Idiopathic Hyperhidrosis Research Articles

Enhancing Quality of Life: Pre- and Postoperative Assessment in Idiopathic Hyperhidrosis Patients.

This study aimed to characterize patients, describe surgical complications, and evaluate the pre- and postoperative quality of life (QOL) of individuals who underwent surgery for primary hyperhidrosis (PHH). A prospective, non-randomized, uncontrolled study was conducted, documenting cases of patients undergoing surgery for PHH at a reference center in La Habana, Cuba, from January 2016 to December 2022. A total of 49 cases were described, with a median age of 16 years; 59.1% were female. The most common presentation was palmar-plantar-axillary, observed in 53% of cases. The palmar presentation was more frequent in female patients (p<0.05). Within 24 hours post-procedure, 85.7% of patients showed dryness in the palmar and axillary areas, with surgical complications occurring in 14.3% of cases (intercostal neuritis, pneumothorax, and hemothorax). CHof some form was recorded in 89.8% of cases. At least 30 days after the surgery, 95.9% of the patients reported a significant improvement in their QOL. Thoracic sympathectomy is an efficient and safe method for treating hyperhidrosis in adolescents, leading to an enhanced QOL. However, this study reported a higher incidence of complications, particularly CH, compared to previous national and international studies.

Utilities of Botulinum Toxins in Dermatology and Cosmetology.

Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacterium with a well-known efficacy and safety profile in the focal idiopathic hyperhidrosis treatment. BoNT comprises seven different neurotoxins; however, only toxins A and B are clinically employed. BoNT is lately practiced in off-label therapies for a variety of skin diseases. Scar prevention, hyperhidrosis, rhytides, eccrine nevus, alopecia, psoriasis, Darier disease, bullous skin disease, pompholyx and Raynaud’s phenomenon are some of the novel indications for BoNT in cosmetic and notably non-cosmetic aspects of dermatology. To employ BoNT correctly in clinical practice, we must have a thorough understanding of the functional anatomy of the mimetic muscles. An intensive literature search was conducted to update all dermatology-oriented experiments and clinical trials on the described element of BoNT for this general overview of BoNT use in dermatology. This review aims to analyse the role of BoNT in dermatology and cosmetology.

Paroxysmal localized Hyperhidrosis, a case-report: When excessive sweating occurs in combination with severe headaches

Paroxysmal localized hyperhidrosis is a rare disorder of the central autonomic nervous system. No association between paroxysmal hyperhidrosis and severe headache has been previously described in literature.Case description: A 65-year-old woman with idiopathic paroxysmal localized hyperhidrosis combined with severe holocranial headache attacks is described in this case report. Extensive diagnostic testing by means of laboratory examinations, 24-hour urinalyses, chest X-ray, abdominal ultrasound and computed tomography scans, and brain and spinal cord magnetic resonance imaging could not identify an underlying disorder. A diagnosis of idiopathic paroxysmal localized hyperhidrosis was made, and the patient was successfully treated with clonidine 0.075 mg three times a day, without any side effects. Paroxysmal localized hyperhidrosis is a rare central autonomic nervous system disorder that can occur in combination with severe headache. Both the headache and paroxysmal hyperhidrosis complaints were treated effectively with clonidine in the patient described in this case-report.

Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review.

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

Modern non-cosmetic treatment with botulinum toxins

Botulinum toxin has been known in medical history for along time. The first scientific investigations and thoughts on possible indications in the treatment of muscular disorders were published by the German physician and poet Justinus Kerner in 1822. The physiological effect of botulinum toxin was identified in the middle of the twentieth century and the first clinical use was reported in 1977. It was first used in ophthalmology for the correction of strabismus and some years later the therapy of blepharospasm and cervical dystonia was established. Further indications, all supported by randomized controlled studies, are spastic tone increase of the limbs after lesions of the central nervous system, idiopathic axillar hyperhidrosis, chronic migraine and neurogenic or idiopathic bladder hyperactivity. In addition to these indications, alarge number of further possible options have been published in the literature. Beside its effect on transmission at the neuromuscular synapses, botulinum toxin has also been shown to affect the sensory transmission of nociceptive fibers.

