and who came back once or more for repeat treatments when the effect of BTX-A started to fade away. “Jet Anesthesia” was the pain management method used in this group.

PMID: 19450405 [PubMed – indexed for MEDLINE]

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An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.

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An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.

Eur J Cardiothorac Surg. 2009 Aug;36(2):360-3

Authors: Ureña A, Ramos R, Masuet C, Macia I, Rivas F, Escobar I, Villalonga R, Moya J

Abstract
BACKGROUND: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine plantar hyperhidrosis before and after EBTS.
METHODS: A total of 198 patients with primary hyperhidrosis underwent 396 thoracoscopic sympathicolysis of ganglia T2-T3 in a prospective study. All completed a preoperative questionnaire, followed by a second questionnaire 12 months after the operation. The questionnaires evaluated sweating in the different body areas. Only the zones of anhydrosis were considered in delimiting the cutaneous expression of sympathetic ganglia T2-T3.
RESULTS: Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001).
CONCLUSIONS: EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.

PMID: 19410478 [PubMed – indexed for MEDLINE]