Información del artículo
Abstract
Nearly 3% of the population has hyperhidrosis. Quality of life is affected, impacting on social relationships and professional activity, and social anxiety disorder can sometime develop.
We review the definition and causes of hyperhidrosis and the clinical evaluation of patients. After describing the different clinical aspects of the condition, we discuss the medical and surgical treatments. Of such treatments currently available, particular mention is made of the use of botulinum toxin in some forms of hyperhidrosis as an intermediate option between the traditional treatments and surgery. We also draw attention to the use of minimal access surgical techniques (videothoracoscopy), which, over the past decade, have become established as an effective, safe, and permanent approach for the treatment of hyperhidrosis when indicated.
Keywords:
Hyperhidrosis
Topical treatments
Iontophoresis
Botulinum toxin
Videothoracoscopic sympathectomy
Resumen
La hiperhidrosis afecta casi al 3% de la población. Hay una disminución de la calidad de vida que perjudica las relaciones sociales y las actividades profesionales, presentándose ocasionalmente fobia social.
En esta revisión se analiza el concepto y las causas de hiperhidrosis, así como la evaluación clínica del paciente que la padece. Tras discutir los distintos aspectos clínicos de la hiperhidrosis se revisan los diferentes tratamientos médicos y quirúrgicos.
Actualmente disponemos de varios tratamientos de tipo médico y quirúrgico. Se resalta la aportación de la toxina botulínica como opción intermedia en ciertas formas de hiperhidrosis, entre los tratamientos clásicos y el tratamiento quirúrgico. También se destaca la contribución de las técnicas quirúrgicas de acceso mínimo (videotoracoscopia), que se han consolidado en esta última década como una opción efectiva permanente y segura para el tratamiento de esta afección en los casos indicados.
Palabras clave:
Hiperhidrosis
Métodos tópicos
Iontoforesis
Toxina botulínica
Simpatectomía videotoracoscópica
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References
[1.]
W.P. Cheshire, R. Freeman.
Disorders of sweating.
Semin Neurol, 23 (2003), pp. 399-406
[2.]
R. Adar, A. Kurchin, A. Zweig, M. Mozes.
Palmar hyperhidrosis and its surgical treatment: A report of 100 cases.
Ann Surg, 186 (1977), pp. 34-41
[3.]
D.R. Strutton, J.K. Kowalski, D.A. Glaser, P.E. Stang.
US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey.
J Am Acad Dermatol, 51 (2004), pp. 241-248
[4.]
T.S. Lin, S.J. Kuo, M.C. Chou.
Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: Analysis of 2,000 cases.
Neurosurgery, 51 (2002), pp. 84-87
[5.]
K. Sato, W.H. Kan, K. Saga, K.T. Sato.
Biology for sweat glands and their disorders. I. Normal sweat gland function.
J Am Acad Dermatol, 20 (1989), pp. 537-565
[6.]
D.A. Glaser, A.A. Hebert, D.M. Pariser, N. Solish.
Primary focal hyperhidrosis: scope of the problem.
Cutis, 79 (2007), pp. 5-17
[7.]
M.O. Biebl, G. Fraedrich, P. Larcher, H. Biedermann, W. Biebl.
Amelioration of specific phobias after thoracic sympathetic block in patients with localized hyperhidrosis.
Ann Thorac Surg, 83 (2007), pp. 1578-1579
[8.]
P.B. Licht, L. Ladegaard, H.K. Pilegaard.
Thoracoscopic sympathectomy for isolated facial blushing.
Ann Thorac Surg, 81 (2006), pp. 1863-1866
[10.]
J. Moya, R. Ramos, J. Prat, R. Morera, R. Bernat, R. Villalonga, et al.
Cambios anatomopatológicos observados en los ganglios simpáticos de pacientes intervenidos de hiperhidrosis palmoaxilar. Estudio de 55 muestras.
Arch Bronconeumol, 39 (2003), pp. 115-117
[11.]
S. Iwase, T. Ikeda, H. Kitazawa, S. Hakusui, J. Sugenoya, T. Mano.
Altered response in cutaneous sympathetic outflow to mental and thermal stimuli in primary palmoplantar hyperhidrosis.
J Auton Nerv Syst, 64 (1997), pp. 65-73
[12.]
