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Subject: Re: ETS to cure Hyperhidrosis
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF NEURO MD on May 20, 1997 at 12:59:16:
In Reply to: ETS to cure Hyperhidrosis posted by A. Mack on May 09, 1997 at 18:56:57:
: I have Hyperhidrosis and have found that ETS would
"cure" Hyperhidrosis. I put "cure" in quotations
because there has not been any long term studies
on the effectivenes of ETS. But short term seems
promising. I am concerned about complications like Horner's
syndrome and other neurological disorders and
sensory deficits. I am having a hard time finding
experienced surgeons in the United States to consult. Do you have any opinions or information on this procedure? Thank you for your time.
I must admit I am not an expert in treatment of hyperhidrosis. I performed a search on medhelp's library and found a reference by a Dr.Ivo Tarfusser. I have copied the information he has provided in hopes that it may help you. I cannot comment on the surgical reference that is provided. I have no experience with this. The web site was http://www.parsec.it/summit/hyper/e.htm. I would recommend you seek the advice of a dermatologist that may be of more assistance. If you are interested the Cleveland Clinic Foundation may be able to provide you with information. Patient education 1-800-223-2273 ext 42656.
I am unable to comment on the accuracy of this reference. Here is the exert from the reference:
Overview Sweating is a natural phaenomenon necessary for the regulation of an individual's
body-temperature. The secretion of sweat is mediated by a portion of our
vegetative nervous system (the Sympathetic Nervous System). In some people
(approximately 1% of the population), this system is working at a very high activity
level, far higher than needed to keep a constant temperature. This condition is
referred to as hyperhidrosis. Classification and Causes Causes
* primary = essential = idiopathic (unknown cause)
* secondary (known cause)
Locations
* palmar (hands)
* axillary (armpits)
* plantar (feet)
* facial (face)
* truncal (trunc)
* general 1. Hyperhidrosis as part of an underlying condition (secondary hyperhidrosis)
Some conditions can promote excessive sweating, as a rule involving the whole body:
* Hyperthyroidism or similar endocrine diseases
* Endocrine treatment for prostatic cancer or other types of malignant diseases
* Severe psychiatric disorders
* Obesity
* Menopause 2. Hyperhidrosis without known cause (=primary or essential hyperhidrosis)
This is a far more frequent condition than secondary hyperhidrosis and appears, generally,
localized in one or several locations of the body (most often hands, feet, armpits or a
combination of them). It usually starts during childhood or adolescence and persists all life.
Nervousness and anxiety can elicit or aggravate sweating, but psychological/psichiatric
disturbances are only rarely the cause of the disorder. Manifestations of Primary Hyperhidrosis Palmar Hyperhidrosis
Excessive sweating of the hands is, generally, by far the most distressing condition. The
hands are much more exposed in social and professional activities than any other part of
our body. Many individuals with this condition are limited in their choice of profession,
because unable to manipulate materials sensitive to humidity (paper etc) or reluctant to
shake hands; some patients arrive to the point to avoid social contact. The degree of
sweating varies and may range from moderate moisture to dripping. Most patients notice
that their hands not only feel moist, but also cold.
Axillary Hyperhidrosis
Also hyperhidrosis of the armpits can be embarrassing causing large wet marks and
sometimes a white halo of salt from sweating on the cloths.
Plantar Hyperhidrosis
Other locations
Less frequently, it is located only to the trunc and/or the thighs. Other patient are suffering
from copious sweating in the face. * Many individuals suffer form a combination of the above cathegories.
* Sweating can appear suddenly or manifest itself more continuously.
* It can be elicited by high outside temperatures or emotional stress, or appears without any
obvious reason.
* Generally, it worsens during the warm season and gets better during winter. Treatment In secondary hyperhidrosis, the underlying condition should be treated first. Patints on hormonal
therapy for prostatic cancer (castration, LHRH-analoges) with disturbing sweat attacks can get
relief by the administration of antiestrogens (ciproterone acetate). In patients with primary hyperhidrosis or for symptomatic treatment of heavy sweating in patients
with secondary hyperhidrosis, not treatable otherwise, the following methods have been adopted.
