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Surgical treatment of hyperhidrosis axillae.

58 patients have been operated on for axillary hyperhidrosis by excision of the skin and subcutaneous tissue. The hyperhidrotic area was determined by application of a crêpe paper in the axilla. Either 60% or 90% of the hyperhidrotic area was excised, using a bat-like pattern. Only after excision of 90% of the hyperhidrotic area acceptable results were achieved. In a series of 22 patients with 90% excision bilaterally 18 had excellent results, three were good, and one was poor. The entire series was without complication. The advantage of this technique is its simplicity, freedom from complication, performance on an out-patient basis, and short convalescent time.

Adolescent↗

Changes in hemodynamics of the carotid and middle cerebral arteries before and after endoscopic sympathectomy in patients with palmar hyperhidrosis: preliminary results.

OBJECT: The purpose of this study was to analyze the change in carotid and middle cerebral artery (MCA) hemodynamics before and after endoscopic upper thoracic sympathectomy in patients with palmar hyperhidrosis (PH). METHODS: Sixty-eight patients with PH (35 males and 33 females) for whom the average age was 24.5+/-10.7 years (+/- standard deviation) were recruited into this study. These patients all underwent routine upper T-2 sympathectomy to treat their PH. Ultrasonography studies of the carotid arteries (CAs) and MCA were obtained in each patient before and after T-2 sympathectomy. The blood flow volume, flow velocity, and resistivity index (RI) in the bilateral common CAs (CCAs), internal CAs (ICAs), and external CAs (ECAs) were evaluated using duplex ultrasonography. The systolic peak velocity, mean velocity, diastolic peak velocity, pulsatility index, and RI of the bilateral MCAs were evaluated using transcranial Doppler ultrasonography. Blood pressure and heart rate were also recorded during this study. The Student paired t-test was used to analyze the differences between studies before and after bilateral T-2 sympathectomy. There was a significant reduction in diastolic pressure after T-2 sympathectomy (p = 0.003), but not in systolic pressure or heart rate. The vessel diameter was increased after sympathectomy in the left CAs and right CCA. The T-2 sympathectomy led to significant elevation of blood flow volume and RI in the left CCA, ICA, and ECA (p < 0.05). The authors found significant increases in maximum flow velocity and RI in the left MCA (p < 0.05). CONCLUSIONS: Patients who underwent T-2 sympathectomy demonstrated a significant increase in blood flow volume and flow velocities of the CAs and MCA, especially on the left side. Asymmetry of sympathetic influence on the hemodynamics of the CAs and MCA was noted. The usefulness of sympathectomy for the treatment of ischemic cardiovascular and cerebrovascular disease deserves further investigation.

Adolescent↗

The changes of skin temperature on hands and feet during and after T3 sympathicotomy for palmar hyperhidrosis.

Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.

Adolescent↗

Hypothermia, hyperhidrosis, myokymia and increased urinary excretion of catecholamines associated with a thymoma.

OBJECTIVE: To report a rare syndrome associated with a thymoma and its first successful treatment with gammaglobulin. CLINICAL FEATURES: A 49-year-old white male presented with marked hypothermia, hyperhidrosis, myokymia and increased urinary excretion of catecholamines four weeks after complete excision of a malignant thymoma. He became increasingly drowsy, obtunded and required ventilatory support. INTERVENTION AND OUTCOME: A catecholamine secreting tumour was excluded and he was treated with intravenous gammaglobulin for five days, with dramatic improvement in his condition. Six months later he remains in remission. CONCLUSION: The response to treatment in this patient suggests an immunological pathogenesis for this rare group of symptoms associated with a thymoma.

Catecholamines↗

Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride.

Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4 mg, with 0.25 mg to be taken at bedtime, to prevent daytime sedation) [corrected] and a topical solution of 20% aluminum chloride in anhydrous ethyl alcohol (Drysol). Over a period of 2 or 3 weeks, the patient achieved a complete remission of symptoms, while having only mild side effects. The treatment regimen also had the added advantage of lowering generalized anxiety.

Administration, Topical↗

[How I treat ... idiopathic hyperhidrosis].

Palmo-plantar and/or axillary idiopathic hyperhidrosis is unpleasant and sometimes invalidating. Its malodorous variant which is due to biodegradation by bacterias is called bromhidrosis. According to the severity of the condition, several therapies exist including psychotherapy, various topical products, iontophoresis, botulinic toxin injections and thoracic sympathectomy.

