Abstract
Hyperhidrosis, the medical term for excessive sweating beyond physiological need, is a condition with serious emotional and social consequences for affected patients. Symptoms usually appear in focal areas such as the feet, hands, axillae and face. Non-surgical treatment options such as topical antiperspirants or systemic medications are usually offered as a first step of treatment, although these therapies are often ineffective, especially in severe and intolerable cases of hyperhidrosis. In the treatment algorithm for patients suffering from hyperhidrosis, surgical thoracoscopic sympathicotomy offers a permanent solution, which is particularly effective in the treatment of palmar hyperhidrosis and facial blushing. In this review, we describe the current status of thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing. In addition, we share the specific treatment approach, technique and results of our Hyperhidrosis Expert Center. Last, we share recommendations to ensure an effective, reproducible and safe application of single-port thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing, based on our extensive experience.
Highlights
Published: 31 January 2022Hyperhidrosis or excessive sweating is a medical condition with disabling emotional and social consequences for affected patients [1]
As of 2021, over 1500 procedures with the technique we previously described have been performed in the Hyperhidrosis Expert Center
As of 2021, we have performed more than 40 single-stage single-port thoracoscopic R2 sympathicotomy procedures for severe facial blushing in the Hyperhidrosis Expert Center
Summary
Hyperhidrosis or excessive sweating is a medical condition with disabling emotional and social consequences for affected patients [1]. The pathophysiology of primary focal hyperhidrosis (PFH) has not yet been fully elucidated. PFH should be distinguished from secondary hyperhidrosis, in which excessive sweating is usually more generalized and elicited by underlying systemic conditions or medication [5–7]. The field of treatment options for PFH is constantly evolving in an attempt to relieve patients of both mental and physical consequences of the disease. A step-wise approach with topical antiperspirants, botulinum toxin injections, iontophoresis and systemic medication is generally recommended [8–10]. Aluminum chloride has been reported as the most effective topical antiperspirant as a first-line treatment in axillary hyperhidrosis, and armpit dryness can be achieved within 48 h. An important disadvantage of this treatment is Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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