In psychiatric patients with hyperhidrosis, successful treatment this symptom often reduces the
tendency towards emotional distress. Antiperspirants
Iontophoresis
Drugs
Psychotherapy
Surgery
Other treatment methods ANTIPERSPIRANTS Usually recommended as the first therapeutic measure. The most effective agent
appears to be alluminum chloride (20-25%) in 70-90% alcohol, applied in the
evening 2-3 times/week. Generally, this treatment is sufficient in cases with light to
moderate hyperhidrosis but has to repeated regularly. IONTOPHORESIS Can be tried if antiperspirants have not lead to the desired result. This method
consists in applying low intensity electric current (15-18 mA), supplied by a D/C
generator, to the palms and/or soles immersed in an electrolyte solution. The procedure has to be repeated regularly, initially in 20' sessions several times/week,
gradually stretching out the interval between treatments to 1-2 weeks. The results
vary: many patients, suffering from light or moderate hyperhiderosis, are happy with
the method, some may consider it too time-consuming or inefficient, and
comparably expensive. It is difficult to apply in axillary, and impossible to use in
diffuse hyperhidrosis of the face or the trunc/thigh region. Equipment, specifically designed for the treatment of hyperhidrosis at home or in the
physician's office, is commercially available from different suppliers. DRUGS There are no specific drugs available against profuse sweating. Psychotropic (mostly
sedative) and/or anticholinergic drugs are often tested but show usually too many
side-effects before any noticeable result can be achieved. Hence, they are, as a rule,
not recommended. In those few cases who suffer from profuse sweating on the
trunc (but not the extremities), a low dose of anticholinergic agent can slightly
alleviate the symptoms without rendering life unsupportable from side-effects (dry
mouth, accomodation difficulties of the eyes, etc), but a dosage necessary to
normalize the amount of sweating will rarely be tolerated. PSYCHOTHERAPY Very limited effect in the absolut majority of patients. Psychological problems are in
most cases a consequence of hyperhidrosis, not the cause. Hence, psychiatric or
psychopharmacologic therapy cannot cure this disorder, at most it may help the
patient to accept living with the problem. SURGERY Excision of the axillary sweat glands Patients with axillary hyperhidrosis who are unresponsive to medical therapy
can be effectively treated by excision of the axillary sweat glands. If sweating
extends beyond the hairy portion of the axilla, several skin incisions may be
needed, sometimes resulting in formation of hypertrophic and/or constrictive
scars. Sympathectomy - The principle of sympathectomy is to interrupt the nerve tracks and nodes
(ganglia) which transmit the signals to the sweat glands. Basically, this can be
achieved for all locations in the body, but only the nerve nodes responsible
for the sweat glands of the palms, the armpits and the face are accessible
without the need for a major surgical procedure. Today, the treatment of
choice for moderate to severe palmar and facial hyperhidrosis (but also
axillary, especially if combined with palmar sweating), consists in a surgical
procedure known as Endoscopic Thoracic Sympathectomy. This
minimal-invasive endoscopic technique has been developed in recent years in
a few hospitals in Europe, superseeding Conventional Thoracic
Sympathectomy, a very traumatic procedure performed in the past. The
endoscopic technique is very safe, if performed by a surgeon experienced in
this type of procedure, and leads to definitive cure in nearly 100% of patients,
leaving only a minimal scar in the armpit. - Individuals with combined hyperhidrosis of the palms and soles have a
good chance to improve teh sweating of their feet after an operation aiming to
suppress sweating of the hands. Isolated plantar hyperhidrosis can, however
only cured by Lumbar Sympathectomy, an open abdominal procedure. - Diffuse hyperhidrosis of the trunc or general sweating of the whole body
cannot be treated by surgery. OTHER TREATMENT METHODS "Alternative Medicine" In the experience of the author, many patients, disappointed by the treatment
offered by their doctors, have tried different methods of alternative therapy
including homoeopathy, massage, acupuncture and phytotherapeutic drugs, in
almost all cases without noticeable improvement. "Lasertherapy" Some desperate patients have undergone this kind of treatment, involving
direct irradiation of the palms and resulting in 3rd degree burn lesions with
heavy cicatrisation, without any effect regarding sweating. This technique is
absolutely contra-indicated. Hypnosis There are no systematic studies on this method. Few patiens have tried it,
reporting poor results on palmar hyperhidrosis. Botulinus toxin A family of toxins produced by a bacteria known as Clostridium botulinum.
This toxin is one of the most lethal poisons known, interfering with the effect
of the transmitter substance acethylcholine at the synapses (the contact point
of a nerve ending with another nerve cell or a muscle) and leading to
progressive paralysis of all muscles in the body, including the respiratory
muscles. In extremely low doses, botulinus toxin has been adopted in cases
with localized muscle hyperactivity (lid spasms, torticollis, etc), resulting in a
reduction in transmitting impulses to the muscle. No official reports are so far
available regarding this treatment in hyperhidrosis. Reduction in activity of the
autonomous system (dry mouth, bladder paralysis, bowel inactivity) is a
known phaenomenon in severe botulism (botulinus poisoning), but will hardly
be achieved without detrimental side-effects on the muscle activity. Here is a reference for the surgical treatment. Again, I have no experience with this group, so this is in no way a recommendation. However, it may be a useful tool to finding you appropriate therapy. If you undergo a treatment of any sorts, I would recommend a academic institution. Their treatments are usually the most advanced.
US-Coordinator: Ruth Matti SURGICAL TEAM ADVISERS, INC.
5445 Collins Avenue, Suite CU-8-A
Miami Beach, FL 33140
Phone: (305) 868-8181, (800) 548-0395
Fax: (305) 868-8188
E-mail: SwedenUSA@msn.com
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