D. Manca, J. Valls-Sole, M.A. Callejas.
Excitability recovery curve of the sympathetic skin response in healthy volunteers and patients with palmar hyperhidrosis.
Clin Neurophysiol, 111 (2000), pp. 1767-1770
[13.]
I. Higashimoto, K. Yoshiura, N. Hirakawa, K. Higashimoto, H. Soejima, T. Totoki, et al.
Primary hyperhidrosis locus maps to 14q11.2-q13.
Am J Med Genet A, 140 (2006), pp. 567-572
[14.]
J.M. Swinehart.
Treatment of axillary hyperhidrosis: combination of the starch-iodine test with the tumescent liposuction technique.
Dermatol Surg, 26 (2000), pp. 392-396
[15.]
M. Hund, I. Kinkelin, M. Naumann, H. Hamm.
Definition of axillary hyperhidrosis by gravimetric assessment.
Arch Dermatol, 138 (2002), pp. 539-541
[16.]
J.R. de Campos, P. Kauffman, C. Werebe Ede, L.O. Andrade Filho, S. Kusniek, N. Wolosker, et al.
Quality of life, before and after thoracic sympathectomy: report on 378 operated patients.
Ann Thorac Surg, 76 (2003), pp. 886-891
[17.]
C.R. Touw, L. Hakkaart-van Roijen, P. Verboom, C. Paul, F.F. Rutten, A.Y. Finlay.
Quality of life and clinical outcome in psoriasis patients using intermittent cyclosporin.
Br J Dermatol, 144 (2001), pp. 967-972
[18.]
M.K. Naumann, H. Hamm, N.J. Lowe.
Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial.
Br J Dermatol, 147 (2002), pp. 1218-1226
[19.]
J.E. Ware, M. Kosinski, S.D. Keller.
A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
Med Care, 343 (1996), pp. 220-233
[20.]
A. Campanati, L. Penna, T. Guzzo, L. Menotta, B. Silvestri, G. Lagalla, et al.
Quality-of-life assessment in patients with hyperhidrosis before and after treatment with botulinum toxin: results of an open-label study.
Clin Ther, 25 (2003), pp. 298-308
[21.]
A.Y. Finlay, G.K. Khan.
Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use.
Clin Exp Dermatol, 19 (1994), pp. 210-216
[22.]
M.C. Swan, T. Paes.
Quality of life evaluation following endoscopic transthoracic sympathectomy for upper limb and facial hyperhidrosis.
Ann Chir Gynaecol, 90 (2001), pp. 157-159
[23.]
A. Benohanian, A. Dansereau, C. Bolduc, E. Bloom.
Localized hyperhidrosis treated with aluminum chloride in a salicylic acid gel base.
Int J Dermatol, 37 (1998), pp. 701-708
[24.]
O. Jensen, T. Karlsmark.
Palmoplantar hyperhidrosis. Treatment with alcohol solution of aluminium chloride hexahydrate: a simple method of transpiration measurement.
Dermatologica, 161 (1980), pp. 133-135
[25.]
M.A. Callejas, R. Grimalt.
Topical glycopyrrolate in craniofacial hyperhidrosis.
Med Clin(Barc), 131 (2008), pp. 157
[26.]
E. Cladellas, M.A. Callejas, R. Grimalt.
A medical alternative to the treatment of compensatory sweating.
Dermatologic Ther, 21 (2008), pp. 406-408
[27.]
A.A. Rabinstein, E.E. Benarroch.
Treatment of paroxysmal sympathetic hyperactivity.
Curr Treat Options Neurol, 10 (2008), pp. 151-157
[29.]
S.K. Praharaj, M. Arora.
Paroxetine useful for palmar-plantar hyperhidrosis.
Ann Pharmacother, 40 (2006), pp. 1884-1886
[30.]
G.Y. Na, B.C. Park, W.J. Lee, D.J. Park, W. Kim do, M.N. Kim.
Control of palmar hyperhidrosis with a new “dry-type” iontophoretic device.
Dermatol Surg, 33 (2007), pp. 57-61
[31.]
O.P. Kreyden.
Iontophoresis for palmoplantar hyperhidrosis.
J Cosmet Dermatol, 3 (2004), pp. 211-214
[32.]
J.L. Shen, G.S. Lin, W.M. Li.
A new strategy of iontophoresis for hyperhidrosis.
