Gustatory sweating associated with unilateral hyperpigmentation.
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Botulinum toxin treatment is an efficient, well-tolerated technique for patients suffering from gustatory sweating, first described by our group. With the experience gained in recent years we were able to improve on some of our skills in the diagnosis and treatment of gustatory sweating and here we wish to focus on some interesting aspects: (1) the necessity for an exact anamnesis before treatment with botulinum toxin to ensure correct treatment; (2) the advantages of Minor's test in special situations, for example, when sweating occurs in regions of hairy skin, retroauricular, at the back of the auricle and in areas distant from the site of salivary gland surgery; (3) the reduction of pain during treatment using an anesthetic ointment containing lidocaine and prilocaine as active substances; (4) intracutaneous injections in areas anterior to the fascia-protected skin of the lateral face-covering mimetic muscles, and (5) the occasional necessity for short-time reinjection in small areas of persistent sweating.
Herein reported is a 41-year-old white man with lifelong gustatory sweating over the vertex of the head induced by orange juice, tomatoes, onions, and certain nonchocolate candies and snack foods. IgE RAST and prick tests were negative to those offending foods for which test antigens were available. The types of gustatory sweating and their therapeutic modalities are summarized.
A 73-year-old man suffered from gustatory sweating after submandibular gland removal. Frey's syndrome was diagnosed and successfully treated with intracutaneous injections with botulinum A toxin.
BACKGROUND: Botulinum toxin A has meanwhile become a proven method for treatment of gustatory sweating (focal hyperhidrosis, Frey's syndrome). Clear-cut recommendations regarding dosage of botulinum toxin A in Frey's syndrome are currently not available. The aim of this prospective randomized study therefore was to investigate botulinum toxin A with respect to its efficacy in Frey's syndrome, the ideal dose yielding maximal duration of the effect, and patient contentedness as well as unwanted side effects in patients of the Clinic of OMF Surgery at the Ruhr-University of Bochum. PATIENTS AND METHOD: Twenty patients suffering from severe Frey's syndrome as a result of operations of the parotid gland were examined with the starch iodine test according to Minor. The gustatory skin areas were re-examined after intracutaneous injection of botulinum toxin A for up to 1 year. The patients ( n=20) were randomly assigned to two different treatment groups (group I: 2 MU/cm(2), n=10; group II: 3 MU/cm(2), n=10). RESULTS: Mean sweating skin areas in the two treatment groups ranged between 39+/-9 and 32+/-12 cm(2), respectively. A single injection of 3 MU botulinum toxin A resulted in a nearly complete blockade of gustatory sweating for the observation period of 1 year. In the group treated with 2 MU botulinum toxin A, 44% of the total gustatory skin areas were still sweating, thus necessitating a second injection of botulinum toxin A in these patients. CONCLUSION: Intracutaneous injection of botulinum toxin A represents a highly effective and minimally invasive procedure for the treatment of Frey's syndrome. This study shows for the first time that a dosage of 3 MU/cm(2) of botulinum toxin A achieves a complete and reliable blockade of gustatory sweating lasting for at least 12 months. This dose may therefore be recommended for treatment of this syndrome.
A new suggestion for treating marked sweating with Frey's syndrome namely, sweat suppression by aluminium chloride, is presented, together with a survey of the different attempts to suppress the hyperhidrosis. The mechanism of sweat suppression, the form of application and the results in 28 patients suffering from marked gustatory sweating, are outlined. After a single application, an interval of several weeks free of symptoms can be expected.
Hyperhidrosis is a chronic condition characterized by excessive sweating. Recent studies report that it affects approximately 2.8% of the population and typically begins during adolescence. Gustatory sweating usually occurs after parotid gland injury or surgery, and both disorders can be debilitating for those who are affected. Both diseases respond very well to botulinum toxin therapy and this article will review the use of botulinum toxins, including the serotypes used, dosing, and complications.
Quite by chance, when reading an old manuscript dealing with fistulae of the parotid duct, the author came across a clear description of what is now well known as gustatory sweating (Frey's syndrome). The incident which gave rise to this observation is recalled and the account is reproduced in the original text.
Botulinum toxin has been successfully used to treat Frey's syndrome occurring in a 31-year-old patient following superficial parotidectomy for pleomorphic adenoma. An initial injection of 7.5 U (0.3 ml over 6 cm2 of cheek) resulted in 3 months' resolution of gustatory sweating and flushing and a second injection 12 months' symptomatic improvement. The symptoms recurred after further facial surgery.
Facial sweating associated with eating develops occasionally after thoracic sympathectomy. Its occurrence has never been previously documented in association with a tumor in the upper chest. This report describes the first case of Pancoast's tumor presenting as hemifacial gustatory sweating.
A case of Frey's syndrome arising in a free radial forearm flap used to reconstruct a defect in the parotid region is reported. To our knowledge, Frey's syndrome, although common following parotidectomy, has not been reported in a free flap. It is possible that parasympathetic secretomotor fibres gained access to the fasciocutaneous flap via the cutaneous nerve stumps in its edge, resulting in gustatory sweating.
A 35-year-old man, previously healthy except for a grade 1 goitre, sustained a spontaneous left pneumothorax treated with a Bülau drain. When the left pneumothorax recurred 2 months later a left thoracotomy was performed. Two bullae at the lung apex were resected and a pleurodesis performed. After the operation the patient noted hypaesthesia of the dorsum of the left upper arm, mild ptosis of the left eyelid as well as reduced sweat secretion over the left half of the face and the left rib cage. The hypaesthesia improved, but the sympathetic nerve deficits remained. There were no other neurological signs. 9 months later, within one minute of eating a sour apple, the patient developed severe sweating over the left half of the face and the left chest. The reaction was confirmed by infra-red thermography which proved that the skin temperature in the sweating region had fallen to 3 degrees C. The likely cause of localized gustatory sweating is intra-operative damage of the stellate ganglion or its preganglionic nerve connections. Treatment is limited to avoidance of the precipitating gustatory stimulus.
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.
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