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Majid Hosseini S, Ghandali E, Reza Moghimi H, Khademi-Kalantari K, Talebian Moghaddam S, Akbarzadeh Baghban A, Maryam Mortazavi S. A comparative evaluation of aluminum chloride hexahydrate gel iontophoresis versus tap water iontophoresis in people with primary palmar hyperhidrosis: A randomised clinical trial. Indian J Dermatol Venereol Leprol 2024; 90:52-58. [PMID: 37436009 DOI: 10.25259/ijdvl_975_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/25/2023] [Indexed: 07/13/2023]
Abstract
Background Primary palmar hyperhidrosis causes a lot of problems for patients and negatively affects their quality of life. Currently, iontophoresis with tap water and aluminum chloride hexahydrate is used for primary palmar hyperhidrosis. Yet, little evidence exists about iontophoresis with aluminum chloride hexahydrate in the form of gel. This study investigated the effect of aluminum chloride hexahydrate gel iontophoresis compared to tap water iontophoresis on primary palmar hyperhidrosis. Methods In this randomised controlled trial study, 32 patients with primary palmar hyperhidrosis were divided randomly into two groups (n = 16). Participants received 7 sessions of iontophoresis with aluminum chloride hexahydrate gel or tap water every other day on the dominant hand. The sweating rate was measured by gravimetry and iodine-starch tests before and after the last treatment session. Results Following the iontophoresis, the rate of sweating in both hands in the two groups was significantly reduced (P < 0.001). However, the sweating rate in the treated hand and the non-treated hand showed no significant difference. There was no significant difference observed in sweating rate reduction between both groups over time, but the larger effect size values observed in the aluminum chloride hexahydrate gel iontophoresis group may suggest the superiority of this gel over tap water in reducing the rate of sweating. Limitations Further investigations with longer follow-up are needed to confirm the hypothesis regarding the effectiveness of aluminum chloride hexahydrate gel iontophoresis over other types of iontophoresis. In addition, contraindications of iontophoresis such as pregnancy, pacemakers, and epilepsy should be considered. Conclusion The present study provides preliminary evidence suggesting that aluminum chloride hexahydrate gel iontophoresis is an effective alternative treatment to decrease sweating rate in extended areas with fewer side effects in patients with primary palmar hyperhidrosis.
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Affiliation(s)
- Seyed Majid Hosseini
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Ghandali
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Moghimi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian Moghaddam
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Biostatistics, Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Maryam Mortazavi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Muacevic A, Adler JR, Naz Khan K, Memon S, Naveed T, Shah SA, Farooq O, Ali U. Comparison of the Efficacy of Tap Water Iontophoresis Versus Aluminum Chloride Hexahydrate in the Treatment of Palmoplantar Hyperhidrosis. Cureus 2022; 14:e32367. [PMID: 36627989 PMCID: PMC9826940 DOI: 10.7759/cureus.32367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare the efficacy of tap water iontophoresis (TWI) versus aluminum chloride (AC) hexahydrate in the treatment of palmoplantar hyperhidrosis. METHODS The study was a randomized control trial performed at the dermatology department of Pakistan Navy Station (PNS) Shifa Hospital, Karachi from March 2022 to September 2022. A total of 70 palmoplantar hyperhidrosis patients were included in the study after getting approval from the ethical committee. Patients were divided into two groups. Group A patients were treated with TWI three times a week for four weeks. Group B patients were treated with a 20% AC topical solution applied at night to the affected areas for four weeks. The Hyperhidrosis Disease Severity Scale (HDSS) score for both groups was calculated at baseline, one, two, three, and four weeks. The final response was labeled at four weeks by comparing mean HDSS reduction in both groups. SPSS version 28 (IBM Corp., Armonk, NY) was used for data analysis. RESULTS Mean HDSS was compared for both groups at the end of the study, which showed a significant reduction in the mean score from 3.40 ± 0.65 to 1.48 ± 0.78 in group A, as compared to a decline in scores in group B from 3.28 ± 0.67 to 2.14 ± 0.94 (p = 0.002). In group A, zero, one, two, and three points HDSS improvement was 2.9%, 25.7%, 48.6%, and 22.9%, respectively. Whereas in group B, it was 34.3%, 22.9%, 34.3%, and 8.6%, respectively (p = 0.001). CONCLUSION As compared to AC topical solution, TWI is an effective, safe, and inexpensive management option for palmoplantar hyperhidrosis. It causes more improvement in HDSS scores and has lesser side effects.