Clonidine is effective for the treatment of primary idiopathic hyperhidrosis and hot flushes: a case report

BackgroundWhile primary hyperhidrosis can be seen in men, accompanying hot flushes is rarely seen in men. Primary hyperhidrosis is thought to be related to overactivity of the sympathetic nervous system while hot flushes are believed to be related to altered peripheral vascular reactivity and a narrowed thermoregulatory zone.Case presentationI report the case of a 29-year-old man of Arab origin who presented to a dermatology clinic with a complaint of generalized sweating, with heavier involvement of his inguinal region, axilla, and lower back. His complaint was associated with a transient hot sensation and erythema over the affected areas. He did not respond to topical antiperspirants containing aluminum chloride, topical aluminum chloride, or to botulinum toxin A injected in both inguinal areas. He was then referred to an endocrinology clinic to rule out secondary causes of hyperhidrosis and hot flushes; a primary diagnosis was confirmed. He did not respond to oral glycopyrrolate and additionally was complaining of its anticholinergic side effects. The glycopyrrolate was then replaced with oral clonidine 0.15 mg twice a day. Clonidine was well tolerated without remarkable side effects and he quickly started to feel marked improvement which was maintained for 2 years.ConclusionsI report an atypical presentation of primary hyperhidrosis and hot flushes that was effectively controlled by clonidine without remarkable side effects. Further research on a large number of patients may be required before recommending clonidine in similar conditions.

A new method for evaluation of the autonomic nervous system in patients with idiopathic hyperhidrosis: systolic blood pressure and heart rate recovery after graded exercise.

Idiopathic hyperhidrosis (IH) is characterized by excessive and uncontrolled production of sweat, mainly localized to the soles, palms, axillae and craniofacial area. Although IH is a disease concerning the autonomic nervous system, it is not clear yet whether this dysfunction is local or systemic. To evaluate the autonomic control of cardiovascular system by measuring values of heart rate recovery (HRR) and systolic blood pressure recovery (SBPR) obtained at various time intervals after maximal graded exercise treadmill testing in patients with IH compared with controls. The study population comprised 36 patients with IH (20 men, 16 women; mean age 25 ± 7 years) and 36 healthy controls (HCs) (12 men, 24 women; mean age 27 ± 5 years). All patients were selected from young, nonobese and healthy sedentary individuals. Peak HR values reached in patients with IH were significantly higher compared with the HC group (P < 0.001). The obtained HRR values at minutes 3, 4 and 5 were significantly lower in the IH than the HC group [57 ± 16 vs. 64 ± 9 (P = 0.03); 61 ± 14 vs. 68 ± 9 (P = 0.03); 64 ± 12 vs. 70 ± 7 (P < 0.01)]. In addition, calculated mean values for SBPR1 and SBPR2 were > 1 in patients with IH (1.04 ± 0.15 vs. 0.98 ± 0.08 and 1.0 ± 0.12 vs. 0.94 ± 0.06, respectively) and these were statistically significant compared with the HC group (P = 0.04 and P = 0.03, respectively). The significantly impaired SBPR and decreased HRR values we observed in patients with IH may indicate that the autonomic dysfunction in IH is a systemic disorder with cardiovascular effects, rather than a merely local disease. Both HRR and SBPR values may provide additional information about predicting adverse cardiovascular events in the future even in apparently healthy young patients with IH.

Idiopathic hyperhidrosis: Is response to parasympathetic function test altered?

