Palmar Sweating Research Articles

In vivo assessments of microneedle arrays and iontophoresis of pilocarpine in human palmar sweating.

Emotional stress-induced sweating in glabrous skin of the palm and sole, which can be excessive in some individuals (hyperhidrosis), can negatively impact quality of life. Understanding the mechanisms underlying this response can lead to potential treatments. Transdermal iontophoresis is a method to administer ionized sudorific agents to sweat glands within the dermis. However, due to the reduced permeability of pharmacological agents in thicker skin such as the palms, this technique has been shown to be less effective when applied in thicker skin. Thus, we assessed the effectiveness of pre-treating palmar skin with microneedles to create micropores on the stratum corneum of the palm to enhance the iontophoretic delivery of pilocarpine to modulate sweat production. On three separate sessions, we applied microneedles (0.78cm2, 190 needles with a length of 875μm) to palm and forearm skin sites. Upon removal of the microneedles, we assessed the number of perforations colored by gentian violet in the forearm only (Protocol 1, n=20), skin barrier function indexed by transepidermal water loss (TEWL) (Protocol 2, n=21), and sweating induced by the iontophoretic application of 1% pilocarpine (Protocol 3, n=43). Briefly, we measured 1) ∼172 dyed spots on forearm skin, 2) an increase of ∼300% and∼900% in TEWL on palm and forearm skin, respectively; and 3) a 2-fold increase in sweating on the palm only following the application of the microneedles. Notably, the microneedle array failed to enhance pilocarpine delivery at either the palm or forearm skin sites. We showed the application of a microneedle array enhanced skin permeability and sweat production on the palm without a concomitant increase in pilocarpine delivery. Therefore, this methodology could be employed to advance our understanding of the causes and treatments of medical conditions such as hyperhidrosis.

Effects of Medical Drugs According to Sweating Localization in Primary Hyperhidrosis

Background: Primary hyperhidrosis is excessive sweating localized to different parts of the body, mostly on the hands. It is exact cause unknown, negatively affects the psychosocial structure of the person and a clinically important health problem.
 Aims: In the study, it was aimed to examine the effects of drugs used on primary hyperhidrosis.
 Study Design: The drugs used by the patients who applied to the thoracic surgery clinic with the complaint of sweating and their effects were analyzed retrospectively. Ersin Arslan Training and Research Hospital Thoracic Surgery Clinic between January 1, 2015, and September 30, 2021 (outcomes of seven years).
 Methodology: A total of 120 patients(45 female, 75 male and age range 8-67) with sweating complaints were identified. Age, gender, sweating localization and drugs used were examined. Statistically, data were analyzed with 95% confidence interval(CI) and Chi Square test.
 Results: A total of 120 patients were analyzed. 37.5% were female and 62.5% male.The mean age was 27.1±1.54 years.Patients were use 23.4% Aluminum hydrochloride cream),20.8% Bornaprine hydrochloride, 20% Hyoscine-N-butylbromide.According to sweating localizations;42.6% palmar only, 18.7% palmar and axilla, 18.7% palmar and craniofacial, 7.8% palmar and plantar, 5.9% diffuse, 4.5% cranial, 1.8% palmar and abdomen.It is more often between ages of 21-30 and in male.According to the complaints of patients with a history of using medical treatment; there were 34.5% partial response and 20.2% complete response, and no response to medical treatment in 45.3%.
 Conclusion: In the study; according to the localization of sweating;Aluminum hydrochloride cream reduces sweating on the palmar, and Hyoscine-N-butylbromide reduces axillary and palmar sweating. Bornaprine hydrochloride reduces sweating on all localizations except craniofacial and abdomen, and is related with a complete response on palmar sweating.According to sweating localizations; although there are localizations where all three drugs used are effective, it has been concluded that these drugs used in primary hyperhidrosis do not respond fully at a high rate.

Eyes Closing and Drowsiness in Human Subjects Decrease Baseline Galvanic Skin Response and Active Palmar Sweating: Relationship Between Galvanic Skin and Palmar Perspiration Responses.