Administration, Topical↗

Thermographic study of palmar and facial skin temperature of hyperhidrosis patients before and after thoracic sympathectomy.

PURPOSE: The purpose of this study was to investigate the roles of the second thoracic sympathetic segment in the sympathetic innervation of the hands and face, and to compare skin temperature changes in the palms, fingers, face, and neck of palmar hyperhidrosis (PH) patients before and after endoscopic thoracic sympathectomy. METHODS: Twenty-two patients, 14 women and eight men, with severe PH were treated with endoscopic ablation of the T2 segment. The skin temperatures of the hands, neck, and face were assessed by infrared thermography both before and after operation. RESULTS: All obtained satisfactory relief of PH. Before sympathectomy, thermography revealed that the palmar skin temperature (PST) was significantly lower than the facial temperature by 1.3 degrees C (paired t-test, p < 0.005). After sympathectomy, thermography showed significant elevations in temperature mainly of the thenars, palms, digits, and nose, but not of the forehead, mandible, or neck (ANOVA, p < 0.05 with Bonferroni t-test). The variations in PST among PH patients were much greater preoperatively than postoperatively. More prominent postoperative PST elevation was found in PH patients with lower preoperative PST (r = 0.898, p < 0.001). CONCLUSIONS: These findings demonstrate that the T2 segment is the key source of sympathetic innervation to the hand and that the T2 segment contributes only trivial sympathetic innervation to the face. The results of the present thermography studies offer descriptive information about the autonomic innervation of the upper thoracic sympathetic trunk.

Adolescent↗

Improving botulinum toxin therapy for palmar hyperhidrosis: wrist block and technical considerations.

Botulinum A exotoxin has become an excellent therapeutic option to treat focal hyperhidrosis, but when the problem affects the palmar region the technique has some drawbacks. Pain with injection is difficult to tolerate and the large dose needed to treat both hands are two concerns, as well as muscle weakness secondary to botulinum toxin diffusion and the possibility of antibody production. All these problems limit the number of patients treated. The author's suggestion is to treat only the dominant hand, after performing a wrist block. The use of a device adapted from a cartridge rubber may help to control the injection depth and the risk of muscular weakness.

Botulinum Toxins, Type A↗

[Changes of autonomic functions by endoscopic upper thoracic sympathectomy on idiopathic hyperhidrosis].

Changes of autonomic functions before and after bilateral endoscopic upper thoracic sympathectomy (EUTS) were evaluated in 13 patients with idiopathic hyperhidrosis, with the sympathetic skin response, coefficient of variation of R-R intervals, mean heart rate, thermography, and non-invasive Valsalva test of the tonometry method. EUTS electronically destructs the upper thoracic sympathetic ganglions which innervate the upper extremities, and partially the heart. The decrement of mean heart rate, and persistent inhibition of the vascular contraction and hidrosis of the hands appeared after EUTS. These manifestations were effect produced by the abortion of sympathetic activity by EUTS. In 10 of the 12 cases, the baroreceptor sensitivity index II of Valsalva test which reflects the sympathetic autonomic nervous function of the heart showed normal pattern after EUTS. Four cases revealed reincrement of both the blood pressure and heart rate at the latter half phase of the second stage of the Valsalva test. The sympathetic dysfunction of the heart was limited to the decrement of mean heart rate although EUTS partially destroys sympathetic fibers innervating the heart. A long-term study is necessary to evaluate the effect of EUTS on the cardiac function.

Adolescent↗

A survey on anesthesia for thoracoscopic sympathetic surgery in treatment of hyperhidrosis palmaris in Taiwan.

Thoracoscopic approach to sympathetic surgery has gained its popularity and emerged as the main stream in the treatment of hyperhidrosis palmaris in Taiwan. Different kinds of anesthesia have been practiced and reported in these surgeries. We made a survey of anesthetic methods in twelve medical centers and regional hospitals of the island. It was found out that the choice of the anesthesia was mainly dependent on the mutual trust and the full communication between the anesthesiologist and the surgeon, both based on their skills and the operative methods chosen by the surgeon. Single-lumen endotracheal tube with general inhalation anesthesia is practiced in most of the hospitals surveyed. Sevoflurane and desflurane are the choices of the inhalational anesthetic agents. In short, the anesthesiologists tend to practice the type of anesthesia that is simple but safe enough to secure the airway of the patient throughout the thoracoscopic sympathetic surgery.

