Treatment Of Primary Palmar Hyperhidrosis Research Articles

Ultrasound-guided percutaneous puncturing technique: novel radiofrequency ablation technique for thoracic sympathectomy in the treatment of palmar hyperhidrosis.

Radiofrequency thoracic sympathectomy is routinely conducted under computed tomographic or fluoroscopic guidance in the treatment of palmar hyperhidrosis. However, it remains a great challenge to perform a thoracic paravertebral puncture precisely and safely, because it is associated with repeated exposure to radiation and the risk of a pneumothorax. Alternatively, an ultrasound-guided technique can provide high-resolution and real-time needle tracking during the percutaneous procedure. We have provided our experience of ultrasonic guidance in radiofrequency sympathectomy for the treatment of primary palmar hyperhidrosis.

LB1706 Development of a novel dry iontophoresis glove for the treatment of primary palmar hyperhidrosis

LB1706 Development of a novel dry iontophoresis glove for the treatment of primary palmar hyperhidrosis

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis.

Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand's exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient's daily activities and quality of life. The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH. A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation. Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05). Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.

A novel lotion formulation of 20% oxybutynin hydrochloride for the treatment of primary palmar hyperhidrosis: A randomized, placebo-controlled, double-blind, phase III study

No previous controlled studies have been specifically designed or adequately powered to show the efficacy of topical oxybutynin for palmar hyperhidrosis by using quantitative measures. To evaluate efficacy of 20% oxybutynin hydrochloride lotion (20% OL) in reducing palmar sweat volume in patients with primary palmar hyperhidrosis (PPHH). In a randomized controlled trial, Japanese patients with PPHH aged 12years and older received either 20% OL (n=144) or placebo (n=140) on both palms once daily for 4weeks. Palmar sweat volume was measured by the ventilated capsule method. For the primary outcome, response was defined as a reduction of sweat volume of at least 50% from baseline. At week 4, the responder rate for sweat volume was significantly higher in the 20% OL arm than in the placebo arm (52.8% vs 24.3%, respectively; treatment difference, 28.5% [95% CI, 17.7% to 39.3%]; P<.001). No serious adverse events occurred, and no adverse events led to treatment discontinuation. The treatment period was only 4weeks. In patients with PPHH, 20% OL is superior to placebo in reducing palmar sweat volume.

Assessment of Compensatory Sweating Following Video Assisted Thoracoscopic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis at Two Different Levels (T2-3) Versus (T2-T4) .

Assessment of Compensatory Sweating Following Video Assisted Thoracoscopic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis at Two Different Levels (T2-3) Versus (T2-T4) .

Percutaneous Radiofrequency Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Case-Controlled Study of Rib-Based Anatomical Targeting

PurposeTo compare the efficacy, adverse reactions, quality of life, and patient satisfaction of percutaneous radiofrequency (RF) thoracic sympatholysis at different rib-based anatomic targets for primary palmar hyperhidrosis (PPHH). Materials and MethodsPatients with PPHH were divided according to the target, namely, the upper edge (Group U) and lateral border (Group L) of the fourth rib; there were 30 patients (mean age, 24.9 years; women, 31, 51.7%) and 60 cases in each group. The Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI) were assessed. ResultsFrom before RF sympatholysis to 12 months after, the proportion of patients with HDSS Grades III and IV (100%–26.7%) and the DLQI (19.78 ± 5.08 to 4.98 ± 4.18) decreased significantly (P < .001). At 3, 6, and 12 months after RF, the HDSS grades were better in Group L than in Group U (P = .005, .002, and .004). At 6 and 12 months after RF, the DLQI in Group L was lower than that in Group U (P = .012 and .016), and at 1, 6, and 12 months after RF, patient satisfaction was higher than that in Group U (P = .025, .014, and .009). Adverse events were mild; 8 patients (13.3%) demonstrated compensatory hyperhidrosis at 12 months after RF, and there was no difference between the 2 groups (P = .448); neuralgia and pneumothorax also did not differ (P = .522 and .643). ConclusionsRF sympatholysis targeting the lateral border of the fourth rib had higher efficacy, better quality of life, and higher patient satisfaction.

Clipping versus Division of Sympathetic Chain in Thoracoscopic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis

Clipping versus Division of Sympathetic Chain in Thoracoscopic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis

Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version).

Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’ social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.