We previously constructed a perspiration ratemeter for the measurement of palmar sweating in human subjects. Although galvanic skin response (GSR) has been used to evaluate emotional responses in human subjects, little is known about the relationships between the phasic and baseline components in GSR and active palmar sweating. From the aforementioned, we aimed to investigate the relationships in human subjects with handgrip exercise and eyes closing or opening. Fifteen healthy volunteers (mean age: 26.9 ± 8.7 years) participated in the present experiments. We investigated the effects of maximal handgrip exercise, eyes closing or opening, and self-awareness of drowsy on the GSR, active palmar sweating, R-R interval in electrocardiograph (ECG), and percentage of α wave in EEG. The faster phasic component in GSR completely agreed with the starting point of active palmar sweating. Handgrip exercise induced significantly faster spike in GSR, active palmar sweating, and decrease in R-R interval in ECG. Eyes closing produced significant decreases in baseline GSR and active palmar sweating in all human subjects. The percentage of α wave in electroencephalograph (EEG) also increased. In contrast, eyes opening increased significantly the baseline GSR and active palmar sweating. In the equivalent electrical model of human skin, the eyes closing–mediated time-dependent decrease in the baseline GSR completely agreed with the hypothesis that the palmar skin voltage only in the model decreased time dependently to 0.4 of the control during 6 min. The self-awareness of drowsy in mid-night working with computer produced similar decreases in baseline GSR and active palmar sweating to the responses with eyes closing in all human subjects. In conclusion, the faster spike in GSR completely agreed with the starting point of active palmar sweating. Eyes closing and opening or self-awareness of drowsy significantly produced changes in baseline GSR and active palmar sweating, which may become useful tools for evaluating clearness or drowsiness in human subjects.

Brake Operation and Palmar Perspiration Reflect Older Adult Drivers' Ability to Predict Hazards: Driving Simulation Research

Brake Operation and Palmar Perspiration Reflect Older Adult Drivers' Ability to Predict Hazards: Driving Simulation Research

Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping.

Thoracoscopic sympathetic surgery is regarded as a definitive treatment for palmar hyperhidrosis. However, the optimal surgical strategy remains unclear. The aim of this study was to compare outcomes based on the level and type of sympathetic disconnection in patients with palmar hyperhidrosis. From January 2009 to December 2014, 101 patients with palmar hyperhidrosis underwent thoracoscopic sympathetic surgery at Gangnam Severance Hospital. Complete follow-up information was obtained from 59 patients. We retrospectively analyzed the results of operation, degree of palmar sweating (%), grade of compensatory sweating (none, mild, moderate, severe, very severe), grade of satisfaction (very satisfied, satisfied, moderate, dissatisfied, very dissatisfied), and recurrence/failure. R4 sympathicotomy, R4 sympathetic clipping, and R3 sympathetic clipping were performed in 16, 20, and 23 patients, respectively. The mean degree of palmar sweating after sympathetic surgery was not significantly different between these three groups (17.50% vs. 27.00% vs. 29.78%; P=0.38). The rate of life-bothering compensatory sweating was lower in the R4 sympathicotomy group compared with those of other two groups (0% vs. 25%, 47.8%; P=0.09). The rate of very satisfied to moderate grades of satisfaction were lower in the R3 sympathetic clipping group compared with those of other two groups (93.8%, 100% vs. 73.9%; P=0.07). The rate of recurrence/failure rates were lower in the R4 sympathicotomy group compared with those of other two groups (12.50% vs. 35.00%, 34.8%; P=0.25). Sympathetic surgery at the R3 level was the only significant risk factor for patient dissatisfaction (odd ratio =12.353, 95% confidence interval =1.376-110.914; P=0.025). Our data support that R4 sympathicotomy had lower grades of compensatory sweating, higher grades of satisfaction, and lower rates of recurrence/failure. We therefore consider R4 sympathicotomy as an optimal surgical treatment for palmar hyperhidrosis.

Biosignal analysis to assess mental stress in automatic driving of trucks: palmar perspiration and masseter electromyography.

