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A case of a 15-year-old male with unilateral facial circumscribed hyperhidrosis is reported. No morphological anomalies of the eccrine sweat glands could be noted. The results obtained with local applications of aluminium hexachloride in 20% alcoholic solution are discussed together with the few previous cases appearing in the literature.
Axillary hyperhidrosis consists of excessive sweating, producing severe embarrassment and a personal and social handicap. Anatomy and physiology of sweating are reviewed. A localized surgical attack on the excessively active sweat glands is preferred to topical anti-perspirants and systemic medications which are inadequate. Flaps are elevated and the resection includes the glands down to the dermal level. No skin excision seems to be necessary. Long term results are analysed, and the satisfaction of the patients demonstrates the efficacy of this treatment.
In a randomised, double-blind, controlled clinical trial of the effect of treatment with tap water iontophoresis, 11 patients with palmar hyperhidrosis were treated actively on one hand and with placebo on the other. The patients' sweat production was 100% higher (median) than measured in control subjects of the same age and sex. Prior to iontophoresis, the patient's sweat production was the same on both hands but after treatment it was reduced significantly on the treated hand (p less than 0.01) compared with the sweat production prior to treatment as well as with that of the untreated side. An 81% reduction (median) in sweating was found in 6 patients receiving maintenance treatment every second week.
The present report deals with an unique case of myokymia-hyperhidrosis syndrome. A 46-year-old man developed generalized relatively slow, undulating movement of the muscles, excessive sweating, muscle cramps and easy fatigability since three years ago. On admission, he had generalized myokymia, abnormal movements consisting of slow, undulating and worm-like muscular contractions. There was no muscle atrophy or weakness, or sensory deficits. Deep tendon reflexes were diminished and no Babinski sign or other pathological reflexes were present. Muscle tone was in normal range. Neither fasciculation nor myotonia was found. Laboratory examinations revealed elevation of BMR with normal thyroid function. The value of anti-Ach receptor antibody was below 0.6nmol/l. EMG recordings showed (1) continuous spontaneous repetitive discharges of NMU at a frequency of 30-50Hz, with duration of 1-2 seconds and amplitude of about 1 mV, were demonstrated at rest and the findings were consistent with myokymia, (2) waxing phenomenon was observed on repetitive peripheral nerve stimuli, which didn't improve by the tension test, and (3) high amplitude, long duration and polyphasic NMU, a sign of denervation, were observed on voluntary contraction. Muscle biopsy specimens from the left quadriceps showed a number of internal nuclei. On electron microscopy, clustered mitochondria and filamentous bodies were very often found in subsarcolemma. From these observations, damage to peripheral nerves, neuromuscular junctions and muscles may be responsible for the generalized myokymia in our patient.
Therapeutic action of bornaprine on localized forms of hyperhidrosis is studied in 12 patients. 50% improved after a week treatment. Other patients showed an acceptable change in the third or fourth week. Side effects only appeared in one patient.
The development of a modern and specific device, using the principle of ionophoresis, enables now to treat a symptom, sometimes severely disabling, before which physicians felt helpless until now: hyperhidrosis. The methodology is simple, and the treatment well tolerated. The efficacy, demonstrated by our study, is particularly impressive, if a strict protocol is followed.
The technique of endoscopic sympathectomy is described and its value in the treatment of upper limb hyperhidrosis is reported in an initial series of 7 patients (13 sympathectomies). It is recommended as the treatment of choice for this condition.
123 patients suffering from axillary hyperhidrosis have been operated on as outpatients under local anaesthesia, with radical ablation of sweat glands. All except 7 patients were satisfied with the result. There were few complications. A group of patients and controls were extensively studied including quantitative sweat testing and axillary biopsis. Apart from increased axillary sweating during the test, no differences could be found. The basic etiology of the condition is still unknown.
By using a technique in which the hair-bearing skin of the axilla is undermined through three small incisions the eccrine glands can be methodically removed. The resulting scarring is minimal and is aesthetically acceptable. In a series of 25 patients (50 axillae) 23 were totally cured of their hyperhidrosis. The remaining 2 patients were sufficiently improved not to require any further treatment. The technique may be undertaken under either local or general anaesthesia.
Surgical treatment of hyperhidrosis axillaris is described using a housed razor blade to remove subcutaneous sweat glands.
Seven patients with hyperhidrosis of the palms or soles resistant to topical application of aluminum chloride solution were treated successfully with tap water iontophoresis. After an average of 10 or 11 treatments 80% sweating suppression was found on palms and 74% suppression on soles. As side effects of treatment discomfort and transient skin irritation were observed depending on the amperage used. The effect lasts up to several weeks; however, maintenance treatment on an individual schedule is required.
A man with congenital hypertrophy of the left leg experienced concomitant fungal and gram-negative bacterial infection of the foot on the same side. Oral antibiotic therapy failed, compromised by a post-surgical short bowel. Despite two hospitalizations for intensive care with intravenous antibiotic therapy, the infection did not clear until his plantar hyperhidrosis on the affected side was eliminated by the use of topical aluminum chloride.
The treatment results in 133 patients who underwent bilateral upper dorsal sympathectomy (BUDS) for palmar hyperhidrosis (HH) are reported. Group 1 (67 patients) was followed for 5 to 10 yr (mean 7) and Group 2 (66 patients) was followed for 1 to 4 yr (mean 2). Early results and complications, early and late sequelae, late recurrence and patient satisfaction with the results of the operation were analyzed. The immediate success rate was 98%, and late recurrence of HH was noted in 5.3% of the patients. The incidence of technical complications was lower in Group 2 than in Group 1, otherwise both groups were similar. Persistent, severe Horner's syndrome was present in only one patient at late follow-up. Troublesome compensatory HH persisted in one-third of the patients. Overall patient satisfaction was good, and only 10 patients regretted having undergone the operation. BUDS appears to be the best solution for severe palmar HH in properly selected patients.
All participants with a baseline print score of greater than 1 demonstrated reduced sweating for up to six weeks following treatment with the Drionic device. Because of experimental design flaw, similar results were not obtained from those participants producing a baseline sweat print of 1. Therefore, the impression from these results is that, while not completely supported by objective data, it is possible to substantiate the subjective information related by patients in the control of hyperhidrosis.
A thoracic sympathetic ganglionectomy was performed on 457 patients with palmar hyperhidrosis, resulting in a complete cessation of the excessive palmar sweating but not a total abolition of the sweating of the upper extremity, forehead, face, neck, upper chest and upper back. This procedure does not produce a Horner's syndrome. The present data provide evidence that sympathetic pathways for controlling sweating of the above-mentioned skin areas come mainly through the second thoracic ganglion, and therefore from the spinal cord segment below T1 in man.
Sweat glands from the palm of a patient with hyperhidrosis were examined by light and electron microscopy before and after treatment with tap water iontophoresis. No changes in structure were noted after treatment, disclaiming the currently accepted theory that mechanical ductal obstruction is the mechanism of action of this method. Furthermore, we believe the safety and effectiveness of this treatment are supported by our experience.
Iontophoresis has been demonstrated to be an effective treatment for hyperhidrosis. The technique is simple and can be used in the practitioner's office. Once patients are euhidrotic, they can be taught to give the treatments to themselves, and the iontophoresis therapy can be continued at home.
The degeneration activity of effector organs is due to a period of transmitter release from degenerating sympathetic post-ganglionic nerve endings. This is the theoretical explanation for a period of sweating some days following sympathectomy for hyperhidrosis seen in some patients operated on with the thoracoscopic technique in Jönköping, Sweden. The reasons for degeneration activity, well documented in animal experiments, are discussed in this paper.