HYPERHIDROSIS

I. Epidemiology

  1. May affect 0.6-1% of population (Ann. Surg 186:34, 1977)

II. Differential dx

  1. Hyperthyroidism
  2. Acromegaly or other hyperpituitarism
  3. Diabetes
  4. Alcohol use
  5. Chronic infection
  6. Collagen vascular disease
  7. Sarcoidosis
  8. Pheochromoocytoma
  9. Carcinoid syndrome

III. Treatments that have been used--rarely significantly helpful; most have not been confirmed in controlled trials

  1. Glycopyrrolate (Robinul) 1mg 1-2tabs BID-TID (an anticholinergic; causes dry mouth and blurry vision; can also use topically? 1-2mg/ml in H20)
  2. Propantheline
  3. Phenoxybenzamine 10mg/d (not if suspect pheo!)
  4. Clonidine
  5. SSRI's
  6. Aluminum chloride in ethanol topically for axillae
  7. Iontophoresis for hands (?)
  8. Calcium channel blockers

IV. Subcutaneous curettage of axillae to remove eccrine sweat glands

  1. Fails in 20% of cases
  2. Can cause reduced arm ROM

V. Thoracic sympathectomy

  1. Known since 1920's to eliminate axillary and hand sweating
  2. Usually destroy T2 and T3 ganglia bilaterally; sometimes also T4-T6
  3. Thoracoscopic much simpler than open procedure; can be a 1-day hospitalization
  4. Promotional materials from mention 85% success in relief of facial sweating but published literature doesn't
  5. Can precede actual sympathectomy by a stellate block to show the likely outcome and test for effect of Horner's sd.
  6. Complications of thoracoscopic procedure
  1. Pneumothorax
  2. Horner's syndrome
  3. Compensatory sweating elsewhere (up to 37-75% of pts)
  4. Gustatory sweating
  5. Recurrence is rare (0-5% in series as of 1993; for axillary sweating as opposed to palmar sweating, is probably greater, i.e. about 15-20%)
  6. Theoretical risk of denervation of sympathetic supply to the heart, esp. if go below T3, which is usually necessary to control axillary as opposed to palmar hyperhidrosis
  1. Reports of the procedure:
  1. Arch. Surg 113:264, 1978
  2. Br. J. Surg 77:1046-9, 1990
  3. Ann. Surg 215:289-93, 1992
  4. Scand. J. Plast. Reconstr. Hand Surg. 27:29-33, 1993
  5. Eur. J. Vasc. Surg 6:558, 1992
  6. Br. J. Anesth 70:491, 1993
  1. Currently (1997) offered by "Surgical Team Advisers, Inc." 5445 Collins Ave Suit CU-8-A, Miami Beach, FL 33140 (305) 868-8181; SwedenUWA@msn.com offering package deals including airfare, etc. to Gothenburg, Sweden for $5,950 for surgery to be done by Claes, Drott, Gothberg, and Dalman at Boras Hospital tel. 46 33 16 10 00. An Ivo Tarfussed, MD is also involved with tel/e-mail in Italy: 39 335 24 1686; summit@em.parsec.it

VI. Botulinum toxin injections in palms or axillae (Med. Lett. 41:64, 1999)

  1. Two double-blind trials have found that botulinum toxin type A (Botox) can decrease both palmar and axillary hyperhidrosis (results presented at Am. Acad. Derm. meeting 2001 per AFP)

Other references: Stolman L. "Managing Hyperhidrosis" Cosmetic Dermatology 9/94 or 9/95; Simpson N. "Treating Hyperhidrosis BMJ 296:1345, 1988; J.Am. Acad. Derm 33:78, 1995? (article on endoscopic transthoracic sympathectomy); Sato, K et al., "Biology of Sweat Glands and Their Disorders I. Nl Sweat Gland Function J. A. A. D. 20:537-63, 1989 and II. Disorders of Sweat Gland Function 20:713-26, 1989.

(Sources: Lancet 343:247, 1994; BMJ 306:1221, 1993)