Nowadays insight into human-machine interaction is a critical topic with the large-scale development of intelligent vehicles. Biosignal analysis can provide a deeper understanding of driver behaviors that may indicate rationally practical use of the automatic technology. Therefore, this study concentrates on biosignal analysis to quantitatively evaluate mental stress of drivers during automatic driving of trucks, with vehicles set at a closed gap distance apart to reduce air resistance to save energy consumption. By application of two wearable sensor systems, a continuous measurement was realized for palmar perspiration and masseter electromyography, and a biosignal processing method was proposed to assess mental stress levels. In a driving simulator experiment, ten participants completed automatic driving with 4, 8, and 12 m gap distances from the preceding vehicle, and manual driving with about 25 m gap distance as a reference. It was found that mental stress significantly increased when the gap distances decreased, and an abrupt increase in mental stress of drivers was also observed accompanying a sudden change of the gap distance during automatic driving, which corresponded to significantly higher ride discomfort according to subjective reports.

Long-term outcomes after endothoracic sympathetic block at the T4 ganglion for upper limb hyperhidrosis

The aim of this study was to evaluate long-term results, quality of life, satisfaction and compensatory sweating after endothoracic sympathetic block at T4 (ESB4). Patients who underwent an ESB4 procedure for palmar or palmoaxillary hyperhidrosis between 2001 and 2008 were included in a prospective study at a university hospital. Questionnaires devised by Keller and Milanez de Campos were applied to evaluate disease-specific quality of life. A total of 189 patients underwent 374 ESB4 procedures. Of 174 evaluated patients, 54 (31·0 per cent) had palmar and 120 (69·0 per cent) had palmoaxillary hyperhidrosis. Median follow-up was 92 months. In both groups, treatment successfully reduced hyperhidrosis (P < 0·001) and quality of life increased significantly after ESB4 (P < 0·001), remaining stable after 5 years. Overall satisfaction rates decreased owing to the development of compensatory sweating and recurrence during follow-up. Compensatory sweating affected 41 patients (23·6 per cent), and was severe in 11 (6·7 per cent) of 163 patients at 5-year follow-up; eight of these 11 patients had been treated for palmoaxillary sweating. The severity of compensatory sweating did not deteriorate with time. The severe recurrence rate increased to 11·0 per cent during follow-up, and was twice as common in patients treated for palmoaxillary sweating as in those treated for palmar sweating (13·2 versus 6·1 per cent respectively). Nine reoperations (5·2 per cent) were performed for persistent sweating, recurrence or compensatory sweating. T4 endothoracic sympathetic clip application is safe and effective in patients with upper limb hyperhidrosis, with stable long-term improvements in quality of life.

Hypermyelination and overexpression of neuregulin-1 in thoracic sympathetic nerves in patients with primary palmar hyperhidrosis

Primary palmar hyperhidrosis (PPH) is a condition characterized by high levels of palmar perspiration in excess of physiological need. The etiopathogenesis of PPH is thought to be related to hyperactivity of the sympathetic system, but the exact mechanism is still obscure. The aim of this study was to observe the ultrastructure of the thoracic sympathetic nerves and measure the expression of neuregulin-1 (Nrg-1) in thoracic sympathetic nerve tissue in patients with PPH relative to control subjects. Samples of T3 sympathetic ganglia were obtained from 58 subjects: 30 PPH patients who underwent endoscopic thoracic sympathectomy and 28 control subjects who underwent pleurectomy for chronic empyema. The ultrastructure of the myelin sheath of the sympathetic axons was observed using electron microscopy, and the thickness of the myelin sheath was compared between the two groups. Expression of Nrg-1 mRNA in thoracic sympathetic nerve tissue was evaluated using reverse transcription–polymerase chain reaction analysis. Subjects in the hyperhidrosis group had a significantly greater average myelin thickness and a significantly lower g-ratio relative to the control group. The hyperhidrosis group had significantly higher relative expression of Nrg-1 mRNA in thoracic sympathetic nerve tissue. Hypermyelination of the thoracic sympathetic axons is probably one pathogenetic mechanism underlying PPH. Nrg-1 is likely to be an important cause of hypermyelination in thoracic sympathetic axons in patients with PPH.

