Hyperhidrosis Research . org – Page 66 – A collection of the latest publications on hyperhidrosis

November 11, 2018

Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases.

Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases.

Indian J Surg. 2015 Aug;77(4):270-5

Authors: Shi H, Shu Y, Shi W, Lu S, Sun C

Abstract
The objective of this study is to investigate the feasibility and safety of single-port microthoracoscopic thoracic sympathicotomy for the treatment of palmar hyperhidrosis. Between January 2008 and March 2013, 56 patients (36 male, 20 female; mean age 25.6 years, age range 16-39 years) underwent single-port microthoracoscopic thoracic sympathicotomy for palmar hyperhidrosis. Nineteen patients (33.9 %) had moderate palmar hyperhidrosis that could thoroughly wet a handkerchief, and 37 (66.1 %) had severe palmar hyperhidrosis with sweat dripping from the palm. Eight patients (14.3 %) had a positive family history, 34 (60.7 %) had plantar hyperhidrosis, 22 (39.3 %) had axillary hyperhidrosis, and 20 (35.7 %) had both plantar and axillary hyperhidrosis. In addition, 21 patients (37.5 %) had palmar pompholyx, five (8.9 %) had keratolysis exfoliativa, 10 (17.9 %) had chilblains, and nine (16.1 %) had palmar rhagades. A single 10-mm skin incision was made in the third intercostal space at the anterior axillary line, posterior to the pectoralis muscle. A 5-mm microthoracoscope and a 3-mm microelectrocautery hook were inserted through a single port into the thoracic cavity. The third and fourth ribs were identified, and the sympathetic chain was cut using the microelectrocautery hook. The bypassing nerve fibers, such as the Kuntz nerve fiber bundle, were ablated for 2-3 cm along the surface of the rib. The palmar temperature was recorded before and after sympathicotomy. All 56 procedures were completed using single-port microthoracoscopy. No postoperative complications such as hemorrhage, wound infection, hemopneumothorax, bradycardia, or Horner’s syndrome were observed. Bilateral procedures were completed in 20-56 min (mean 30 min). The palmar temperature increased by 2.2 ± 0.3 °C after surgery. The postoperative hospital stay was 1-4 days (mean 2.5 days). Mild compensatory sweating of the back and thigh occurred in five patients (8.9 %) at 2-3 days after surgery and disappeared at 7-15 days. The patients were followed up for 28.5 months (range 1-62 months). Hyperhidrosis resolved in both hands after surgery, and the previously wet, cold hands became dry and warm. The efficacy rate was 100 %. Plantar hyperhidrosis was also significantly reduced in 33 of the 34 patients with this condition (remission rate 97.1 %), and axillary hyperhidrosis was significantly reduced in 19 of 22 patients (remission rate 86.4 %). Eighteen of the 20 patients (90.0 %) with both plantar and axillary hyperhidrosis experienced significant alleviation of their symptoms. Single-port microthoracoscopic thoracic sympathicotomy is a safe, convenient, and effective method of treating palmar hyperhidrosis. This procedure can accurately locate the sympathetic chain with a small incision, minimal invasiveness, and good cosmetic results. The procedure is suitable for extensive clinical use.

PMID: 26702233 [PubMed]

November 11, 2018

Post-traumatic unilateral plantar hyperhidrosis.

Post-traumatic unilateral plantar hyperhidrosis.

Clin Auton Res. 2016 Feb;26(1):75-7

Authors: Eren Y, Yavasoglu NG, Comoglu SS

Abstract
Localized unilateral hyperhidrosis is rare and poorly understood, sometimes stemming from trauma. Feet, quite vulnerable to trauma are affected by disease-mediated plantar hyperhidrosis, usually bilaterally. This report describes partial hyperhidrosis developing post-traumatically on the left plantar region of a 52-year-old male.

PMID: 26691636 [PubMed – indexed for MEDLINE]

November 11, 2018

Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil.

Icon for Scientific Electronic Library Online

Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil.

An Bras Dermatol. 2015 Sep-Oct;90(5):661-5

Authors: Lima SO, Aragão JF, Machado Neto J, Almeida KB, Menezes LM, Santana VR

Abstract
BACKGROUND: Hyperhidrosis or excessive sweat production occurs at 2.9-9% of the population.
OBJECTIVE: To estimate the prevalence and disorders due to primary hyperhidrosis (HP) in medicine students in the state of Sergipe.
METHODS: Cross-sectional study using individual interviews.
RESULTS: Hyperhidrosis was found in 14.76% of subjects, the most affected regions were palmar, plantar and axillary, causing prejudice in daily activities. Family history occurred in 45% and 22.72% was diagnosed by a physician.
CONCLUSION: The prevalence of hyperhidrosis in medicine students of Sergipe was high, with strong family and a small portion of diagnoses made by medical professionals.

