Re: ETS to cure Hyperhidrosis

[CF-NEURO-MD]

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
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