Plantar Hyperhidrosis Research Articles

The Influence of the COVID-19 Pandemic on the Addressability to Treatment of Children with Hyperhidrosis-A Retrospective Study and a Short Review.

This study was carried out to demonstrate the negative influence that the COVID-19 pandemic had on the ability of patients to treat hyperhidrosis with iontophoresis. The purpose of this study is to identify the annual distribution of patients with hyperhidrosis as well as elaborate a curve of cases within the time interval studied. It is a retrospective study initiated in the Department of Neuropsychomotor Rehabilitation of the "Sf. Ioan" Emergency Clinical Hospital for Children, Galati, Romania, in which we analyzed the electronic database, the treatment, and the consultation files of all the children who presented between January 2013 and December 2023. We found 111 patients who met the inclusion criteria. During the 3 years of the pandemic, the number of patients who came to our clinic suddenly dropped to 0. This study was conducted on a relatively small number of patients in a Neuropsychomotor Recovery clinic. This study includes only patients with palmar and/or plantar hyperhidrosis who presented to the clinic for iontophoresis. Although it is a disease that significantly influences the quality of life, patients and their families do not consider hyperhidrosis to be an urgent problem that can be improved by treatment.

Long term outcome of Video-Assisted Thoracoscopic Sympathectomy at thoracic level (R2-3) versus (R2-4) on Plantar Hyperhidrosis associated with Primary Palmar Hyperhidrosis

Long term outcome of Video-Assisted Thoracoscopic Sympathectomy at thoracic level (R2-3) versus (R2-4) on Plantar Hyperhidrosis associated with Primary Palmar Hyperhidrosis

Botulinum Toxin A and B for Palmoplantar Hyperhidrosis.

Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL. A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100-550) units BTX-A and a median dose (low to high) of 200 (200-500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475-1000) units BTX-B was injected. At follow-up 2weeks post-treatment, patients' Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001). We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.

Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study.

Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men. The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications. A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered. 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%). Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

Development of polymer insole in additive manufacturing for people with plantar hyperhidrosis

Development of polymer insole in additive manufacturing for people with plantar hyperhidrosis

Management of primary plantar hyperhidrosis with botulinum toxin type A: A retrospective case series of 129 patients.

To date, scientific data on the efficacy of botulinum toxin type A (BoNT-A) for primary plantar hyperhidrosis (PPH) are mainly derived from case reports and small case series. Herein, we sought to assess the efficacy and safety of BoNT-A for PPH on a large series of patients. Medical records of patients who were referred to the outpatient department for hyperhidrosis of a tertiary care hospital and received BoNT-A for PPH from March 2003 until December 2022 were reviewed. A total of 129 patients [12 males, 117 females; median age 32 years (range, 16-72)] were included in the study, after excluding 24 patients with insufficient documented follow-up data. Most patients [115 (89.1%)] received onabotulinumtoxin-A, nine (7.0%) abobotulinumtoxin-A and five (3.9%) both in subsequent sessions. The mean number of sessions was 2.02 [standard deviation (SD), 2.29] and the mean duration of response 6.16 months (SD, 4.01). The percentage of response, as evaluated by Minor's test, was 71.67%, 63.44%, 47.78% and 34.13% after 1, 3, 6 and 9 months, respectively. Most patients were satisfied (21.7%) or very satisfied (58.9%) with the treatment. No serious side effects were reported. The results of this retrospective study suggest that BoNT-A is an effective and safe treatment option for PPH.

T3-T5 Thoracoscopic sympathectomy versus sympathicotomy in the treatment of palmar–axillary–plantar hyperhidrosis