Management of essential hyperhidrosis of upper limbs by radiofrequency thermocoagulation of second thoracic ganglion

IntroductionEssential hyperhidrosis is an idiopathic condition characterized by markedly excessive sweating especially in the hands. ObjectiveThis study was done to evaluate the functional results of radiofrequency thermocoagulation of T2 ganglion in 10 patients suffered from essential hyperhidrosis of both upper limbs. MethodsThis retrospective study was carried out on 10 patients suffered from essential hyperhidrosis of both upper limbs. The male to female ratio was 2 to 3 (4 males and 6 females) and their ages ranged from 16 to 28 years. Simultaneous palmar and plantar sweating was present in five patients (50%), simultaneous palmar and craniofacial hyperhidrosis in two patients (20%), and simultaneous palmar and axillary hyperhidrosis in one patient (10%), while palmar hyperhidrosis alone was found only in two patients (20%). All cases underwent surgery in the form of radiofrequency thermocoagulation (RFT) of T2 on both sides under local anesthesia and sedation using C-arm radiological guidance. Mean postoperative follow up examination period was 24 months. ResultsThere was no operative mortality. Pneumothorax occurred on left side in one patient. Transient partial Horner's syndrome occurred on the right side in another patient. Postoperatively, 9 patients (90%) had clinical improvement of their palmar sweating. The last patient had partial improvement on right side and no improvement on the left side. The operation was repeated in one case with recurrence on the right side who improved. At the last follow up, excellent results were obtained in 90% of limbs, fair results in 5% of limbs, and poor results in 5% of limbs. ConclusionThe results of this study indicate that second thoracic ganglionectomy and sympathectomy performed with the use of percutaneous RFT is a very effective treatment for palmar hyperhidrosis that provide excellent immediate and long-term results as well as a low complication rate.

Endoscopic Transthoracic Limited Sympathotomy for Palmar-Plantar Hyperhidrosis: Outcomes and Complications During a 10-Year Period

OBJECTIVE To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade. PATIENTS AND METHODS We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications. RESULTS Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%). CONCLUSION In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

Two Cases of Palmar Hyperhidrosis in which Palmar Perspiration was Measured Using Evaporimeter

Two Cases of Palmar Hyperhidrosis in which Palmar Perspiration was Measured Using Evaporimeter

Graves Disease With Midline Ectopic and Bifid Pyramidal Lobes on Pertechnetate Thyroid Scintigraphy

Thyroid ectopia may present in isolation as the only functioning gland or may coexist along with a normal pretracheal thyroid. It is usually an asymptomatic mass and tends to increase in size under stress, when hormone demands increase, as in puberty, pregnancy, and stress. A pyramidal lobe is visualized when there is significant stimulation to the thyroid, is usually unilateral, and can arise from either lobe or isthmus, extending superiorly. We present a case of a patient with Graves disease, demonstrating an ectopic midline inferior nodule and bilateral pyramidal lobes on a pertechnetate thyroid scan. A 31-year-old male patient presented with a recent history of progressively increasing tremors, weight loss, tiredness, and increased sweating of 5-months duration. He had no history of thyroid complaints or contributory medical, surgical, and family history. On general physical examination, he had tachycardia with a pulse rate of 108/minute, fine tremors of the extremities, mild thyromegaly, and increased palmar sweating. His thyroid function tests were T3: 7.8 ng/mL (normal range 0.8–1.8 ng/mL), T4: 24.9 μg/dL (normal range 4.5–12.5 μg/dL), and TSH: 002 μIU/mL (normal range 0.5–9 μIU/mL). Tc 99m pertechnetate imaging was performed, which demonstrated diffuse, homogenous increased tracer uptake in bilateral thyroid lobes, bifid pyramidal lobes, and suppressed salivary gland uptake. In addition, there was a midline focus of intense tracer uptake inferior and separate from the thyroid margin, demonstrating increased vascularity on the flow images. USG Doppler was performed, which demonstrated increased vascularity in the nodule, supplied by the inferior thyroid artery and the echo texture similar to the rest of the thyroid tissue. Repeat pertechnetate scan done 3 months later demonstrated similar scan findings with a mild increase in the thyroid uptake (23%-33%). He was treated with 10 mCi of I-131 and is presently on follow-up and is asymptomatic.