PMID: 26560211 [PubMed – indexed for MEDLINE]

November 11, 2018

Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases.

Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases.

Dermatol Ther. 2016 Jan-Feb;29(1):32-6

Authors: González-Ramos J, Sendagorta-Cudós E, González-López G, Mayor-Ibarguren A, Feltes-Ochoa R, Herranz-Pinto P

Abstract
Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six-month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.

PMID: 26445325 [PubMed – indexed for MEDLINE]

November 11, 2018

Papillon-Lefevre Syndrome In An Adolescent Female: A Case Study.

Papillon-Lefevre Syndrome In An Adolescent Female: A Case Study.

J Clin Diagn Res. 2015 May;9(5):ZD23-5

Authors: Jijin MJ, Jaishankar HP, Narayaran VS, Rangaswamy K, Puthaswamy KA

Abstract
Papillon-Lefevre Syndrome (PLS) is a rare inherited autosomal-recessive condition with one-third of the patients’ showing consanguinity of the parents. Lesions are characterised by palmar-plantar hyperkeratosis and hyperhidrosis. Early onset of periodonditis, severe periodontal destruction in both primary and permanent dentitions, and calcification of the duramater form the three important features of this disease. Here, we present a case of a 14-year-old female who presented to the Department of Oral Medicine and Radiology with a complaint of mobility of the teeth since four months. Oral examination of the patient showed generalised mobility of the teeth. General physical examination of the patient showed dry scaly skin on dorsum of bilateral feet, hands, and knee. The patient had familial history positive for consanguinity. The patient was medically diagnosed as positive for PLS. The patients with PLS show combination of dermatological and dental lesions and it requires the dentist to assume a more prominent role in early treatment and rehabilitation. There is a need for symbiotic and synergetic approach between the two specialties for effective management of this rare disease.

PMID: 26155583 [PubMed]

November 11, 2018

[Image-guided pain therapy. Sympathicolysis].

[Image-guided pain therapy. Sympathicolysis].

Radiologe. 2015 Jun;55(6):462-9

Authors: Burbelko M, Wagner HJ, Gutberlet M, Grothoff M

Abstract
BACKGROUND: In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome.
METHODS: The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added.
RESULTS: The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome.
CONCLUSION: After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar SL.

PMID: 26063075 [PubMed – indexed for MEDLINE]

November 11, 2018

Unilateral sequential endoscopic thoracic sympathectomy for palmar hyperhidrosis: a proposed technique to overcome compensatory hyperhidrosis and improve plantar hyperhidrosis.

Unilateral sequential endoscopic thoracic sympathectomy for palmar hyperhidrosis: a proposed technique to overcome compensatory hyperhidrosis and improve plantar hyperhidrosis.

J Laparoendosc Adv Surg Tech A. 2015 May;25(5):370-4

Authors: Youssef T, Soliman M

Abstract
BACKGROUND: Although endoscopic thoracic sympathectomy (ETS) offers permanent cure of palmar hyperhidrosis (PH), compensatory hyperhidrosis (CH) often complicates the procedure. We analyzed the outcomes of a 2-month interval for unilateral sequential ETS (S-ETS) in comparison with simultaneous bilateral ETS (B-ETS), notably regarding CH and associated plantar hyperhidrosis, in treating patients with PH.
PATIENTS AND METHODS: Four hundred seven patients with intractable PH were randomly assigned into two groups: the B-ETS group (204 patients) and the S-ETS group (203 patients).
RESULTS: Three hundred sixty-four patients completed the study. Complication rates were comparable for both groups. No patient died perioperatively, and no conversion was necessary. Treatment success on follow-up was 97.2% for S-ETS and 96.7% for B-ETS. The incidence of CH was decreased substantially from 131 (71.1%) patients in the B-ETS group to 22 (12.2%) patients in the S-ETS group (P<.001), with no patient suffering severe CH in the S-ETS group compared with 33 (25.5%) patients in the B-ETS group. Eighty-four (58.3%) patients in the S-ETS group had simultaneous disappearance or decreased perspiration on the soles. All patients in the S-ETS group were satisfied, whereas 37.9% of B-ETS patients were unsatisfied with their operation, mostly because of CH and recurrences.
CONCLUSIONS: Although both sympathectomies were effective, safe, and minimally invasive methods for treatment of PH, unilateral sequential ETS appeared to be a more optimal technique in terms of reduction of CH to a minimum and improvement of associated plantar hyperhidrosis.