Thoracoscopic Sympathectomy versus Thoracoscopic Sympathotomy for The Treatment of Primary Palmar Hyperhidrosis in Children and Adolescents

Thoracoscopic Sympathectomy versus Thoracoscopic Sympathotomy for The Treatment of Primary Palmar Hyperhidrosis in Children and Adolescents

Efficacy, Safety and Quality of Life of Oxybutynin versus Aluminum Chloride Hexahydrate in Treating Primary Palmar Hyperhidrosis.

Palmar hyperhidrosis is characterized by excessive sweating beyond the physiological needs of the patient's body and the most frequent form is primary or essential. Different treatments protocols have been proposed to control or decrease sweating. This study aimed to compare the efficacy and safety of oral oxybutynin versus topical aluminum chloride hexahydrate (ACH) in treating primary palmar hyperhidrosis. Also, to assess quality of life (QOL) as a measure of improvement of hyperhidrosis state. Patients were randomized using the block randomization with sealed envelope method into two treatment groups; oral oxybutynin group and topical ACH group. Hyperhidrosis Disease Severity Scale (HDSS) was used as a primary outcome measure to assess the efficacy of the drug in both groups. Clinical grading and the QOL were used as secondary outcome measures. The safety was evaluated by recording side effects in the follow-up visits. HDSS, clinical grading and QOL score showed a statistically significant improvement in the oral oxybutynin groups. One week after stoppage of treatment, the symptoms recurred again in both groups with return of HDSS and QOL scores to pretreatment levels. The most common side effects were dry mouth (65.8%) and itching (65.0%) for oral oxybutynin group and topical ACH group; respectively. Treatment of primary palmar hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it gives better results and much more improvement in QOL when compared to topical ACH. QOL questionnaire and clinical grading should also be considered as useful tools in the assessment of response to treatment.

The treatment of palmar hyperhidrosis - a systematic review.

Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management. A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017. Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients' symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement. There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.

Effectiveness of Photodynamic Therapy for Management of Primary Palmar Hyperhidrosis

Abstract Background Hyperhidorsis is a condition in which sweat production exceeds that which is needed for thermoregulation, and can affect the hands, feet, axiall, face, back, grain, and legs. It is adisabling condition that affect, both children and adults, with in audience rate of 1-3% and onset usually during childhood or adokscne. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity. Objectives So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using two photosensitizers [MB2% and eosin]. Patients and Methods Twenty patients with primary palmar hyperhidrosis were recruited from the outpatient clinic of the Dermatology and Venereology department, Faculty of Medicine – Ain Shams University during the period from 2017 to 2018. The protocol was approved by Faculty of Medicine, Ain Shams University ethical committee (FWA000017585). An informed written consent was obtained from all patients prior to enrolment in the study. It is a right-left controlled study which included 20 patients with primary palmar hyperhidrosis. Results Our study showed that the PDT had positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least twelve weeks after treatment stoppage. Conclusion Photodynamic therapy is an effective, safe and cheap method for management of primary palmar hyperhidrosis. Both eosin and methylene blue 2% can be used effectively as photosensitizers for photodynamic therapy with good results for treatment of primary palmar hyperhidrosis with minimal tolerable side effects.

The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

Background: Primary hyperhidrosis is a sympathetic disorder characterized by prolonged and uncontrollable sweating. It is associated with emotional stress or psychological causes that preferably affects the axillae, palms, feet, and face. Video-assisted thoracoscopic sympathetic surgery is currently a globally recognized treatment for primary palmar hyperhidrosis (PH). However, compensatory sweating (CS) is the most prominent long-term adverse effect of thoracoscopic sympathectomy. Objectives: Here, we aim to perform selective sympathetic ramicotomy for primary palmar hyperhidrosis patients and evaluate the clinical outcomes of satisfaction, as well as the effect on the frequency, location, and severity of compensatory sweating. Methods: In this single-arm trial study, 24 sympathectomies were carried out on 12 patients with primary palmar hyperhidrosis who were candidates for bilateral thoracoscopic selective sympathectomy (ramicotomy) at Imam Khomeini Hospital. The patients’ demographic information was interviewed and followed up using telephone questionnaires in the health center one week after surgery. Then, the rates of compensatory sweating, satisfaction, and failure or recurrence were retrospectively analyzed. Results: No significant differences were observed between age, gender, weight, BMI, and compensatory sweating rates. Notwithstanding, there was a statistically significant difference in the severity of compensatory sweating with patients’ height (P = 0.016). Compensatory sweating occurred in 66.7% of the patients; 50% of the patients were mild, 16.7% of the patients were moderate, and there was no intolerable compensatory sweating or recurrence. The most incidence of compensatory sweating was on the lower back. The rate of satisfaction was 94.5 ± 7.8%. Conclusions: Selective thoracoscopic sympathectomy (ramicotomy) is an effective surgical procedure with a very high level of precision and satisfaction. This technique hence should be considered the method of choice for the treatment of primary palmar hyperhidrosis.

