Is compensatory hyperhidrosis after thoracic sympathicotomy in palmar hyperhidrosis patients related to the excitability of thoracic sympathetic ganglions?

Abstract

The mechanism of compensatory hyperhidrosis remains unclear. The aim of this study was to explore the relationship between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability to assess the effectiveness of thoracoscopic T4 sympathicotomy for treating palmar hyperhidrosis. Sixty-six cases of T4 sympathetic ganglions were prospectively collected from patients with palmar hyperhidrosis who underwent thoracoscopic T4 sympathicotomy from 2013 to 2016 in our department. The expression levels of choline acetyltransferase (ChAT), vasoactive intestinal peptide (VIP), and synaptophysin were detected using immunohistochemistry. Patients with palmar hyperhidrosis were followed-up for examination of postoperative sweating status. Thirty-eight cases (57.6%) of compensatory hyperhidrosis were identified. Mild compensatory hyperhidrosis occurred in 26 patients (39.4%), moderate in 11 (16.7%), and severe in 1 (1.5%). The rate of compensatory hyperhidrosis was higher in patients with axilla hyperhidrosis than those without (76.0% vs. 46.3%, P=0.018). However, the clinical data were similar between the compensatory hyperhidrosis group and the no compensatory hyperhidrosis group. In addition, the ChAT, VIP, and synaptophysin expression levels were not significantly different between the two groups (P values of 0.356, 0.071, and 0.141, respectively). Furthermore, the ChAT, VIP, and synaptophysin expression levels in the mild group were similar to those observed in the moderate/intense group (P values of 0.089, 0.124, and 0.149, respectively). The remission rate was 100% in palmar hyperhidrosis, 48.2% (27/56) in pedal hyperhidrosis, 56.0% (14/25) in axilla hyperhidrosis and 88.9% (16/18) in skin symptoms. No signs of chapped skin on the palms were found. There was no significant correlation between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability; however, compensatory hyperhidrosis is more likely to simultaneously occur in patients with axilla hyperhidrosis. The satisfactory efficacy of thoracoscopic T4 sympathicotomy indicates that it may an ideal technique for palmar hyperhidrosis.