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Campanati A, Gregoriou S, Milia-Argyti A, Kontochristopoulos G, Radi G, Diotallevi F, Martina E, Offidani A. THE PHARMACOLOGICAL TREATMENT AND MANAGEMENT OF HYPERHIDROSIS. Expert Opin Pharmacother 2022; 23:1217-1231. [PMID: 35686667 DOI: 10.1080/14656566.2022.2083499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Idiopathichyperhidrosis is a dysfunctional disorder involving eccrine sweat glands and its impact on patients' daily quality of life is well-known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options. AREAS COVERED The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatments flow-chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar and craniofacial hyperhidrosis. EXPERT OPINION Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis can represent an additive therapeutic option for patients with insufficient response to topical treatment according to a step wise therapeutic approach. Until the pathophysiological mechanisms underlying hyperhidrosis are clear, and the etiological therapeutic approach become realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms.
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Affiliation(s)
- Anna Campanati
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Stamatis Gregoriou
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Adamantia Milia-Argyti
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - George Kontochristopoulos
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Giulia Radi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Federico Diotallevi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Emanuela Martina
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Annamaria Offidani
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
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Intra tester reliability of sympathetic skin responses in subjects with primary palmar hyperhidrosis. J Bodyw Mov Ther 2020; 24:57-62. [DOI: 10.1016/j.jbmt.2020.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/19/2022]
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Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions. Clin Cosmet Investig Dermatol 2019; 12:733-744. [PMID: 31632121 PMCID: PMC6781850 DOI: 10.2147/ccid.s210973] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Abstract
Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.
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Affiliation(s)
- Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Georgios Kontochristopoulos
- State Department of Dermatology-Venereology, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. J Am Acad Dermatol 2019; 81:669-680. [PMID: 30710603 DOI: 10.1016/j.jaad.2018.11.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
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Affiliation(s)
- Jason E. Sammons
- Department of Clinical Medicine, Avalon University School of Medicine, Willemstad, CW, USA
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Abstract
AIM To critically appraise current literature regarding the management of plantar hyperhidrosis in the form of a structured review. METHOD A literature search was conducted using various databases and search criteria. DISCUSSION The literature reports the use of conservative, medical and surgical treatment modalities for the management of plantar hyperhidrosis. However, long-term follow-up data are rare and some treatment modalities currently available are not fully understood. CONCLUSION There is a considerable dearth in the literature on the management of plantar hyperhidrosis. Further study in larger populations with longer follow-up times is critical to access the long-term effects of treatment. Nonetheless, iontophoresis, botulinum toxin injection and lumbar sympathectomy are promising treatment modalities for this disorder.
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Affiliation(s)
- Sanjay Singh
- a Royal Lancaster Infirmary University Hospitals of Morecambe Bay , Lancaster , UK
| | - Simranjit Kaur
- a Royal Lancaster Infirmary University Hospitals of Morecambe Bay , Lancaster , UK
| | - Paul Wilson
- a Royal Lancaster Infirmary University Hospitals of Morecambe Bay , Lancaster , UK
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Chia H, Tan A, Chong W, Tey H. Efficacy of iontophoresis with glycopyrronium bromide for treatment of primary palmar hyperhidrosis. J Eur Acad Dermatol Venereol 2011; 26:1167-70. [DOI: 10.1111/j.1468-3083.2011.04197.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Callejas M, Grimalt R, Cladellas E. Hyperhidrosis Update. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Karakoc Y, Aydemir EH, Kalkan MT. Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis. Int J Dermatol 2004; 43:503-5. [PMID: 15230888 DOI: 10.1111/j.1365-4632.2004.02122.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Direct electrical current (d.c.) administration based on tap water iontophoresis has been used as a therapeutic option for palmoplantar hyperhidrosis. The placebo effect of this technique has not been investigated adequately. AIM To investigate whether d.c. administration has a possible placebo effect in the treatment of palmoplantar hyperhidrosis. METHODS As a placebo, low alternating electrical current (a.c.; 9-12 mA, 10-15 V, and 8-10 Hz) was applied to the palms of 15 patients with idiopathic palmoplantar hyperhidrosis. The placebo effect was evaluated by inspection and sweat intensity measurements performed before and after placebo application. Patients then received d.c. treatment (18-22 mA, 40-60 V) according to the same procedure as applied for placebo. The final sweat intensity measurements of the patients were performed 1 week after the last session of d.c. treatment. Sweat intensities measured before and after placebo and at the end of d.c. treatment were analyzed statistically by paired t-test. RESULTS The initial sweat intensity measurements of the palms, before placebo application, were 3.12 +/- 0.39 g/h on the right side and 3.17 +/- 0.28 g/h on the left side. The second sweat intensity measurements, 1 week after the last session of placebo, were 3.08 +/- 0.46 g/h on the right side and 3.16 +/- 0.21 g/h on the left side. There were no significant differences between the initial and second sets of sweat intensity measurements of the hands (P > 0.05 for both sides). The final sweat intensity measurements, 1 week after the last session of d.c. treatment, were 0.38 +/- 0.06 g/h on the right side and 0.39 +/- 0.07 g/h on the left side. CONCLUSIONS Statistical evaluation of sweat intensity measurements and inspections revealed that d.c. administration had no placebo effect in the treatment of palmoplantar hyperhidrosis.