Background: Idiopathic hyperhidrosis is characterized by excessive sweating, especially of palms of the hands and soles of the feet. It is said to be owing to sympathetic overactivity. However, autonomic nervous system as a whole could be dysfunctional in this condition, rather than isolated sympathetic dysfunction. Aims and Objective: We have undertaken this study to test and compare the autonomic function status in these patients with age- and sex-matched healthy individuals. Materials and Methods: Twenty, normal subjects with no known autonomic dysfunction as controls and 20, known idiopathic hyperhidrosis patients as subjects were taken for this study. Autonomic function tests were performed in both these groups and the results were compared. Result: Sympathetic function tests, which were performed, were within the normal range whereas parasympathetic tests were normal except for response to deep breathing test, which showed a significant increase (P < 0.01) in the hyperhidrosis patients, compared with the controls. Conclusion: Response to deep breathing, a parasympathetic test, was significantly increased in the patients with hyperhidrosis compared with controls in this study; we will conclude this study with the findings that the idiopathic hyperhidrosis seems to be a complex dysfunction of autonomic nervous system, which involves autonomic pathways other than those related to excess sweating.

Idiopathic Hyperhidrosis; Is response to Parasympathetic function test altered?

Background: Idiopathic Hyperhidrosis is characterized by excessive sweating, especially of palms and feet. It is said to be due to sympathetic over activity. However, autonomic nervous system as a whole, itself could be dysfunctional in this condition, rather than isolated sympathetic dysfunction. Thus, we have undertaken the present study to test and compare the autonomic function status in these patients with age and sex matched healthy individuals. Material and Methods: Twenty, normal subjects with no known autonomic dysfunction as controls and twenty, known idiopathic Hyperhidrosis patients as subjects were taken for the present study. Autonomic function tests were performed in both these groups and were compared. Result: Sympathetic function tests, which were performed, were within the normal range whereas parasympathetic tests were normal except for response to deep breathing test, which showed a significant increase (P < 0.01) in the Hyperhidrosis patients, compared to the controls. Conclusion: Response to deep breathing, a parasympathetic test was significantly increased in patients with Hyperhidrosis compared to controls in the present study, which will conclude the study with the findings that the idiopathic Hyperhidrosis seems to be a complex dysfunction of autonomic nervous system, that involves autonomic pathways other than those related to excess sweating. Keywords: Idiopathic Hyperhidrosis; Autonomic Function Test; Parasympathetic dysfunction; Sympathetic over activity.

Evaluation of the effectiveness of thoracic sympathectomy in the treatment of primary hyperhidrosis of hands and armpits using the measurement of skin resistance.

IntroductionHyperhidrosis is excessive sweating beyond the needs of thermoregulation. It is disease which mostly affects young people, often carrying a considerable amount of socio-economic implications. Thoracic sympathectomy is now considered to be the "gold standard" in the treatment of idiopathic hyperhidrosis of hands and armpits.AimAssessment of early effectiveness of thoracic sympathectomy using skin resistance measurements performed before surgery and in the postoperative period.Material and methodsA group of 20 patients with idiopathic excessive sweating of hands and the armpit was enrolled in the study. Patients underwent two-stage thoracic sympathectomy with resection of Th2-Th4 ganglions. The skin resistance measurements were made at six previously designated points on the day of surgery and the first day after the operation.ResultsIn all operated patients we obtained complete remission of symptoms on the first day after the surgery. Inhibition of sweating was confirmed using the standard starch iodine (Minor) test. At all measurement points we obtained a statistically significant increase of skin resistance, assuming p < 0.05. To check whether there is a statistically significant difference in the results before and after surgery we used sequence pairs Wilcoxon test.ConclusionsThoracic sympathectomy is an effective curative treatment for primary hyperhidrosis of hands and armpits. Statistically significant increase of skin resistance in all cases is a good method of assessing the effectiveness of the above surgery in the early postoperative period.

Alterations in cardiovascular autonomic function tests in idiopathic hyperhidrosis