Efficacy of photodynamic therapy for treatment of primary palmar hyperhidrosis.

Palmar hyperhidrosis represents a condition with a significant cosmetic and psychological burden. Various treatment modalities are available; however, searching for newer options to meet patients' needs and expectations is encouraged. The study aimed to evaluate the efficacy of photodynamic therapy (PDT) for treatment of primary palmar hyperhidrosis. Two different photosensitizers for PDT were evaluated: eosin Y, and methylene blue. The study focused on the clinical efficacy, patient's satisfaction, and the time and number of sessions needed to achieve a satisfactory response. Twenty patients with primary palmar hyperhidrosis were enrolled in a single-center clinical study. Patients were treated with PDT for a maximum of eight sessions. Two photosensitizers were tested: eosin Y, and methylene blue for the right and left hand, respectively. The Hyperhidrosis disease severity scale (HDSS), and Sweating Intensity Visual Scale of Minor's test were used for assessment. Photodynamic therapy effectively reduced the severity scores of hyperhidrosis with comparable results between the two photosensitizers. The treatment effect was maintained up to 3 months after the last procedure. Photodynamic therapy is a good treatment option for primary palmar hyperhidrosis with results maintainable for 3 months after the treatment end.

Transareolar single-port endoscopic thoracic sympathectomy with a flexible endoscope for primary palmar hyperhidrosis: a prospective randomized controlled trial.

BackgroundTransareolar single-port endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been reported. This study assessed the performance of this novel minimally invasive technique for primary palmar hyperhidrosis (PPH).MethodsFrom January 2019 to September 2019, 118 males with severe PPH requiring single-port and bilateral ETS were randomly allocated to undergo transareolar ETS using a flexible endoscope (group A, n=58) or transaxillary ETS using a 5 mm thoracoscope (group B, n=60).ResultsBoth groups had similar patient characteristics. All procedures were performed successfully, with no mortality or conversion to open surgery. All patients had dry and warm palms immediately after surgery. Compared with group B, group A had a significantly shorter median incision length [5.1 (5.0–5.2) vs. 10.9 (10.8–11.9) mm; P<0.001], and significantly lower median postoperative pain score [1 (1.0–2.0) vs. 3 (3.0–4.0); P<0.001]. There were no differences between the two groups in operative time, palmar temperature increase, and transient postoperative sweating. After complete follow-up, group A had a significantly higher median cosmetic score than group B [4.0 (3.0–4.0) vs. 3.0 (3.0–3.0); P<0.001]. There were no differences between the two groups regarding symptom resolution, compensatory hyperhidrosis, and satisfaction score. No patient reported residual pain or symptom recurrence.ConclusionsTransareolar single-port ETS with a flexible endoscope is safe, effective, and minimally invasive with a small incision, minimal pain, and excellent cosmetic results. This novel procedure is suitable for routine treatment of PPH in males.

Fractional CO2 laser-assisted Botulinum toxin type A delivery for the treatment of primary palmar hyperhidrosis.

Intradermal injections of botulinum toxin type A (BTX-A) have been used successfully to treat patients with primary palmoplantar hyperhidrosis (PPH). However, problems with local injections of BTX-A for palmar hyperhidrosis include injection pain and reduced palmar muscle strength. This case series describes three patients with PPH. Patients were followed up for 3months and assessed using the minor iodine starch test and the visual analog scale (VAS). Over two sessions within a 2-week interval, all patients received treatment on one palm, while the other palm served as the untreated control. Treated palms received fractional CO2 laser therapy and immediate post-operative topical application of BTX-A solution for a total of 50units. Sweat production was assessed based on the size of the sweat-producing area (measured by the minor iodine starch test) and subjective assessment of sweat production using the visual analog scale (VAS) at baseline, 2weeks after the first treatment, and 1, 2, and 3months after the second treatment. In the BTX-A-treated palm, the decrease in the mean sweat production was 51.6% at 2weeks after the first treatment, and 88.5%, 67.8%, and 52.9%, at 1, 2, and 3months after the final treatment when compared to the baseline. In the untreated palms, the decrease in the mean sweat production was 2% on all follow-ups when compared to the baseline. No adverse effect was observed in any patient. Fractional CO2 laser is a safe technique for BTX-A delivery on the palm area and is demonstrated to be safe and effective in decreasing sweat secretion of hyperhidrosis palm.

