Effects of Medical Drugs According to Sweating Localization in Primary Hyperhidrosis

Background: Primary hyperhidrosis is excessive sweating localized to different parts of the body, mostly on the hands. It is exact cause unknown, negatively affects the psychosocial structure of the person and a clinically important health problem. Aims: In the study, it was aimed to examine the effects of drugs used on primary hyperhidrosis. Study Design: The drugs used by the patients who applied to the thoracic surgery clinic with the complaint of sweating and their effects were analyzed retrospectively. Ersin Arslan Training and Research Hospital Thoracic Surgery Clinic between January 1, 2015, and September 30, 2021 (outcomes of seven years). Methodology: A total of 120 patients(45 female, 75 male and age range 8-67) with sweating complaints were identified. Age, gender, sweating localization and drugs used were examined. Statistically, data were analyzed with 95% confidence interval(CI) and Chi Square test. Results: A total of 120 patients were analyzed. 37.5% were female and 62.5% male.The mean age was 27.1±1.54 years.Patients were use 23.4% Aluminum hydrochloride cream),20.8% Bornaprine hydrochloride, 20% Hyoscine-N-butylbromide.According to sweating localizations;42.6% palmar only, 18.7% palmar and axilla, 18.7% palmar and craniofacial, 7.8% palmar and plantar, 5.9% diffuse, 4.5% cranial, 1.8% palmar and abdomen.It is more often between ages of 21-30 and in male.According to the complaints of patients with a history of using medical treatment; there were 34.5% partial response and 20.2% complete response, and no response to medical treatment in 45.3%. Conclusion: In the study; according to the localization of sweating;Aluminum hydrochloride cream reduces sweating on the palmar, and Hyoscine-N-butylbromide reduces axillary and palmar sweating. Bornaprine hydrochloride reduces sweating on all localizations except craniofacial and abdomen, and is related with a complete response on palmar sweating.According to sweating localizations; although there are localizations where all three drugs used are effective, it has been concluded that these drugs used in primary hyperhidrosis do not respond fully at a high rate.

Eyes Closing and Drowsiness in Human Subjects Decrease Baseline Galvanic Skin Response and Active Palmar Sweating: Relationship Between Galvanic Skin and Palmar Perspiration Responses

We previously constructed a perspiration ratemeter for the measurement of palmar sweating in human subjects. Although galvanic skin response (GSR) has been used to evaluate emotional responses in human subjects, little is known about the relationships between the phasic and baseline components in GSR and active palmar sweating. From the aforementioned, we aimed to investigate the relationships in human subjects with handgrip exercise and eyes closing or opening. Fifteen healthy volunteers (mean age: 26.9 ± 8.7 years) participated in the present experiments. We investigated the effects of maximal handgrip exercise, eyes closing or opening, and self-awareness of drowsy on the GSR, active palmar sweating, R-R interval in electrocardiograph (ECG), and percentage of α wave in EEG. The faster phasic component in GSR completely agreed with the starting point of active palmar sweating. Handgrip exercise induced significantly faster spike in GSR, active palmar sweating, and decrease in R-R interval in ECG. Eyes closing produced significant decreases in baseline GSR and active palmar sweating in all human subjects. The percentage of α wave in electroencephalograph (EEG) also increased. In contrast, eyes opening increased significantly the baseline GSR and active palmar sweating. In the equivalent electrical model of human skin, the eyes closing–mediated time-dependent decrease in the baseline GSR completely agreed with the hypothesis that the palmar skin voltage only in the model decreased time dependently to 0.4 of the control during 6 min. The self-awareness of drowsy in mid-night working with computer produced similar decreases in baseline GSR and active palmar sweating to the responses with eyes closing in all human subjects. In conclusion, the faster spike in GSR completely agreed with the starting point of active palmar sweating. Eyes closing and opening or self-awareness of drowsy significantly produced changes in baseline GSR and active palmar sweating, which may become useful tools for evaluating clearness or drowsiness in human subjects.

Efficacy of Miniuniportal Video-Assisted Thoracoscopic Selective Sympathectomy (Ramicotomy) for the Treatment of Severe Palmar and Axillar Hyperhidrosis

Background Video-assisted thoracoscopic surgery (VATS) clipping of the sympathetic branch has become the standard approach for the treatment of essential hyperhidrosis when conservative treatment failed. However, this is associated with relevant potential complications such as postoperative compensatory sweating and recurrent sweating. We report the outcome after selective sympathectomy (ramicotomy) through a miniuniportal VATS approach in patients with therapy-refractory palmar and/or axillary hyperhidrosis. Methods A total of 51 consecutive patients (37 females, mean age: 30 years, range: 12–64 years) who suffered from therapy-refractory palmar and/or axillary severe hyperhidrosis were included. Data were prospectively collected and retrospectively analyzed. All patients underwent bilateral miniuniportal VATS ramicotomy. Duration of surgery, hospital stay, recurrent, and compensatory sweating were documented. Results All patients had palmar sweating, where 51% had additional axillary sweating and 57% had additional plantar sweating. In all patients, selective division of the rami communicantes of the thoracic sympathetic ganglions Th2 to Th5 was performed. The mean duration of bilateral surgery for both sides was 67 ± 2.5 minutes. The mean postoperative hospital stay was 2 ± 1 days. After surgery and at further follow-up (mean: 12 ± 2.5 months), all patients presented dry and warm hands and axillae, without any evidence of compensatory or recurrent sweating. All patients described a remarkable increase in quality of life. Conclusion Miniuniportal VATS ramicotomy represents a feasible surgical technique with a very high success and satisfaction rate. Therefore, this approach should be considered as the method of choice for the treatment of patients with severe therapy-refractory palmar and axillary hyperhidrosis.

Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis

OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.