We performed cardiovascular autonomic function tests to assess sympathetic and parasympathetic functions in patients with idiopathic hyperhidrosis.We studied 35 patients with idiopathic hyperhidrosis and 35 age- and sex-matched controls. A thermoregulatory sweat test (TST) was performed in all subjects. Sweating was qualitatively (Minor's test at 22°C) and quantitatively (skin conductance) evaluated. Orthostatism, tilt to 65°, cold pressor test, deep breathing, Valsalva maneuver and hyperventilation were performed in patients and controls.A greater fall in blood pressure values was observed in patients than in controls in the upright tests (p<0.05). In particular, postural hypotension was present in a subgroup of patients (34%), in whom changes in lying-to-standing blood pressure and heart rate were greater (p<0.001) than those of the remaining patients. The TST revealed that the total body sweat rate (ml/cm²/min) was more pronounced in patients with postural hypotension (p<0.001) than in the other patients and controls. The skin conductance values of patients with postural hypotension were higher (p<0.001) than those of the remaining patients. A positive correlation was found between skin conductance values and postural hypotension. Dehydration and poor water intake may play a role in postural hypotension in patients with severe hyperhidrosis and pronounced thermoregulatory sweating.A significantly marked increase in parasympathetic function was observed in patients. Responses to deep breathing, Valsalva maneuver and hyperventilation were significantly greater in patients (p<0.001) than in controls.Idiopathic hyperhidrosis seems to be a complex dysfunction that involves autonomic pathways other than those related to sweating.

Bilateral sympathectomy via thoracoscope for treatment of idiopathic hyperhidrosis

Objective To summarize our experience in endoscopic thoracic sympathectomy (ETS) in treating palmar hyperhidrosis (PH) and investigate the feasibility of ETS for treating PH by hand surgeons.Methods From 2006 to 2010,23 patients who had palmar hyperhidrosis were treated by a single surgeon via endoscopic thoracic sympathectomy.The T2 to T3 thoracic sympathetic chain was interrupted by electrocautery.The patients were followed up once every three months.Treatment that resulted in palm skin temperature increase of 1℃ or more and dry and warm palm skin was considered effective.Treatment that resulted in palm skin temperature increase less then 1℃ and wet palm skin was considered ineffective.Results All patients had immediate cessation of palmar hyperhidrosis.Mild compensatory hyperhidrosis on the back or sole was noted in 4 patients.No moderate to severe compensatory hyperhidrosis or other complications were observed.Postoperative follow-up ranged from 3 moths to 3 years,with an average of 18 months.There was no recurrence.The effective rate was 100％.Conclusion Endoscopic thoracic sympathectomy is a safe and effective way to treat palmar hyperhidrosis and is a procedure that can be mastered by hand surgeons without a steep leaming curve. Key words: Thoracoscopes; Hyperhidrosis; Sympathectomy; Compensatory hyperhidrosis

Treatment of focal idiopathic hyperhidrosis with Botulinum Toxin Type A: clinical predictive factors of relapse‐free survival

No material about the identification of predictive clinical factors of therapeutic response to Botulinum Toxin Type A (BTX-A) in focal idiopathic hyperhidrosis has been found. To evaluate if age, sex, extension rate of hyperhidrotic area, localization, disease-related impairment of life quality, number of previous local, non-invasive treatments different from BTX-A, and duration of disease, may affect the relapse-free survival (RFS) after a BTX-A treatment in palmar and axillary focal idiopathic hyperhidrosis. Forty-one patients suffering from palmar hyperhidrosis, and 38 patients suffering from axillary hyperhidrosis received intradermal injections of BTX-A. All patients were clinically screened before and after treatment; they were followed for 15 months after it, according to Hyperhidrosis Disease Severity Scale (HDSS), Minor's test, and DLQI test, to state disease severity, and disease-related impairment of quality of life. The duration of therapeutic effect of BTX-A is not significantly influenced by age (P = 0.783), sex (P = 0.762), extension of hyperhidrotic area (P = 0.770), site of involvement (P = 0.402), disease-induced impairment of life quality (P = 0.745), number of previous therapies (P = 0.730), or site of involvement (P = 0.402). In palmar idiopathic hyperhidrosis, patients with a longer disease history show a shorter duration of RFS after a treatment with BTX-A (P = 0.01). Patients suffering from palmar hyperhidrosis have a longer lasting disease, and a length of disease more than 20 years in these patients influences the RFS after BTX-A treatment.