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Affiliation(s)
- Yunus Karakoc
- Departments of Biophysics and Dermatology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, Ahn S, Stolman LP. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274-86. [PMID: 15280848 DOI: 10.1016/j.jaad.2003.12.029] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arigon JP, Chapuis O, Sainton T, Rouquie D, Bouchard A, Brocq FX, Pons F, Jancovici R. [Thoracic sympathectomy: treatment for hyperhidrosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2004; 60:95-103. [PMID: 15133446 DOI: 10.1016/s0761-8417(04)73476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Hyperhidrosis is a benign functional anomaly which is highly stressful for the patient. Active management is required. Several medical options are available but are often ineffective. The thoracic sympathic system plays a fundamental role in propagating stimulation of sudoral gland secretion. Endoscopic thoracic sympatecomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. We describe the technique used in our unit and present results and possible complications. This method has been used by many teams for several Years and despite some differences, most confirm major patient benefit. Phenomena of transferred sudation are frequent by are usually not invalidating. Patients should however be informed of this possibility because the effect is often irreversible.
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Affiliation(s)
- J-P Arigon
- Service de Chirurgie Thoracique et Générale, Hôpital d'Instruction des Armées Percy, 101, avenue Henry-Barbusse, 92140 Clamart.
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Connolly M, de Berker D. Management of primary hyperhidrosis: a summary of the different treatment modalities. Am J Clin Dermatol 2004; 4:681-97. [PMID: 14507230 DOI: 10.2165/00128071-200304100-00003] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Hyperhidrosis is a common and distressing condition involving increased production of sweat. A variety of treatment modalities are used to try to control or reduce sweating. Sweat is secreted by eccrine glands innervated by cholinergic fibers from the sympathetic nervous system. Primary hyperhidrosis most commonly affects palms, axillae and soles. Secondary hyperhidrosis is caused by an underlying condition, and treatment involves the removal or control of this condition. The treatment options for primary hyperhidrosis involve a range of topical or systemic medications, psychotherapy and surgical or non-surgical invasive techniques. Topical antiperspirants are quick and easy to apply but they can cause skin irritation and have a short half life. Systemic medications, in particular anticholinergics, reduce sweating but the dose required to control sweating can cause significant adverse effects, thus, limiting the medications' effectiveness. Iontophoresis is a simple and well tolerated method for the treatment of hyperhidrosis without long-term adverse effects; however, long-term maintenance treatments are required to keep patients symptom free. Botulinum toxin A has emerged as a treatment for hyperhidrosis over the past 5-6 years with studies showing good results. Unfortunately, botulinum toxin A is not a permanent solution, and patients require repeat injections every 6-8 months to maintain benefits. Psychotherapy has been beneficial in a small number of cases. Percutaneous computed tomography-guided phenol sympathicolysis achieved good results but has a high long-term failure rate. Surgery has also been shown to successfully reduce hyperhidrosis but, like other therapies, has several complications and patients need to be informed of these prior to undergoing surgery. The excision of axillary sweat glands can cause unsightly scarring and transthoracic sympathectomy (either open or endoscopic) can be associated with complications of compensatory and gustatory hyperhidrosis, Horner syndrome and neuralgia, some of which patients may find worse than the condition itself.