Thoracoscopic sympathotomy for palmar hyperhidrosis: How young is too young?

Background/PurposePrimary hyperhidrosis affects 1%–3% of the general population, with increased incidence in teenagers, having an important impact in the quality of life. This study evaluates the efficacy and patients' satisfaction after bilateral thoracoscopic sympathotomy. MethodsRetrospective analysis of pediatric patients with palmar primary hyperhidrosis that underwent bilateral thoracoscopic sympathotomy over the last eight years. The procedure was performed with 2 ports and simple transection of the sympathetic chain. Pre and postoperative sweating severity was evaluated by telephone interview, using the Hyperhidrosis Disease Severity Scale (HDSS). Results23 patients (19 girls; 15.5 [11–19] years-old) underwent bilateral thoracoscopic sympathotomy. All complained of palmar hyperhidrosis, which resolved in all cases. Compensatory sweating occurred in 47.8% of patients. 21 patients answered the telephone interview: all of them would recommend the surgery to others. Sweating severity improved in all patients, with a mean decrease of 1.95 values of the HDSS from preoperative to postoperative evaluation (p < 0.05). There was neither morbidity nor mortality. ConclusionsBilateral thoracoscopic sympathotomy is a safe and effective treatment for primary palmar hyperhidrosis. Being the first report on pediatric application of HDSS, we conclude that children are very satisfied with the final outcome. Type of studyTreatment study. Level of evidenceLevel III.

C-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial

Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of life, occupational activities, and social interactions. Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. Study Design: This is a randomized single-blinded trial. Setting: This study took place in a single hospital. Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. Limitations: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection.

A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating.

IntroductionThoracoscopic sympathectomy (TS) has been proven to be a safe and effective treatment for primary palmar hyperhidrosis (PH). However, the complications include compensatory hyperhidrosis (CH), and over-dry hands may occur in some patients after TS.AimTo compare the therapeutic effect of T3 and T4 TS on primary PH and primary PH with axillary and plantar sweating.Material and methodsWe retrospectively analyzed 100 patients with PH who had undergone T3 (group A, n = 49) or T4 (group B, n = 51) TS in our department, with at least 1 year of postoperative follow-up.ResultsAt discharge, no major complications or deaths occurred in either group. The condition of sweaty hands was fully improved in 44 of 49 patients in group A and all patients in group B, with a significant difference (p = 0.031). After 12 months of follow-up, 18 (36.7%) patients in group A and 4 (7.8%) patients in group B developed CH, 16 (48.5%) patients in group A and 24 (77.4%) patients in group B had improved axillary sweating, with a significant difference (p < 0.05). The satisfaction rate of group B was significantly higher than that of group A (p < 0.01).ConclusionsBoth T3 and T4 TS were safe and effective treatments for PH patients, but the incidence of CH in T4 TS was lower than that in T3 TS. T3 TS may be more suitable for patients with severe PH, while T4 TS had a better therapeutic effect on PH patients with axillary sweating.

Anxiety after Sympathectomy in patients with primary palmar hyperhidrosis may prolong the duration of compensatory hyperhidrosis

BackgroundCompensatory hyperhidrosis (CH) is a frequent side effect after sympathectomy for the treatment of primary palmar hyperhidrosis. We determined the effects of demographic and clinical factors which may increase the duration of CH (DCH).MethodsOne hundred twenty-two patients who had undergone sympathectomies from 2014 to 2016 were retrospectively reviewed. Anxiety was evaluated using the State and Trait Anxiety Inventory score. Follow-up evaluations continued until CH remitted. A Cox proportional hazards model was used to determine the association between DCH and variables.ResultsDCH ranged from 5 to 27 weeks (median, 11.47 weeks). Severe CH (HR = 0.318, 95% CI, 0.136–0.741) and exacerbated anxiety 1 month post-operatively (HR = 0.816, 95% CI, 0.746–0.893) may prolong CH. A positive correlation between post-operative anxiety and DCH was common in patients with moderate or severe CH, and in cases with forearm CH.ConclusionsPre- and post-operative anxiety should be evaluated, and anti-anxiety treatment is offered to patients with moderate-to-severe CH to shorten the DCH.