Randomisierte, plazebokontrollierte klinische Doppelblindstudie zur Wirksamkeit und Verträglichkeit der oralen Therapie mit Methantheliniumbromid (Vagantin®) bei fokaler Hyperhidrose

Zusammenfassung Hintergrund: Methantheliniumbromid (Vagantin®) ist ein quarternäres Ammoniumderivat mit anticholinerger Wirkung, das seit 1951 als orales Therapeutikum bei fokaler Hyperhidrose eingesetzt wird. Daten zur Wirksamkeit und Sicherheit lagen bisher nur in Form von Fallberichten und Fallserien vor. Wir berichten über die Ergebnisse der ersten randomisierten klinisch plazebokontrollierten Doppelblindstudie zur Wirksamkeit und Sicherheit dieses Präparates. Patienten/Material und Methoden: Insgesamt wurden 41 Patienten (davon 31 (76 %) weiblich) mit einem mittleren Alter (± Standardabweichung) von 28 ± 9,8 Jahren (Spannweite 18,7 – 54,8) in die Studie eingeschlossen. Voraussetzung für einen Studieneinschluß waren eine seit mindestens einem Jahr bestehende fokale Hyperhidrose der Achseln und/oder der Hände und deren gravimetrisch gemessene Schweißproduktion von mindestens 50 mg/min. Die Patienten erhielten täglich über 4 Wochen 2 × 50 mg Methantheliniumbromid bzw. Plazebo p. o. Zur Kontrolle des Therapieeffektes wurde zum einen die Schweißproduktion vor und unter Therapie bestimmt sowie die subjektive Zufriedenheit der Patienten mit der Therapie erfragt. Ergebnisse: Der Nachweis der Wirksamkeit gelang vor allem für Patienten mit gravimetrisch gesicherter axillärer Hyperhidrose von ≥ 50 mg pro min vor Therapie. Hier fanden sich unter Therapie deutliche Unterschiede zwischen Verum und Plazebo (p = 0,02, χ2‐Test, zweiseitig).Für die Gesamtgruppe zeigte sich für den Bereich der Achseln eine signifikante Verminderung der gravimetrischen Schweißproduktion in der Verumgruppe von 89,2 ± 73,4 mg/min vor Therapie auf 53,3 ± 48,7 mg/min unter Therapie (p = 0,02, Wilcoxon‐Test, zweiseitig), wohingegen in der Plazebogruppe die Meßwerte mit 60,7 ± 42,8 mg/min vor Therapie und 59,1 ± 40,6 mg/min unter Therapie nahezu unverändert blieben (p = 0,92, Wilcoxon‐Test, zweiseitig). Im Bereich der Hände konnten keine Unterschiede zwischen der Verum‐ und der Plazebogruppe gefunden werden.Während der gesamten Studiendauer traten keine schwerwiegenden unerwünschten Ereignisse auf. Einzige signifikante Nebenwirkung war die in der Verumgruppe zu erwartende Mundtrockenheit als bekannte Nebenwirkung oraler Anticholinergika. Diskussion: Methantheliniumbromid wird seit Jahren in der Behandlung der fokalen Hyperhidrose verwendet. Bisher lagen zur Wirksamkeit und Sicherheit jedoch keine größeren Studien vor. In dieser Arbeit konnte erstmals in einer klinischen Studie eine Verminderung der Schweißproduktion im Bereich der Achseln bei guter Verträglichkeit nachgewiesen werden. Die Therapie der fokalen axillären Hyperhidrose mit Methantheliniumbromid 2 × 50 mg/d p. o. kann deshalb empfohlen werden. Vor allem in den Fällen, in denen eine alleinige Lokaltherapie mit z. B. Aluminiumchloridhexahydratlösung sich als wenig wirksam erweist. Im Bereich der Hände konnte keine klinisch relevante Wirkung nachgewiesen werden.