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Affiliation(s)
- Maureen Connolly
- Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, UK
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Affiliation(s)
- Jessie S Cheung
- Department of Dermatology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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Abstract
BACKGROUND Primary (idiopathic) hyperhidrosis is a benign disease of unknown etiology, leading to the disruption of professional and social life and emotional problems. A variety of treatment methods have been used to control or reduce the profuse sweating. In this study, we report the efficacy of direct current (d.c.) administration in the treatment of idiopathic hyperhidrosis. METHODS One hundred and twelve patients with idiopathic hyperhidrosis were enrolled in the study. Initial sweat intensities of the palms were measured by means of the pad glove method. The patients were treated in eight sessions with d.c. administration using a complete regulated d.c. unit based on tap water iontophoresis. The final sweat intensities of responders were determined 20 days after the last treatment. Nonresponders returned earlier than 20 days, with final sweat intensities measured at least 5 days after the last treatment. In 26 responders, plantar hyperhidrosis was also treated. After the first remission period, the second of eight treatments was applied to the palms of 37 responders. RESULTS This therapy controlled palmar hyperhidrosis in 81.2% of cases. The final sweat intensities of the palms of responders were significantly reduced after eight treatments (P < 0.001). The first average remission period was 35 days. Minimal undesirable effects were noted. CONCLUSIONS This technique appears to control hyperhidrosis on the palms and soles only if regular treatment is applied. Plantar hyperhidrosis appeared to resolve simultaneously when palmar hyperhidrosis was successfully treated.
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Affiliation(s)
- Yunus Karakoç
- Department of Biophysics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Affiliation(s)
- A K Leung
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, and Asian Medical Centre (affiliated with the University of Calgary Medical Clinic), Canada
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Leung AK, Cho HY, Choi MC, Chan PY. Hypohidrosis in children. THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 1999; 119:101-7. [PMID: 11043004 DOI: 10.1177/146642409911900208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypohidrosis has many causes. The condition may be generalised or segmental, acute or progressive and central or peripheral in origin. Most of the causes can be diagnosed from the history and physical examination. Laboratory investigations are usually not necessary. Treatment should be directed at the underlying cause whenever possible.
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Affiliation(s)
- A K Leung
- Department of Pediatrics, University of Calgary, Asian Medical Centre
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Kassan DG, Lynch AM, Stiller MJ. Physical enhancement of dermatologic drug delivery: iontophoresis and phonophoresis. J Am Acad Dermatol 1996; 34:657-66. [PMID: 8601657 DOI: 10.1016/s0190-9622(96)80069-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Iontophoresis and phonophoresis are emerging technologies capable of enhancing drug penetration through the stratum corneum, the principal barrier to percutaneous absorption. With utilization of applied electric current or ultrasonic waves, respectively, iontophoresis and phonophoresis have shown efficacy in an increasing number of clinical applications. This article reviews the underlying principles, current status, and potential of iontophoresis and phonophoresis in dermatologic therapy.
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Affiliation(s)
- D G Kassan
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
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Herbst F, Plas EG, Függer R, Fritsch A. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. Ann Surg 1994; 220:86-90. [PMID: 8024363 PMCID: PMC1234291 DOI: 10.1097/00000658-199407000-00012] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This evaluated the long-term outcome after endoscopic thoracic sympathectomy (ETS) from below D1 to D4, using a single-site access technique for primary hyperhidrosis of the upper limbs. SUMMARY BACKGROUND DATA Primary hyperhidrosis of the upper limbs is a distressing and often socially disabling condition. Endoscopic thoracic sympathectomy is considered the treatment of choice, causing minimal morbidity and high initial success rates. However, data regarding long-term results are scarce. METHODS Two hundred seventy of 323 patients (83.7%), in whom 480 sympathectomies were performed, answered a questionnaire after a mean of 14.6 years postoperatively regarding the early postoperative result, side effects, and complications caused by the operation and long-term results with particular emphasis on patient satisfaction. RESULTS There was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1%) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).
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Affiliation(s)
- F Herbst
- Department of Surgery, University of Vienna, Austria
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