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PubMedDate not supplied

Bleomycin sulfate in the treatment of mosaic plantar verrucae: a follow-up study.

In this report, the authors will supplement research performed in 1989 by Sollitto, Napoli, and Gazivoda on the use of intralesional bleomycin for the treatment of verrucae. With various alterations of technique, their original success rate of 32.2% was improved to 65.4%. Thus, bleomycin is a very effective first line treatment for multiple verrucae, particularly of the mosaic variety. An association is also made between patients with pedal hyperhidrosis and the occurrence of multiple verrucae, notably lesions that prove recalcitrant to initial therapy.

Adolescent↗
PubMed2001

Posterior approach for the simultaneous, bilateral thoracoscopic sympathectomy.

If there is an indication for sympathectomy in the case of severe hyperhidrosis or rubeosis, in our opinion the posterior approach is preferable because of the advantages in surgical technique and anesthesia. Bilateral treatment can be accomplished in a single admission, with all the concomitant advantages.

Adolescent↗
PubMed2003

A family with a variant form of primary hypertrophic osteoarthropathy restricted to the lower extremities.

We report a case of a family with a variant form of primary hypertrophic osteoarthropathy (HOA) restricted to the lower extremities without digital clubbing or cutaneous changes. Three family members suffered from pain, swelling and hyperhidrosis of both feet. X-rays showed destruction and osteoproliferative changes of the metatarsal bones with periostal hyperostosis close to the talus. There was an increased 99m-Tc-MDP uptake in the early phase of bone scintigraphy. Fibrosis of the marrow with stimulated osteoclastic resorption and the presence of detritus synovialitis were visible in a bone and joint biopsy. All known infectious, neurologic, metabolic and malignant diseases, which affect the bone and joints, were excluded.

Adult↗
PubMed2003

Centrally mediated reflex vasodilation in the gingiva induced by painful tooth-pulp stimulation in sympathectomized human subjects.

This study was designed to determine whether painful electrical stimulation of the tooth pulp induces centrally mediated reflex vasomotor changes in human gingiva and whether the sympathetic nervous system is involved in the vasomotor responses. Dynamic changes in maxillary gingival blood flow (GBF) following painful electrical stimulation of the mandibular lateral incisor were investigated, by means of laser-Doppler flowmetry, in both healthy volunteers and patients undergoing sympathetic blockade for hyperhidrosis. Increases in GBF were observed in both healthy volunteers and patients on the ipsilateral side without an increase in systemic blood pressure, but the evoked GBF increase disappeared when pain sensation was abolished by local anesthetization with 2% xylocaine solution. The vasodilator responses did not differ in amplitude between before and after the sympathectomy. These results suggest that painful tooth stimulation evokes centrally mediated reflex vasodilation, presumably via parasympathetic efferent fibers, in the human gingiva and that sympathetic vasomotor mechanisms are not involved in these responses.

Adult↗
PubMed1997

Pitted keratolysis: clinical manifestations in 53 cases.

Pitted keratolysis (PK) has been reported to be more common among bare-footed people living in tropical regions. It is now known that the disease is not limited to the tropics but has a world-wide distribution. However, no study has previously been performed analysing the clinical manifestations of the disease in temperate countries. A survey of 53 patients revealed several distinctive clinical features. Hyperhidrosis is the most frequently observed symptom of this condition. Malodour and sliminess of the skin are also distinctive features, evident in 88.7% and 69.8% of the cases, respectively. The most common sites of onset of PK are the pressure-bearing areas, such as the ventral aspect of the toe, the ball of the foot and the heel. The next most common site is a friction area, the interface of the toes. Lesions are rarely seen on the non-pressure-bearing locations. Some of the primary lesions originate as a small defect along the plantar furrow, which gradually grows into the characteristics crateriform pit. Several clinical features are helpful in diagnosing PK.

Adolescent↗
PubMed2001

Dose thresholds and duration of the local anhidrotic effect of botulinum toxin injections: measured by sudometry.