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis--the combined paediatric, adolescents and adult experience.

To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. Retrospective study. University hospital, Israel. 402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years. Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy. 220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied. The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice. Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.

Arithmetic calculation, deep inspiration or handgrip exercise-mediated pre-operational active palmar sweating responses in humans

We examined the effects of repetitive mental stimulation such as arithmetic calculations with sequential subtraction or physical tasks such as handgrip exercise and deep breathing on active palmar sweating responses in humans. Thirty-three healthy, male and female volunteer students (20.4±2.1 years) participated in the present study. The responses of active palmar sweating were evaluated by using the newly developed ratemeter. The galvanic skin response (GSR) was also recorded in 10 out of 33 subjects. The oral explanation of the stimulation or tasks caused a rapid and wavy active palmar sweating response. The pre-operational responses of active palmar sweating to the stimulation or tasks were also observed by the GSR recording. The mental stimulation- and physical tasks-mediated pre-operational responses were significantly reduced by the trials. The mental stimulation or physical tasks also caused a rapid and oscillatory response of active palmar sweating during operation of the stimulation or tasks. The operation-mediated responses to physical tasks were observed ipsilaterally and contralaterally. The physical task-mediated responses were also reproducible, resulting in no habituation. In contrast, the operation-mediated responses to mental stimulation were reduced significantly by the trials, resulting in a marked habituation. The findings suggest that the mental stimulation- and physical tasks-mediated pre-operational responses of active palmar sweating obtained by using the newly developed ratemeter will make useful tests for evaluating neuronal activity of limbic system including amygdala, sympathetic sudomotor activity in the palmar skin and functional properties of the palmar sweat glands.

Nuestra experiencia en el tratamiento de las hiperhidrosis de los miembros superiores mediante videotoracoscopia: análisis tras las primeras 100 intervenciones

Sympathectomy of the thoracic chain is an effective surgical procedure for treating axillary and palmar hyperhidrosis. The procedure has been performed with minimal invasion and good results in recent years through the use of videothoracoscopic surgery. This paper describes the technique and our experience with a series of 50 patients between 16 and 48 years old. The earliest approach was unilateral in successive operations. The procedure was later performed bilaterally, at first with the patients in sequential lateral decubitus positions and later in semi-seated position. Complications were 1 case of incomplete Claude-Bernard-Horner syndrome that resolved spontaneously two months after surgery; 1 failure when sympathectomy was performed without location of the chain, obliging rapid re-operation; laminar pneumothorax in 12% of the series; compensatory hyperhidrosis in 26%; 10% with chest pain due to intercostal involvement, resolving with time; and slight bleeding in 8%. Outcome was excellent, with complete disappearance of axillary and palmar perspiration. Patient satisfaction was 9.2/10 one year after surgery. Mean hospital stay was less than 36 h.

Video-assisted Transthoracic Sympathectomy in the Treatment of Primary Hyperhidrosis: Friend or Foe?

The authors hypothesize that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function; consequently, thoracoscopic sympathectomy to alleviate symptoms in the hands may result in heat dissipation because sweating is transferred to other sites. To investigate this phenomenon and to determine whether it adversely affects patient satisfaction, a standard questionnaire was administered to 626 patients who underwent sympathectomy at a university-associated public hospital between 1991 and 1998; only patients treated at least 6 months before questionnaire distribution were included in the study. Replies were received from 336 (53.7%) individuals. The surveyed patients underwent bilateral T2, T3 (palmar sweating), or T3, T4 (axillary sweating) sympathectomy by a standard video-assisted transthoracic technique. Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena; in addition, patient perception of the success of the surgical procedure was assessed. After sympathectomy, 97.3% (P < 0.0001) and 29.2% (P < 0.001) of patients reported significant improvement in palmar hyperhidrosis and axillary sweating, respectively. Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), and axillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients. Thirty-seven patients (11%) regretted having undergone the surgical procedure. In contrast, 25% and 64% of patients were either satisfied or very satisfied with the outcome of the procedure. From the survey results, the authors conclude that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function and that thoracic sympathectomy may alleviate symptoms in a large proportion of patients. However, for some individuals, compensatory sweating may prove to be an equally troublesome handicap. Because the occurrence of severe compensatory sweating is unpredictable, a reversible sympathectomy may be desirable.

