Hyperhidrosis and Its Treatment

Article information

J Korean Med Assoc. 2005;48(8):757-763
Publication date (electronic) : 2005 August 31
doi : https://doi.org/10.5124/jkma.2005.48.8.757
Department of Thoracic & Cardiovascular Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Korea. dylee@yumc.yonsei.ac.kr, drthora@yumc.yonsei.ac.kr

Abstract

Excessive sweating, or hyperhidrosis, can have detrimental effects on the patient's quality of life, resulting in impairment of daily activities, social interactions and occupational activities. The symptoms of hyperhidrosis also may put the patients at risk of fear, avoidance and even social anxiety disorder. Hyperhidrosis is caused by an excessive, non-thermoregulatory sweat response to emotional stimuli in body regions influenced by the central preoptic-anterior hypothalamus. Treatment options are based on the severity of symptoms and the risks and benefits of therapy. In general, noninvasive topical agents and medications are initial treatment options. Endoscopic sympathetic surgery can be used for severe cases of palmar, axillary and facial hyperhidrosis. Compensatory sweating is an annoying complication after sympathetic surgery; however, various methods have been introduced to reduce or reverse it. Nonetheless, careful selection is needed for the patient to improve the quality of life after the treatment.

References

1. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res 2003. 13256–270.
2. Chung IH, Oh CS, Koh KS, Kim HJ, Paik HC, Lee DY. Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy. J Thorac Cardiovasc Surg 2002. 123498–501.
3. Stevens A, Lowe JS. Histology 1992. London: Gower Medical Publishing; 348–368.
4. Charkoudian N. Skin blood flow in adult human thermoregulation: how it works, when it does not, and why. Mayo Clin Proc 2003. 78603–612.
5. Bini G, Hagbarth KE, Hynninen P, Wallin BG. Thermoregulatory and rhythm-generating mechanisms governing the sudomotor and vasoconstrictor outflow in human cutaneous nerves. J Physiol 1980. 306537–552.
6. Iwase S, Ikeda T, Kitazawa H, Hakusui S, Sugenoya J, Mano T. Altered response in cutaneous sympathetic outflow to mental and thermal stimuli in primary palmoplantar hyperhidrosis. J Auton Nerv Syst 1997. 6465–73.
7. Palmer AJ. Hyperhidrosis; study of a case. Arch Neurol Psychiat 1947. 58582–592.
8. Krogstad AL, Skymne BS, Goran Pegenius BS, Elam M, Wallin BG. Evaluation of objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin treatment. Clin Neurophysiol 2004. 1151909–1916.
9. Shih CJ, Wu JJ, Lin MT. Autonomic dysfunction in palmar hyperhidrosis. J Auton Nerv Syst 1983. 833–43.
10. Eisenach JH, Atkinson JL, Fealey RD. Hyperhidrosis: evolving therapies for a well-established phenomenon. Mayo Clin Proc 2005. 80657–666.
11. Khurana R. In : Low PA, ed. Acral sympathetic dysfunction and hyperhidrosis. Clinical Autonomie Disorders 1997. 2nd edth ed. Philadelphia: Lippincott-Raven; 809–818.
12. Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004. 51241–248.
13. Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 1977. 18634–41.
14. Lee DY, Hong YJ, Shin HK. Thoracoscopic sympathetic surgery for hyperhidrosis. Yonsei Med J 1999. 40589–595.
15. Lin TS, Kuo SJ, Chou MC. Uniportal endoscopie thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery 2002. 51Suppl 5. S84–S87.
16. Reisfeld R, Nguyen R, Pnini A. Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients. Surg Laparosc Endosc Percutan Tech 2000. 105–10.
17. Doolabh N, Horswell S, Williams M, Huber L, Prince S, Mack MJ, et al. Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thorac Surg 2004. 77410–414.
19. Luh JY, Blackwell TA. Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate. South Med J 2002. 95756–758.
20. Torch EM. Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride. South Med J 2000. 9368–69.
21. Akins DL, Meisenheimer JL, Dobson RL. Efficacy of the Drionic unit in the treatment of hyperhidrosis. J Am Acad Dermatol 1987. 16828–832.
22. Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ 2001. 323596–599.
23. Saadia D, Voustianiouk A, Wang AK, Kaufmann H. Botulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study. Neurology 2001. 572095–2099.
24. Shimizu H, Tamada Y, Shimizu J, Ohshima Y, Matsumoto Y, Sugenoya J. Effectiveness of iontophoresis with alternating current (AC) in the treatment of patients with palmoplantar hyperhidrosis. J Dermatol 2003. 30444–449.
25. Nyamekye IK. Current therapeutic options for treating primary hyperhidrosis. Eur J Vasc Endovasc Surg 2004. 27571–576.
26. Hashmonai M, Kopelman D. History of sympathetic surgery. Clin Auton Res 2003. 13Suppl 1. I6–I9.
27. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Grunenwald D, et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 2003. 751075–1079.
28. Lee DY, Kim DH, Paik HC. Selective division of T3 rami communicantes (T3 ramicotomy) in the treatment of palmar hyperhidrosis. Ann Thorac Surg 2004. 781052–1055.
29. Lee DY, Paik HC, Kim DH, Kim HW. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis. Clin Auton Res 2003. 13Suppl 1. S45–S47.
30. Lin CC, Telaranta T. Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery. Ann Chir Gynaecol 2001. 90161–166.
31. Telaranta T. Reversal surgery for reducing the side effects of ETS. A case report. Ann Chir Gynaecol 2001. 90175–176.
32. Neumayer C, Zacherl J, Holak G, Jakesz R, Bischof G. Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing. Clin Auton Res 2003. 13Suppl 1. I52–I57.
33. Pohjavaara P, Telaranta T, Vaisanen E. The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block. Nord J Psychiatry 2003. 5755–60.

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