BACKGROUND: Local injections of botulinum toxin type A (BTX-A) have been used successfully to treat focal hyperhidrosis, but because experimental data were lacking, doses have been chosen arbitrarily or empirically. OBJECTIVES: To analyse dose dependency and duration of BTX-A-derived suppression of sweat gland activity. METHODS: Employing a standardized scheme (four injections, square 2 x 2 cm), different doses of BTX-A [Dysport(R); 2.5-120 mouse units (MU)] were injected subcutaneously at the lateral aspects of both of the lower legs in 15 healthy volunteers. Sweat tests were performed before, and 3 weeks and 6 months after, BTX-A injections. Sweating was visualized by staining with iodine starch, and quantified by capacitance hygrometry after carbachol iontophoresis, the quantitative sudomotor axon reflex test (QSART). RESULTS: Iodine starch staining indicated a threshold dose of 10 MU (2.5 MU cm-2) leading to visible anhidrotic skin spots after 3 weeks in all subjects. This was maintained for 6 months with doses of 50 MU (12.5 MU cm-2) or higher, but the size of the anhidrotic skin area decreased over time (P < 0.001) indicating partial recovery at the edges. After 3 weeks QSART was significantly reduced (P < 0.02) and completely suppressed by doses of 80 MU (20 MU cm-2) or more, although after 6 months QSART increased again to pre-BTX-A levels (P < 0.001). Both methods indicated that the suppression of sweating is dose dependent (QSART: r = -0.70, P < 0.001; iodine starch staining: r = 0.74, P < 0.001). CONCLUSIONS: Our findings suggest that BTX-A effectiveness can be quantified by testing sudomotor function. For the first time threshold doses for the suppression of sweating have been defined.

Adolescent↗
PubMed2000

Botulinum A exotoxin in cosmetic dermatology.

Botulinum A exotoxin, a neurotoxin produced by the bacterium Clostridium botulinum, is now being used by cosmetically oriented specialists for treatment of a large variety of movement associated wrinkles on the face and neck. This form of temporary chemical denervation compliments the cosmetic practitioner's armamentarium alongside resurfacing and tissue augmentation. Additionally, the use of Botulinum toxin to block sympathetic innervation of eccrine sweat glands is proving a valuable treatment of hyperhidrosis of the axillae, palms and soles.

Botulinum Toxins, Type A↗
PubMed2003

An unusual case of palmoplantar keratoderma.

A 55-year-old woman with palmoplantar keratoderma presented an associated hyperhidrosis with distinct odour and maceration. She had had the lesions for about 20 years and this seemed to be an isolated case in her family. This case appeared very unusual because there were no signs of acanthokeratolysis in the biopsies. Two months of treatment with acitretin (Neotigason; 25 mg daily), produced a spectacular result: clearance of all the lesions on both hands and a strong diminution of the lesions on the soles. The Unna-Thost variant of palmoplantar keratoderma usually appears in the first few months of life, and it rarely appears in the third decade. The condition is inherited as an autosomal dominant with high penetrance and expressivity. Our subject appeared to be an exception to these two facts.

Acitretin↗
PubMed1999

Minimally invasive surgery for axillary osmidrosis: combined operation with CO2 laser and subcutaneous tissue remover.

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasionally staining of clothes that may handicap those affected both socially and psychologically. Various types of surgical procedures have been developed for the treatment of axillary hyperhidrosis and osmidrosis. OBJECTIVE: To introduce a new odor measurement method and minimally invasive surgery technique for axillary osmidrosis. METHODS: Eighty-eight patients with axillary osmidrosis were treated by combined operation using a carbon dioxide (CO2) laser and subcutaneous tissue remover. Measurement of axillary odor was done with the cotton-roll method. RESULTS: Eighty-seven of the 88 patients (98.8%) had good to fair results; only one patient (1.2%) had poor results. Complications such as ecchymosis and partial skin necrosis with delayed wound healing occurred in four patients (4.6%). CONCLUSION: A combined technique using a CO2 laser and subcutaneous tissue remover has the advantages of a high success rate, low complication rate, no admission treatment, less scarring, and rapid recovery. This combined approach should become the preferred technique for the treatment of axillary osmidrosis.