Background Compensatory hyperhidrosis is a common complication after thoracoscopic interruption of the sympathetic chain in hyperhidrosis patients. Nonetheless, no interruption technique has been defined to decrease the incidence of that dreadful complication. Herein, we compared T3-5 sympathectomy with sympathicotomy at the same levels with regard to postoperative outcomes. Methods Eighty patients diagnosed with primary palmar–axillary–plantar hyperhidrosis were randomized into two equal groups: the sympathectomy and sympathicotomy groups. They were followed up for 6 months after the procedure. The incidence and criteria of compensatory hyperhidrosis were compared between the two approaches. Results The sympathectomy group showed a significant prolongation of the operative time. However, postoperative pain, hospital stay, and the incidence of complications were statistically comparable between the two approaches. Both procedures were associated with a significant decline in the severity of sweating in the three regions, which was more prominent in the palmar and axillary regions compared with the foot. The incidence of compensatory hyperhidrosis was 65% in sympathectomy patients and 77.5% in sympathicotomy patients, with no significant difference between them (P=0.217). About two-thirds of these cases were temporary, and the majority of them had mild to moderate symptoms. Patient satisfaction did not differ between the two approaches, with poor satisfaction in patients with permanent compensatory hyperhidrosis. Conclusion Both sympathectomy and sympathicotomy had comparable outcomes in patients with palmar–axillary–plantar hyperhidrosis, manifested in comparable decreased sweating severity, incidence of compensatory hyperhidrosis, quality of life, and patient satisfaction.

Predictors of Compensatory Sweating Following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis

Compensatory sweating (CS) is a frequent health concern following treatment of palmar hyperhidrosis using video-assisted thoracoscopic sympathectomy (VATS) and can reduce level of patient satisfaction. A retrospective cohort study including consecutive patients who underwent VATS for primary palmar hyperhidrosis (HH) over a 5-year period was conducted. Various demographic, clinical, and surgical variables were tested for their correlation to postoperative CS through univariate analyses. Variables with significant correlation to outcome were included in a multivariable logistic regression for determining significant predictors. The study included 194, predominantly male (53.6%), patients. About 46% of patients developed CS, mostly during the first month after VATS. Variables with significant correlation (P < 0.05) to CS included age (20 ± 3.6 years), body mass index (BMI) (mean 27 ± 4.9), smoking (34%), associated plantar HH (50%), and laterality of VATS (40.2% in dominant side). Only level of activity showed a statistical trend (P= 0.055). In multivariable logistic regression, BMI, plantar HH, and unilateral VATS were significant predictors for CS. Using receiver operating characteristic curve, the best cutoff point of BMI for prediction was 28.5, with sensitivity 77% and specificity 82%. CS is a frequent health concern early after VATS. Patients with BMI >28.5 and no plantar HH are at higher risk of postoperative CS, and a unilateral dominant side VATS as an initial management step may lessen the risk of CS. Bilateral VATS can be provided for patients with low risk of CS and patients with low satisfaction after unilateral VATS.

Comparison of the efficacy of ETS with different segments for palmar, axillary and plantar hyperhidrosis

BackgroundTo compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis.MethodsWe retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups.ResultsThere were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group.ConclusionPatients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

Effectiveness of Iontophoresis in Treating Plantar Hyperhidrosis.

The purpose of this study was to evaluate the effectiveness of tap water iontophoresis as a treatment for plantar hyperhidrosis. Thirty participants living with idiopathic plantar hyperhidrosis and consented to undergo treatment using iontophoresis were recruited. The Hyperhidrosis Disease Severity Score was used to evaluate the severity of the condition before and after treatment. Tap water iontophoresis was found to be effective in the treatment of plantar hyperhidrosis in the study group (P = .005). Treatment with iontophoresis led to the reduction of disease severity and improvement of quality of life, and it is a safe, easy-to-use method with minimal side effects. This technique should be considered before the use of systemic or aggressive surgical interventions, which could have potentially more severe side effects.

Laparoscopic Superselective Transperitoneal Lumbar Sympathectomy for Treating Plantar Hyperhidrosis

Background: Retroperitoneoscopic lumbar sympathectomyis the standard surgical treatment for plantar hyperhidrosis. However, it is rarely performed due to the technical complexity of the procedure. This study aimed to describe a modified video-assisted lumbar sympathectomy technique, the superselectivetransperitoneal lumbar sympathectomy. Methods: This is a retrospective study of 32 sympathectomies (16 patients) for plantar hyperhidrosis. The procedure is performed with the patient in the supine position and under general anesthesia. A video camera is introduced through the umbilical trocar, and the dissection forceps are introduced through trocars in the suprapubic area and right-and left-iliac fossa. The patient is placed in the Trendelenburg position at the level of the L3 vertebral body.

Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis: surgical technique

Primary hyperhidrosis is a common disease that affects about 5% of the population in which plantar damage exists in 40% of cases responsible for significant social, professional and psychological repercussions. The most effective and sustainable treatment is surgery by thoracic or lumbar sympathectomy depending on the location. Lumbar sympathectomy has long been practiced for the treatment of non-revascularizable obliterating arteriopathy of the lower limbs, and retains a bad reputation, in particular due to sexual dysfunction. However, it is extremely effective for the treatment of plantar hyperhidrosis with 98 to 100% efficiency and thanks to laparoscopy, the operative risks are low and the sexual dysfunction almost nil. Initially described in 1995, since 2002 many teams have improved the technique around the world. The purpose of this article is to describe the technique of retroperitoneoscopic lumbar sympathectomy in 2021 and to discuss its results.

A Novel Percutaneous Delivery System — Needle-Free Injection and Its Clinical Applications in Dermatology

Needle-free injection is commonly used in the fields of inoculation and diabetes. Moreover, its potential as a powerful tool for percutaneous drug delivery is being fully realized in the field of dermatology. Compared with conventional subcutaneous needle injection, needle-free injection causes less pain, has a shorter recovery time, allows for easier control of the pressure and dosage, and is less reliant on the operational technique. Thus, we performed a systematic review of currently available literature to examine the applications of this novel percutaneous delivery system in dermatology. We identified more than 30 prospective and retrospective studies and case reports for inclusion. We found that needle-free injection can be used for both medical and non-medical aesthetic purposes, including treatment of scars, wrinkles, condylomata acuminata, cutaneous tumors, recalcitrant plantar warts, nail psoriasis, and hyperhidrosis. Needle-free injection is very efficient and safe overall, especially when performed with gas-powered injectors; however, close attention is needed when applying high-pressure injectors in areas of relatively thin skin.

Plantarhyperhidrosis: The Efficacy Of Iontophoresis With Tap Water, Glycopyrronium Bromide And Indomethacin

Hyperhidrosis is an excessive production of sweat more than the physiological amount necessary to maintain thermal homeostasis. Primary focal hyperhidrosis is a disorder of unknown etiology, causing excessive, bilateral, symmetrical sweating on the soles of the foot is called plantar hyperhidrosis. The condition results not only in physical impairment, but also interferes with professional and social life. Although not life- threatening, it is very uncomfortable and cause embarrassment and psychological trauma. Iontophoresis is a helpful method, which includes the presentation of particles into the body tissue through the skin. The essential principle is to place the ion particles under an electrode with the same charge, i.e. negative ion placed under cathode and positive ion placed under anode. This complete process is also known as “technique of ion transfer” into the body tissues by using electrical current as a driving force. It is a comparative study with pre and post intervention. 30 subjects with plantar hyperhidrosis were selected based on the inclusion criteria. The study duration was for about 4 weeks30 subjects of age group between 15 –25 years with idiopathic plantar hyperhidrosis of both male and female subjects were included in this study. Subjects with cardiac and respiratory disorders, pregnant or lactating, any cuts, abrasions, eczema or infections on plantar aspect, metal implants like pacemakers, Hypersensitivity to the active substance were excluded. The subjects were divided into 3 group Group A treated with iontophoresis using tap water alone. Group B were treated with iontophoresis using tap water along with 3%-5% of anticholinergic drug, glycopyrronium bromide solution. Group C were treated with iontophoresis using tap water along with 1% of indomethacin (NSAID). The result of this study shows that there were significant changes in outcome measures. On comparing Mean values of Group A, Group B &amp; Group C on Minor test (Starch - Iodine Test) tap Water along with Glycopyrronium Bromide (Group B) shows 1.60 which has the Lower Mean value is effective than Group A and Group C .On comparing Mean values of Group A, Group B &amp; Group C on Visual Analog Scale score tap Water along with Glycopyrronium Bromide (Group B) shows 3.80 which has the Lower Mean value is effective than Group A and Group C. On comparing Mean values of Group A, Group B &amp; Group C on Hyperhidrosis Disease Severity Scale tap Water along with Glycopyrronium Bromide (Group B) shows 1.40 which has the Lower Mean value is effective than Group A and Group C. On comparing all the three groups, Group B shows better result than Group C and Group A in outcome measure. This study concluded that Tap water along with glycopyrronium bromide reduces the excessive sweating and decrease the sweating symptoms in subjects with plantar hyperhidrosis.