Localized crossed hyperhidrosis and the coexistence of thyroid gland disease

Hyperhidrosis is the most common type of sweat gland disorder. It may be localized or generalized. The localized type usually occurs in a symmetrical fashion over the palms, soles and armpits as a response to emotional stimuli. Another form of the localized type is idiopathic localized unilateral hyperhidrosis which is very rare and the etiopathogenesis remains unclear. Here, we report a female patient who had localized crossed hyperhidrotic areas on her body (on the left side of the scalp, face and the shoulder and on the right side of the trunk) and also had thyroid gland disease. We herein discuss this extremely rare presentation of the disease and its association with thyroid gland disease.

Thoracic sympathectomy and cardiopulmonary responses to exercise

The purpose was to study the effect of endoscopic thoracic sympathectomy (ETS) for palmar and/or axillary hyperhidrosis on physiological responses at rest, and during sub-maximal and maximal exercise in ten healthy patients (7 females and 3 males 18-40 years old) with idiopathic palmar and/or axillary hyperhidrosis. T2-T3 thoracoscopic sympathectomy was performed using a simplified one stage bilateral procedure. Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise immediately prior to and 70 days (+/-7.5, SD) after bilateral ETS. Exercise performance capacity and peak VO(2) were not found to be different following bilateral ETS than prior to the ETS. However, heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region but does not affect exercise performance or mechanical/physiologic efficiency, despite a significant reduction in heart rate (both at rest and during exercise). The latter was, most likely, fully compensated by an increase in stroke volume and less likely by an improved muscle O(2) extraction due to more efficient blood distribution, keeping the work-rate and oxygen uptake unaffected.

Use of oral glycopyrronium bromide in hyperhidrosis

Idiopathic hyperhidrosis may be a disabling condition causing emotional stress and negative impact on a patient's quality of life. Oral anticholinergics are one of the treatments available. There are few published data on the use of the anticholinergic drug glycopyrronium bromide (glycopyrrolate) given orally in the treatment of hyperhidrosis. To report a retrospective analysis describing the treatment responses, doses and side-effects of oral glycopyrrolate in the treatment of idiopathic hyperhidrosis. Review of case notes in a series of 24 patients, nine with generalized and 15 with localized hyperhidrosis. Fifteen of 19 evaluable patients (79%) responded to oral glycopyrrolate. However, treatment was limited by side-effects in around one third of patients. A prospective clinical study to compare the efficacy and side-effects of oral anticholinergics is warranted.

Botulinum neurotoxin serotype A: Italian experience in axillary focal idiopathic hyperhidrosis

Botulinum neurotoxin serotype A: Italian experience in axillary focal idiopathic hyperhidrosis

Oculosympathetic hyperactivity in idiopathic hyperhidrosis

We describe a patient suffering from idiopathic hyperhidrosis, more pronounced on the right side, who presented with intermittent oculosympathetic hyperactivity (mydriasis, lid retraction and more rapid pupillary dilatation) on the same side. Mydriasis was induced by stress, loss of sleep and cold pressor test. The clinical features in this patient suggest an involvement of the hypothalamic structures.

Empleo terapéutico de la toxina botulínica

Botulogenic toxin infiltration for the treatment of idiopathic local hyperhidrosis is a safe and well tolerated procedure, with minimum side effects and with an effectiveness demonstrated throughout the years, especially in axillary hyperhidrosis; in the majority of patients with this condition is an effective alternative to surgery. In other locations, the results are more modest and the clinical experience more limited, which forces us to advise the surgery as alternative with an incidence far from desirable.

Video-assisted Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: Results in 102 Cases

The purpose of this retrospective study was to evaluate the immediate and long-term outcome of video-assisted thoracoscopic sympathectomy for idiopathic palmar hyperhidrosis. Between January 1996 and December 2000, a total of 67 patients underwent 102 sympathectomy procedures with excision of the sympathetic chain between the second and fourth sympathetic ganglion. The mean duration of hospitalization was 1.7 +/- 0.6 days. Five patients were lost to follow-up. Mean duration of follow-up for the 96 sympathectomy procedures in the remaining 62 patients was 38 +/- 6.3 months. Patient outcome showed that video-assisted thoracoscopic sympathectomy is the treatment of choice for idiopathic palmar hyperhidrosis. Long-term patient satisfaction is excellent.