Adolescent↗
PubMedDate not supplied

Spinal dysraphism presenting as acro-osteolysis: report of four cases.

The acro-osteolyses are a heterogeneous group of disorders characterized by bone resorption. The disorder may occur as familial, idiopathic, or secondary to vascular, inflammatory, or neurologic conditions. Acro-osteolysis is rare in association with spinal dysraphism. It is even rarer for it to be the presenting symptom in spinal dysraphism. We report here four patients in whom the diagnosis of spinal dysraphism was established while investigating for the various causes of acro-osteolysis. All four patients presented with trophic changes and acro-osteolysis. Hyperhidrosis in the affected limb was seen in three patients. One patient had leg pain, the others had no sensory or motor deficits. Magnetic resonance imaging showed spinal dysraphism in all four patients.

Adolescent↗
PubMedDate not supplied

Palmar-plantar keratoderma of Unna Thost associated with atopic dermatitis: an underrecognized entity?

We report six cases of palmar-plantar keratoderma of Unna Thost (PPKUT) associated with atopic dermatitis. All had typical features of PPKUT with diffuse, yellowish thickening on the palms and soles with a well-defined erythematous rim of demarcation on the sides associated with palmar-plantar hyperhidrosis. The changes were obvious since birth or arose during early life, and were persistent. We believe that the association between the two disorders is not coincidental but an underrecognized entity that may shed light on the underlying pathogenesis of these two conditions.

Adult↗
PubMed1993

Palmar thermometry for intraoperative success control of thoracic sympathectomy.

In a pilot study involving six patients, palmar thermometry was used as a non-invasive method for intraoperative success control during thoracic sympathectomy. Using commercially available thermo-elements and amplifier modules, a marked increase in temperature could be registered in five patients after the severance of their rami communicants grisei for the hand. This effect was associated with the long-term success of therapy for hyperhidrosis in all five patients. This initial experience demonstrates that palmar thermometry is sensitive enough to measure surgical success intraoperatively. The limit of the thoracic sympathectomy in the cranial direction is indicated intraoperatively and Horner's syndrome is avoided with certainty.

Body Temperature↗
PubMed1993

Selective video-assisted thoracoscopic sympathectomy.

Video-assisted and thermometrically controlled thoracoscopic sympathectomy demonstrates new ways in the treatment of upper-limb hyperhidrosis. An anatomical portrayal of the sympathetic chain is possible as a result of the improved visualization and magnification of the operative area provided by the video-optic technique. The difference in temperature, registered by means of a thermometric sensor in the palm of the hand, indicates that the sympathetic nerves responsible for the hyperhidrotic segments have been severed. The number of postoperative Horner's syndromes will be reduced significantly with this method. Until now, we have successfully treated six thermometrically controlled patients. No recurrences have arisen during an 18 months observation period. Neither intraoperative nor postoperative complications were recorded. One patient complained of increased compensatory sweating of the trunk. Thermometrically controlled thoracoscopic sympathectomy is expected to improve the various forms of treatment available for sympathetic reflex dystrophies in the future.

Body Temperature↗
PubMed1985

Thoracic sympathectomy as a therapy for upper extremity ischemia. A long-term follow-up study.

Fifty-seven patients who had 72 thoracic sympathectomies have been reviewed. Twenty-five patients were preoperatively diagnosed as having primary Raynaud's phenomenon, 14 as having Raynaud's phenomenon secondary to arterial occlusion, 17 as having ischemia secondary to arterial occlusion and one as having hyperhidrosis. Twenty percent of the patients initially diagnosed as having primary Raynaud's phenomenon at the time of operation developed a collagenosis during the follow-up period. Improvement after 8 years' follow-up did not depend on the primary indication. Up to the fifth year after surgery a relapse was seen in cases of primary Raynaud's phenomenon. In secondary Raynaud's phenomenon a gradual decrease in improvement of 2% a year was seen during follow-up. In ischemia secondary to arterial occlusion, after 2 years the percentage of improved patients remained constant at a level of 70%. The mean improvement after 8 years follow-up according to the survival test of Gehan was 70 +/- 10%.