Evaluation of blood perfusion using laser doppler flowmetry during endoscopic lumbar sympathectomy in patients with plantar hyperhidrosis: a retrospective observational study

The purpose of this study is to evaluate whether monitoring the changes of skin blood flow may be effective in assessing blood perfusion during endoscopic lumbar sympathectomy (ELS) in patients with plantar hyperhidrosis. In this study, a total of 30 patients who underwent surgical treatment for plantar hyperhidrosis at the Department of Thoracic and Cardiovascular Surgery in Yonsei University Gangnam Severance Hospital, Seoul, Korea, between July 2020 and December 2020, were retrospectively analyzed. Sympathetic denervation was performed on the third lumbar ganglion, and intraoperative laser doppler flowmetry (LDF) was used to detect the lumbar sympathetic chain accurately. We observed an abrupt increase of peripheral blood flow after sympathetic denervation, and the median percent changes of perfusion unit were 173.27 (inter-quartile range, IQR 195.48) and 392.98 (IQR 597.27) for the left and right sympathectomies, respectively. This study demonstrated the efficacy of monitoring skin blood flow via LDF during ELS. This result suggests that exact detection of blood flow using LDF is essential for improving the accuracy of ELS by checking the perfusion site on the sole in patients with plantar hyperhidrosis.

Anatomical variability of the relationship between the sympathetic trunk and the intercostal veins during thoracoscopic sympathectomy

• The article investigates the anatomical variations in venous blood flow on the right and left sides of the second, third, and fourth intercostal spaces in the chest. • The effects of TS were studied in 80 patients with palmar, axillary, plantar, and facial hyperhidrosis. • Surgical procedures involving the right-sided sympathetic trunk may have increased risks due to its anatomical complexity and a higher frequency of dilated and full-blooded anterior crossing intercostal veins.

Endoscopic Lumbar Sympathectomy for Plantar Hyperhidrosis: the Learning Curve and Initial Outcome

Endoscopic Lumbar Sympathectomy (ELS), a definite treatment of Primary Plantar Hyperhidrosis (PPH), remains to be a challenge to thoracic surgeons due to unfamiliarity. Hence, the aim of this study is to evaluate.

Ancillary Techniques to Relieve the Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis.

Ancillary Techniques to Relieve the Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis.

Calidad de vida luego de simpaticotomía toracoscópica por hiperhidrosis focal primaria

Background: Thoracoscopic sympathectomy demonstrated to be a safe surgical procedure for the management of primary focal hyperhidrosis (PFH); however, some patients are not completely satisfied with their quality of life as compensatory sweating is the main adverse event. Objective: The aim of this study was to evaluate the quality of life of patients with PFH undergoing thoracoscopic sympathectomy using an anonymous postoperative survey. Material and methods: Consecutive patients undergoing thoracoscopic sympathectomy between August 2016 and August 2019 were included. Patients who did not respond the telephone survey about their quality of life or who had been followed up for &lt; 6 months. Clinical, intraoperative and postoperative variables were analyzed. Results: During this period 61 patients were operated on and 12 of them were excluded. Mean age was 28.9 years. All the patients presented moderate or severe primary palmar and/or axillary hyperhidrosis with or without facial flushing or plantar hyperhidrosis. Forty-nine patients responded the survey. Surgery completely solved PFH in 32 patients (65.3%) while 17 patients (34.6%) achieved a partial relief; 61% (30 patients) developed compensatory sweating affecting the quality of life in 4 (8%) causing transient discomfort and dissatisfaction in most cases. After a mean follow-up of 36 months (6-72), 97.9% (48 patients) recommended the procedure. Conclusion: Bilateral thoracoscopic sympathectomy is still the most efficient treatment for PFH with high level of satisfaction among the patients operated on. Compensatory sweating was the most common adverse effect and is mild and transient in most cases.

Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

BackgroundPrimary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH.MethodsRLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months.ResultsMean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed.ConclusionsRLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.