Journal of Angiology & Vascular Surgery Category: Medical Type: Mini Review
Management of Hyperhidrosis: A Proposal Protocol for Trainees
- Katherine V Hurst1, Ashok Handa1*, Andrew Gordon2
- 1 Nuffield Department Of Surgical Sciences, University Of Oxford, Oxford, United Kingdom
- 2 Department Of Vascular Surgery, John Radcliffe Hospital, Oxford, United Kingdom
*Corresponding Author:Ashok Handa
Nuffield Department Of Surgical Sciences, University Of Oxford, Oxford, United Kingdom
Received Date: Jul 16, 2015 Accepted Date: Dec 03, 2015 Published Date: Dec 18, 2015
Hyperhidrosis is a chronic condition characterised by excessive sweating , and can effect up to 3% of the population . It can be classed as generalised; involving all the body’s sweat glands, or localized; affecting specific areas of the body only e.g., palms, soles of feet, groin .
The condition is seriously debilitating due to both emotional and social embarrassment. Some patients may also endure physical or occupational disability, hindering their activities of daily living and negatively impacting on their employability . With this in mind it is important to treat patients with successful therapies and ensure adequate follow up is sought after the procedure.
The pitfalls to this procedure are;
1) Failure; due to clipping the wrong ganglion, or to reoccurrence,
2) Compensatory sweating, particularly around the abdomen .
In the case of unilateral sympathectomy, compensatory sweating is rarely a problem, however if a patient requests a sympathectomy on the contralateral side, compensatory sweating of the back, abdomen and feet should be discussed prior to procedure.
We have treated a total of 168 patients from 2007-2015, on a self referral basis. Some patients require injections every 4 months, whilst others only re-present after 2 years. General patient satisfaction is high and outcomes are reputable.
The second pathway involves referral to a plastic surgeon for subdermal liposuction as primary therapy. Although this treatment has a risk of seroma formation , it can be extremely effective in the long term and the seromas tend to settle with time. If this is unsuccessful, botulinum toxin injections could be considered.
Palmar and axillary hyperhidrosis
Our unit has demonstrated reliable results following removal of the T2-T4 ganglia; however studies have shown similar long term outcomes following T3-T4 sympathectomy, and possible reduction in compensatory sweating .
If the patient wishes to have further treatment, there are several options available:
1) If no compensatory sweating has occurred, the T2-T4 (or T3-T4) ganglion can be removed from the contralateral side. An alternative option would be to clip above the T2 ganglion only on the contralateral side and treat the axilla with either botulinum toxin or subdermal liposuction, reducing the risk of compensatory sweating.
2) If compensatory sweating has occurred following treatment of the dominant side, the second option of clipping above the T2 ganglion and treating the axilla separately is advised.
If however the patient fails to have reduced axillary sweating after treatment, they can either be treated with botulinum toxin or subdermal liposuction bilaterally.
Our unit operates on approximately 6-8 patients per year for palmar and axillary hyperhidrosis. All have had adequate outcomes post procedure, with around 60% requesting further sympathectomy on their non dominant side.
Anticholinergic medications can be used either topically or orally. Multiple studies have evaluated their outcomes, and although their efficacy (topically and orally) is in the range of 60-75% , the side effects are marked and they are contraindicated in a wide range of patients .
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
The authors declare no conflict of interest in preparing this article.
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Citation:Hurst KV, Handa A, Gordon A (2015) Management of Hyperhidrosis: A Proposal Protocol for Trainees. J Angiol Vasc Surg 1: 001.
Copyright: © 2015 Katherine V Hurst, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.