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Abstract

We greatly appreciate the comments of Drs Chick and Srinivasa. We agree that surgical therapy should be performed in patients who fail more conservative managements that may also include percutaneous ablation of the sympathetic chain and ganglia.1Augustin M. Radtke M.A. Herberger K. Kornek T. Heigel H. Schaefer I. Prevalence and Disease Burden of Hyperhidrosis in the Adult Population.Dermatology. 2013; 227: 10-13Crossref PubMed Scopus (62) Google Scholar, 2Stefaniak T. Tomaszewski K.A. Proczko-Markuszewska M. Idestal A. Royton A. Abi-Khalil C. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults.J Dermatol. 2013; 40: 819-823PubMed Google Scholar Kim et al3Kim W.O. Yoon K.B. Kil H.K. Yoon D.M. Chemical lumbar sympathetic block in the treatment of plantar hyperhidrosis: a study of 69 patients.Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2008; 34: 1340-1345PubMed Google Scholar and Garcia-Barquin et al4García-Barquín P. Aquerreta Beola J.D. Bondía Gracía J.M. España Alonso A. Pérez Cajaraville J. Bartolomé Leal P. et al.Percutaneous CT–guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis.J Vasc Interv Radiol. 2017; 28: 877-885Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar reported satisfactory early results with percutaneous computed tomography-guided nerve ablations using either alcohol injection or a radiofrequency generated heat. Late recurrent symptoms and a lower patient satisfaction with longer follow-up, however, have also been reported.2Stefaniak T. Tomaszewski K.A. Proczko-Markuszewska M. Idestal A. Royton A. Abi-Khalil C. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults.J Dermatol. 2013; 40: 819-823PubMed Google Scholar, 5Strutton D.R. Kowalski J.W. Glaser D.A. Stang P.E. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey.J Am Acad Dermatol. 2004; 51: 241-248Abstract Full Text Full Text PDF PubMed Scopus (489) Google Scholar Neuronal regeneration after percutaneous ablations are likely responsible for higher recurrence rates and for the compensatory sweating after percutaneous procedures.5Strutton D.R. Kowalski J.W. Glaser D.A. Stang P.E. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey.J Am Acad Dermatol. 2004; 51: 241-248Abstract Full Text Full Text PDF PubMed Scopus (489) Google Scholar, 6Moraites E. Vaughn O.A. Hill S. Incidence and prevalence of hyperhidrosis.Hyperhidrosis. 2014; 32: 457-465Google Scholar, 7Ibrahim O. Kakar R. Bolotin D. Nodzenski M. Disphanurat W. Pace N. et al.The comparative effectiveness of suction-curettage and onabotulinum toxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial.J Am Acad Dermatol. 2013; 69: 88-95Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 8Zheng Z. Liu Y. Min X. Tang J. Liu H. Cheng B. Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso.Neural Regen Res. 2017; 12: 1177Crossref PubMed Scopus (3) Google Scholar, 9Park H.-S. Hensman C. Leong J. Thoracic sympathetic nerve reconstruction for compensatory hyperhidrosis: the Melbourne technique.Ann Transl Med. 2014; 2: 45PubMed Google Scholar The number of patients with long-term follow-up after percutaneous ablations remains small. For this reason, we believe that currently the treatment that provides efficacy and safety with reliable long-term results is surgical sympathectomy, thoracoscopic for facial, palmar, and axillary primary hyperhidrosis, and retroperitoneoscopic for primary plantar hyperhidrosis.10Vannucci F. Araujo J.A. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results.J Thorac Dis. 2017; 9: S178-S192Crossref PubMed Scopus (31) Google Scholar All operative procedures have some degree of adverse effects, of which compensatory sweating is the most disturbing for the patient and decreases patient satisfaction, even if there was resolution of excessive sweating after surgery at the site affected primarily. Patients with hyperhidrosis should be informed of both conservative and surgical treatment options, and they should be well aware of compensatory sweating as a potential side effect. The gold standard for the treatment of primary hyperhidrosis is remains elusive, and well-designed prospective randomized multicenter studies are needed to confirm the best available treatment. Currently, a multidisciplinary team approach involving psychologists, psychiatrists, , dermatologists, and surgical experts is needed to achieve the best result and to improve the quality of life , for these frequently desperate patients. Regarding “Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis”Journal of Vascular SurgeryVol. 68Issue 1PreviewLima et al1 described 58 patients who underwent retroperitoneoscopic lumbar sympathectomy of the L2, L3, and L4 ganglia 116 times for plantar hyperhidrosis. Plantar hyperhidrosis resolved in 100% of patients at 30 days.1 Nineteen patients (33%) experienced transient lower extremity paresthesias and three (5%) reported transient thigh neuralgia.1 No patients died.1 Full-Text PDF Open Archive