Uniportal Endoscopic Superior Thoracic Sympathectomy

A retrospective study presenting our experience with upper thoracic endoscopic sympathectomy in patients with primary palmar hyperhidrosis. One hundred patients (46 women and 54 men) underwent bilateral uniportal endoscopic thoracic sympathectomy since January 1, 1995. Age distribution ranged from 12 to 54 years (mean, 23.4 yr). Sympathectomy on both sides was accomplished within 30 minutes in a single stage. Ninety-six patients (96%) had an uneventful postoperative course and were discharged the following day. Four patients with residual hemothorax required intercostal drainage and were discharged on the third postoperative day. Ninety-six patients were completely satisfied with immediate and permanent relief of palmar perspiration. Compensatory hyperhidrosis was the major complication, which was usually mild and tolerable after reassurance. In only eight patients (8%) was the compensatory hyperhidrosis considered bothersome, requiring treatment with aluminum chloride in ethanol solution at 25%. There was no mortality. Recurrence of palmar hyperhidrosis has been noticed in five patients (5%) during the follow-up period (range, 2-56 mo; mean, 12 mo). At the time of reoperation, a remaining branch of the sympathetic chain could be observed and coagulated. We consider thoracoscopic sympathectomy to be a simple, safe, and effective method for treating palmar hyperhidrosis. It is an effective method for treating patients with palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches.

The Results of Thoracoscopic Sympathetic Trunk Transection for Palmar Hyperhidrosis and Sympathetic Ganglionectomy for Axillary Hyperhidrosis

Objectivesto review our total experience of thoracoscopic sympathetic trunk transection for the treatment of palmar hyperhidrosis and second and third thoracic sympathetic ganglionectomy for axillary hyperhidrosis.Designlongitudinal cohort study following up consecutive patients for 0.3 to 5.5 years.Subjectsfifty-four consecutive patients undergoing thoracoscopic sympathectomy for hyperhidrosis.Methodsprospective evaluation of immediate technical success, complications, late recurrence of hyperhidrosis and patient acceptability.Results100% initial cure for palmar hyperhidrosis, 91% of sympathetic ganglionectomies for axillary hyperhidrosis were technically successful and initially curative. Compensatory sweating 44% patients, most severe after bilateral sympathetic ganglionectomy. Complications occurred in 14% patients, all resolving without further intervention. There were no cases of Horner's syndrome. 13% patients reported a return of some palmar sweating. 5.4% patients developed recurrent palmar hyperhidrosis at 6, 15 and 21 months postoperatively.Conclusiontransection of the sympathetic trunk between the first and second thoracic sympathetic ganglia initially cures 100% of patients treated primarily for palmar hyperhidrosis. Technically successful 2nd and 3rd thoracic sympathetic ganglionectomy initially cures 100% of patients with axillary hyperhidrosis. Compensatory sweating is common after bilateral sympathectomy. Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can be cured by a second thoracoscopic sympathectomy. Horner's syndrome is an avoidable complication of thoracoscopic sympathectomy.

Hyperhidrosis treated by botulinum A exotoxin.

Hyperhidrosis, or excessive sweating, can be emotionally challenging and socially and professionally disruptive, and there have been few effective treatments. Recently, botulinum toxin has been demonstrated to be an effective treatment for hyperhidrosis of the axillae and palms and for gustatory sweating. This article reviews the current treatments and outcomes achieved with chemodenervation of the eccrine sweat glands. The antihydrotic response lasted 6-17 months for gustatory sweating, 2-8 months for axillary sweating, and 13 weeks to 12 months for palmar sweating. Intracutaneous injections of botulinum toxin offer a simple, safe, and effective alternative to other conservative and surgical options.