ARTICLE | HYPERHIDROSIS |
Treatment selection in
hyperhidrosis
depends on the severity of the symptoms and a
thoughtful discussion between doctor and patient, weighing the potential risks and benefits.
Endoscopic thoracic sympathectomy is a
somewhat more invasive procedure that bilaterally divides the thoracic sympathetic chain. This surgical procedure is performed under general anaesthesia and requires displacement of the lung to access the chain near the spine. Risks include iatrogenic HornerÕs Syndrome and injury to nearby structures. Sympathectomy can be used to treat palmar and axillary hyperhidrosis, and the improvement in sweating is generally long-lasting. Treatment selection in hyperhidrosis depends on the
severity of the symptoms and a thoughtful discussion between doctor and patient, weighing the potential risks and benefits. Compensatory hyperhidrosis is a legitimate concern, particularly after thoracic sympathectomy in which skin areas with intact innervation demonstrate increased sweating12
. Surgical
risks have increased the demand for less-invasive treatment options. Few studies have been carried out to compare the efficacy and satisfaction of surgical versus minimally-invasive treatments. As expected, sympathectomy has been shown to have a greater duration of effectiveness than botulinum toxin injections for palmar hyperhidrosis13
.
Conclusions Axillary hyperhidrosis is a potentially socially debilitating condition that is relatively common. Fortunately, effective treatments exist and emerging devices promise long-term improvement with minimal risk. Medical professionals can favourably impact the lives of those suffering with this condition with appropriate counselling and treatment.
Declaration of interest None Figure image 1 ç Brett Kotlus
References
1. Bovell DL, MacDonald A, Meyer BA et al. The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis. Exp Dermatol 2001; 20(12): 1017–20
2. Solish N, Bertucci V, Dansereau A et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33(8): 908–23
3. Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin 2008; 18(2): 157–66
4. Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ 2000; 321(7262): 702–3
5. Hill AC, Baker GF, Jansen GT. Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis. Cutis 1981;
42 ❚ 28(1): 69–70, 72
6. Absar MS, Onwudike M. Efficacy of botulinum toxin type A in the treatment of focal axillary hyperhidrosis. Dermatol Surg 2008; 34(6): 751–5
7. Boni R. Tumescent suction curettage in the treatment of axillary hyperhidrosis: experience in 63 patients. Dermatology 2006; 213(3): 215–7
8. Kotlus BS. Treatment of refractory axillary hyperhidrosis with a 1320-nm Nd:YAG laser. J Cosmet Laser Ther 2011; 13(4): 193–5
9. Commons GW, Lim AF. Treatment of axillary hyperhidrosis/bromhidrosis using VASER ultrasound. Aesthetic Plast Surg 2009; 33(3): 312–23
10. Chih-Ho Hong H, Lupin M, O’Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg 2012 [Epub ahead of print]
11. Glaser DA, Coleman WP 3rd, Fan LK et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg 2012; 38(2): 185–91
12. Santana-Rodriguez N, Clavo B, Calatayud-Gastardi J et al. Severe compensatory hyperhidrosis following thoracic sympathectomy successfully treated with low doses of botulinum toxin A. J Dermatolog Treat 2011 [Epub ahead of print]
13. Ambrogi V, Campione E, Mineo D, Paternò EJ, Pompeo E, Mineo TC. Bilateral thorascopic T2 to T3 sympathectomy versus botulinum injection in palmar hyperhidrosis. Ann Thorac Surg 2009; 88(1): 238–45
June 2012 |
prime-journal.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84