Adult↗
PubMed2000

Histopathological examination of chemo-sympathectomy in cats.

In recent decades, there has been an increase in both the number of sympathectomy techniques, as well as the surgical findings of sympathetic anatomy. Currently the advanced technique of C-arm guided percutaneous thoracic chemo-sympathectomy is widely used for the treatment of palmar hyperhidrosis. However, a better understanding of chemical agents in sympathectomy is required. In this study, chemo-sympathectomy was performed in cats, using alcohol, glycerol and various concentrations of phenol, to determine the chronic neurotoxic effects of these chemical agents on the stellate ganglia. The stellate ganglia of 24 cats were exposed under endotracheal general anesthesia, then injected with about 0.02 ml of absolute alcohol, glycerol and phenol (10%, 25%, 50%, and 75% concentration) solutions, respectively. The stellate ganglia were taken for histological examination three weeks after the chemical injection. The results showed that the degenerative changes in the cytoplasm and nucleus of ganglionic cells and intercellular tissue were moderate and relatively moderate after the injection of alcohol and glycerol, respectively. Meanwhile, the stellate ganglia revealed mild, relatively moderate, serious and extremely serious degeneration after injection of 10%, 25%, 50%, and 75% phenol, respectively. In conclusion, we recommend a high concentration of phenol, in the least volume, as a chemical agent for clinical injection in the upper thoracic sympathetic ganglion.

Animals↗
PubMed1998

Treatment of social phobia by endoscopic thoracic sympathicotomy.

OBJECTIVE: To analyse the severity of various symptoms and the developmental life history in social phobia. To estimate the value of ETS in the treatment of chronic social phobia. DESIGN: Prospective study. SETTING: Clinic for Psychoneurology and Surgery in Tampere, Finland. SUBJECTS: Consecutive series of patients (n = 51). INTERVENTIONS: Endoscopic thoracic sympathicotomy. MAIN OUTCOME MEASURES: Qualitative ideographic inquiry. Questionnaire of the symptom severity using visual analogue scale. RESULTS: The life history included mental and physical abuse in 61%, paternal alcoholism in 26%. Four family subtypes were named: quarrelsome, cruel, alcoholic, and perfectionist. The pathognomonic symptoms of social phobia: hyperhidrosis, palpitation, blushing, tremor, and anxiety, were all highly significantly (p < 0.001) alleviated by ETS. 88% of the patients were satisfied with the result. There were no complications. CONCLUSION: ETS seems a promising alternative to conservative therapy for social phobia.

Adult↗
PubMed2004

Botulinum neurotoxin serotype A: a clinical update on non-cosmetic uses.

PURPOSE: Clinical experience with botulinum toxin type A for non-cosmetic uses that are approved by the Food and Drug Administration (FDA) and various other non-cosmetic uses that are not approved by FDA, including some applications that are widely known and others that currently are emerging, is discussed. SUMMARY: FDA-approved indications for botulinum toxin type A (Botox) include the temporary treatment of cervical dystonia (a neuromuscular disorder involving the head and neck), the oculomotor disorders strabismus (improperly aligned eyes) and blepharospasm (involuntary contraction of the eye muscles), and severe primary axillary hyperhidrosis (excessive sweating). Other uses of botulinum toxin type A that are widely known but not approved by FDA include spastic disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, or cerebral palsy and focal dystonias affecting the limbs, face, jaw, or vocal cords. Treatment and prevention of chronic headache and chronic musculoskeletal pain are emerging uses for botulinum toxin type A. CONCLUSION: Many of the conditions for which botulinum toxin type A has been explored are common and difficult to treat. Temporary improvement in symptoms is associated with botulinum toxin type A injection, and repeat treatment often is required. The drug is well tolerated and has a wide margin of safety.

Botulinum Toxins, Type A↗