Journal of Neonatology & Clinical Pediatrics Category: Clinical Type: Review Article
- Alexander KC Leung1*, Benjamin Barankin2
- 1 Department Of Pediatrics, Alberta Children's Hospital, University Of Calgary, Calgary, Alberta T2M 0H5, Canada
- 2 Toronto Dermatology Centre, Toronto, Canada
*Corresponding Author:Alexander KC Leung
Department Of Pediatrics, Alberta Children's Hospital, University Of Calgary, Calgary, Alberta T2M 0H5, Canada
Received Date: May 26, 2014 Accepted Date: Jun 17, 2014 Published Date: Jul 01, 2014
It has been speculated that the hypothalamic sweat center controlling the palms and soles is distinct from the rest of the hypothalamic sweat centers and is under the exclusive control of the cerebral cortex without input from the thermo sensitive elements . Thus, sweating on the palms and soles rarely, if ever, occurs during sleep or sedation, nor is it augmented in a warm environment.
In some families, the condition has an autosomal dominant mode of inheritance with incomplete penetrance . The responsible genes have been mapped to chromosome 14q11.2-q13 .
Figure 1: A 17-year-old girl with Palmar Hyperhidrosis.
Palmar hyperhidrosis may aggravate eczematous dermatitis . Affected patients are at risk for contact dermatitis and miliari . Hyperhidrosis may lead to maceration of the skin and predisposition to various bacterial and fungal infections.
Iontophoresis causes blockage of the sweat duct at the level of the stratum corneum by directing a mild electrical current through the skin. Although iontophoresis with plain tap water is relatively free of side effects, the necessity for repetitive frequent treatments is a drawback. Treatment can be made more effective by the addition of aluminum chloride or glycopyrronium bromide . For hyperhidrosis of palms or soles, the success rate is in the 80% range.
Systemic anticholinergics, such as glycopyrrolate and oxybutynin have been used with variable improvement in patients with hyperhidrosis . Unpleasant adverse effects include dryness of mouth, blurring of vision, dizziness, constipation, and urinary retention.
Injection of botulinum toxin A or B into the palms has been shown to be effective and safe for the treatment of palmer hyperhidrosis [3,8]. Botulinum toxins work by blocking the presynaptic release of acetylcholine. Side effects include pain at the injection site, dry skin, hematoma, and transient handgrip strength reduction, all of which are temporary . Duration of effect is typically around 6 months. Botulinum toxin treatment can be expensive, and some private insurance plans pay for the treatment.
Endoscopic thoracic sympathectomy may be considered for the rare patient with intractable palmar hyperhidrosis resistant to conservative measures . Video-assisted endoscopic thoracic sympathectomy further improves the success rate with low recurrence . Sympathectomy abolishes eccrine sweating in all areas supplied by the postganglionic fibers. Complications include wound infection, hemorrhage, pneumothorax, recurrent laryngeal nerve palsy, brachial plexus injuries, post-sympathetic neuralgia, Horner's syndrome, gustatory sweating, and compensatory hyperhidrosis in non-denervated areas .
- Leung AK, Chan PY, Choi CK (1999) Hyperhidrosis. Int J Dermat 38: 561-567.
- Higashimoto I, Yoshiura KI, Hirakawa N, Higashimoto K, Soejima H, et al. (2006) Primary palmar hyperhidrosis locus maps to14q11.2-q13. Am J Med Genet 140: 567-572.
- Vazquez-Lopez MS, Relgosa RP (2005) Palmar hyperhidrosis in a 13-year-old boy: treatment with botulinum toxin A. Clin Pediatr 44: 549-551.
- Leung AK (2011) Common Problems in Ambulatory Pediatrics: Symptoms and Signs. (1stedn) Nova Science Publishers, New York, USA: 9-19.
- Ro KM, Cantor RM, Lange KL, Samuel S Ahn (2002) Palmar hyerhidrosis: evidence of genetic transmission. J Vas Surg 35: 382-386.
- Chia HY, Tan AS, Chong WS, Tey HL (2012) Efficacy of iontophoresis with glycopyrronium bromide for treatment of primary palmar hyperhidrosis. J Eur Acad Dermatol Venereol 26: 1167-1170.
- Wolosker N, Schvartsman C, Krutman M, Taiz Pereira Dozono, Almeida Campbell, et al. (2014) Efficacy and quality of life outcomes of oxybutynin for treating palmar hyperhidrosis in children younger than 14 years old. Pediatr Dermatol 31: 48-53.
- Lecouflet M, Leux C, Fenot M, Philippe Célerier, Hervé Maillard (2014) Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: a study of 28 patients. J Am Acad Dermatol 70: 1083-1087.
- Tang H, Wu B, Xu Z, Xue L, Li B, et al. (2014) A new surgical procedure for palmar hyerhidrosis: is it possible to perform endoscopic sympathectomy under deep sedation without intubation? Eur J Cardiothorac Surg.
- Lau R, Ng C, Wong R (2014) Single port video-assisted thoracic surgery VasoView sympathectomy for palmar hyperhidrosis. Chest 145 : 44A.
Citation:Leung AKC, Barankin B (2014) Palmar Hyperhidrosis. J Neonatol Clin Pediatr, 1: 001.
Copyright: © 2014 Alexander KC Leung, 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.