Anesthesia↗

[Results of thoracoscopic sympathectomy in hyperhidrosis of the upper extremities (author's transl)].

Thoracoscopic sympathectomy bei Kux's method was undertaken on 256 occasions for the treatment of 168 patients suffering from hyperhidrosis of the upper extremities. There were no operative fatalities. Thoracotomy was required in only 2 cases, the indication being intraoperative bleeding. 2 further patients developed a tension pneumothorax postoperatively necessitating drainage. The operation was successful in all but 2 cases. Division of the sympathetic chain between T1 and T2 suffices to achieve dryness of the hands; if underarm perspiration is to equally influenced then division of the sympathetic trunk must be extended caudally to the level of T5. On follow-up examination of 104 patients 2 and 10 years after the operation, a successful result was noted in 94% of cases. Unwanted side effects were vicarious and gustatory perspiration, which arose in 39% and 56% of cases respectively, but did not affect the successful outcome of the operation.

Adult↗

[A clinico-physiological analysis of essential hyperhidrosis].

A total of 30 patients with essential hyperhidrosis (EH) and 20 healthy test subjects were examined. Based on the anamnestic and clinical data the patients with EH were distributed into 2 groups: permanent EH and remitting EH (PEH and REH respectively). REH and PEH patients manifested disorders of the suprasegmental part of the autonomic nervous system, which showed up by a rise of the level of reactive and personality anxiety, an increase of the readings of the MIL test scales. PEN patients demonstrated segmental vegetative disorders that manifested by reduced conduction in sweating fibers (a method of evoked cutaneous sympathetic potentials), a lowering of sympathetic effects in the cardiovascular system, a decline of diurnal excretion of catecholamines. The conclusion is made about the presence of 2 forms of EH: permanent EH and remitting EH that differ in the degree of involvement of the suprasegmental and segmental parts of the autonomic nervous system into the pathological process. Based on the reduced conduction in the sympathetic sweating fibers in PEH patients the conclusion is drawn that denervation hypersensitivity to blood catecholamines plays a great role in the pathogenesis of the given pattern of EH.

Adolescent↗

Treatment of hyperhidrosis with botulinum toxin A.

Focal hyperhidrosis of axillae, palms or soles is a frequent, socially debilitating condition triggered by various emotional stimuli. There are several treatment options such as local application of metal sales (aluminum chloride) or tap water iontophoresis, which provide temporary relief for some patients. More recently, local intradermal injections of botulinum toxin A (BTX-A), a neurotoxin blocking the cholinergic stimulus of eccrine sweat glands, offers an effective treatment option with few side-effects. Patient satisfaction rates are high, although treatment effects only last a few months. For definite care, surgical procedures have to be considered.

Algorithms↗

Hyperhidrosis: an approach to diagnosis and management.

Hyperhidrosis is defined as focal or generalized excessive sweating with a prevalence of 2.8% of the general population. This medical condition is associated with significant psychosocial morbidity and has a dramatic impact on activities of daily living. A significant proportion of patients do not consult a physician for this condition. Early diagnosis is essential in order to implement management strategies that have excellent efficacy rates and patient satisfaction.

Humans↗

[Olfactory and gustatory sweating--case report on reflex facial hyperhidrosis].

Localised hyperhidrosis is comparatively rare among the vegetative disorders. A case of pathological gustatory and olfactory sudation is reported, with the sequence of symptoms corresponding to that of the Frey syndrome. Working from the reflex nature of the phenomen, the paper puts forward a model to account for the delayed onset of the manifestation following a peripheral lesion. It is assumed that readjustment of the reflex excitation level takes place according to a modification in peripheral afference, and that a decompensation of the central control mechanisms results in a pathological enhancement of the reflex. The hypothesis of peripheral efferentisl denervation hypersensitivity appears insufficient to account for the delay in manifestation, or even to account for the classic Frey syndrome following an affection of the parotid gland.

Humans↗

Liposuction for treatment of axillary hyperhidrosis.

Axillary hyperhidrosis is a common and often troublesome problem. Current therapy includes topical antiperspirants, systemic anticholinergic medications, iontophoresis, and surgery. Axillary liposuction promises to be the surgical treatment of choice for those patients refractory to other modalities.

Axilla↗