PMID: 25768057 [PubMed – indexed for MEDLINE]

November 11, 2018

Long-term results of the use of oxybutynin for the treatment of plantar hyperhidrosis.

Long-term results of the use of oxybutynin for the treatment of plantar hyperhidrosis.

Int J Dermatol. 2015;54(5):605-11

Authors: Wolosker N, Teivelis MP, Krutman M, de Paula RP, Kauffman P, de Campos JR, Puech-Leão P

Abstract
BACKGROUND: Plantar hyperhidrosis is a common illness with significant impact on quality of life. Oxybutynin presents good short-term results, but longer follow-up results are lacking. We evaluated oxybutynin effectiveness in patients who were not surgically treated and who had at least six months of follow-up.
METHODS: From September 2007 to September 2013, 85 consecutive patients were enrolled in our institutional protocol for the “pharmacological-first” treatment of primary plantar hyperhidrosis with oxybutynin. Eight patients were lost to follow-up, 15 patients have not yet been under treatment for six months, and data were available for 39 patients (all female) treated for at least six months. Data at the start of the protocol, six weeks after beginning treatment, and at their final visit were analyzed.
RESULTS: Twenty-three of the 77 patients (29.87%) did not improve after pharmacological therapy. From the 39 patients with more than six months of follow-up (median 16.9 months, range 9-71), 79.5% reported moderate/great improvement in excessive plantar sweating after six weeks of treatment, and this rate increased to 84.7% in the last follow-up visit; 82.85% showed improvement in other sites presenting hyperhidrosis. Dry mouth was the most common side effect; 51.6% of patients reported it to be moderate/severe at the last visit.
CONCLUSION: In patients with good initial response to oxybutynin, more than 82% presented moderate or great improvement in plantar and other sites’ excessive sweating; dry mouth was the most common side effect but was tolerable and did not lead any patient to interrupt treatment.

PMID: 25600990 [PubMed – indexed for MEDLINE]

November 11, 2018

Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years.

Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years.

Pediatr Dermatol. 2015 Sep-Oct;32(5):663-7

Authors: Wolosker N, Teivelis MP, Krutman M, de Paula RP, Schvartsman C, Kauffman P, de Campos JR, Puech-Leão P

Abstract
Oxybutynin for treating hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

PMID: 25490865 [PubMed – indexed for MEDLINE]

November 11, 2018

Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis.

Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis.

World J Surg. 2015 Apr;39(4):905-11

Authors: Rieger R, Pedevilla S, Lausecker J

Abstract
BACKGROUND: Primary plantar hyperhidrosis is characterised by excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle. The aim of this prospective study was to assess the effect of endoscopic lumbar sympathectomy (ESL) on the quality of life (QL) of patients with primary plantar hyperhidrosis.
METHODS: Bilateral ESL was performed on 52 patients, 31 men and 21 women with primary plantar hyperhidrosis. Perioperative morbidity and clinical results were evaluated in all patients after a mean follow-up of 15 months. Postoperative QL was examined with the SF-36V2 questionnaire and the hyperhidrosis-specific questionnaires devised by Milanez de Campos and Keller.
RESULTS: All procedures were carried out endoscopically with no perioperative morbidity. Plantar hyperhidrosis was eliminated in 50 patients (96%) and two patients (4%) suffered a relapse. Unwanted side effects occurred in the form of compensatory sweating in 34 (65%) and in the form of postsympathectomy neuralgia in 19 patients (37%). Ninety six percentage of patients were satisfied with the postoperative result and 88% would have the surgery repeated. The SF-36V2 questionnaire revealed a significant improvement of QL after lumbar sympathectomy in physical health (physical component summary, p < 0.01) as well as mental health (mental component summary, p < 0.05). Improved QL was also demonstrated in the Milanez de Campos questionnaire in the dimensions functionality/social interactions (p < 0.01), intimacy (p < 0.01), emotionality (p < 0.01) and specific circumstances (p < 0.01) as well as in the Keller questionnaire in the area of plantar hyperhidrosis (p < 0.01).
CONCLUSION: The performance of an ESL in patients with primary plantar hyperhidrosis leads to the effective elimination of excessive sweat secretion of the feet and to an increase in QL.

PMID: 25476759 [PubMed – indexed for MEDLINE]