J Am Acad Dermatol, 22 (1990), pp. 239-241
[33.]
N. Solish, V. Bertucci, A. Dansereau, H.C. Hong, C. Lynde, M. Lupin, Canadian Hyperhidrosis Advisory Committee, et al.
A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee.
Dermatol Surg, 33 (2007), pp. 908-923
[34.]
R. De Bree, I. van der Waal, C.R. Leemans.
Management of Frey syndrome.
Head Neck, 29 (2007), pp. 773-778
[35.]
R. Grimalt, G. Moreno, J. Ferrando.
Multi-injection plate for botulinum toxin application in the treatment of axillary hyperhidrosis.
Dermatol Surg, 27 (2001), pp. 543-544
[36.]
L. Nelson, P. Bachoo, J. Holmes.
Botulinum toxin type B: a new therapy for axillary hyperhidrosis.
Br J Plast Surg, 58 (2005), pp. 228-232
[37.]
L. Baumann, A. Slezinger, M. Halem, J. Vujevich, K. Mallin, C. Charles, et al.
Double-blind, randomized, placebo-controlled pilot study of the safety and efficacy of Myobloc (botulinum toxin type B) for the treatment of palmar hyperhidrosis.
Dermatol Surg, 31 (2005), pp. 263-270
[38.]
F.G. Bechara, M. Sand, G. Moussa, D. Sand, P. Altmeyer, K. Hoffmann, et al.
Treatment of unilateral compensatory sweating after endoscopical thoracic sympathectomy for general hyperhidrosis with botulinum toxin A.
Dermatol Surg, 32 (2006), pp. 745-748
[39.]
M.J. Krasna.
Thoracoscopic sympathectomy: a standardized approach to therapy for hyperhidrosis.
Ann Thorac Surg, 85 (2008), pp. S764-S767
[40.]
I.K. Nyamekye.
Current therapeutic options for treating primary hyperhidrosis.
Eur J Vasc Endovasc Surg, 27 (2004), pp. 571-576
[41.]
R. Jeganathan, S. Jordan, M. Jones, S. Grant, O. Diamond, K. McManus, et al.
Bilateral thoracoscopic sympathectomy: results and long-term follow-up.
Interact Cardiovasc Thorac Surg, 7 (2008), pp. 67-70
[42.]
J.B. Duarte, P. Kux, C.H. Castro, M.G. Cruvinel, J.R. Costa.
Fast track endoscopic thoracic sympathicotomy.
Clin Auton Res, 13 (2003), pp. I63-I65
[43.]
J. Moya, G. Ferrer, R. Morera, R. Pujol, R. Ramos, R. Villalonga, et al.
Estudio comparativo entre la gangliectomía y la simpaticolisis torácica superior para el tratamiento quirúrgico de la hiperhidrosis palmar primaria. A propósito de 185 procedimientos en 100 pacientes.
Actas Dermatosifiliogr, 92 (2001), pp. 369-375
[44.]
T.M. Boley, K.N. Belangee, S. Markwell, S.R. Hazelrigg.
The effect of thoracoscopic sympathectomy on quality of life and symptom management of hyperhidrosis.
J Am Coll Surg, 204 (2007), pp. 435-438
[45.]
M.A. Callejas, M. Rubio, M. Iglesias, J. Belda, E. Canalís, M. Catalán, et al.
Video-assisted thoracoscopic sympathectomy for the treatment of facial flushing: ultrasonic scalpel versus diathermy.
Arch Bronconeumol, 40 (2004), pp. 17-19
[46.]
P.B. Licht, H.K. Pilegaard.
Gustatory side effects after thoracoscopic sympathectomy.
Ann Thorac Surg, 81 (2006), pp. 1043-1047
[47.]
C. Neumayer, P. Panhofer, J. Zacherl, G. Bischof.
Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis.
Arch Surg, 140 (2005), pp. 676-680
[48.]
S. Watarida, S. Shiraishi, M. Fujimura, M. Hirano, T. Nishi, M. Imura, et al.
Laparoscopic lumbar sympathectomy for lower-limb disease.
Surg Endosc, 16 (2002), pp. 500-503
[49.]
M. Romano, A. Giojelli, P.P. Mainenti, O. Tamburrini, M. Salvatore.
Upper thoracic sympathetic chain neurolysis under CT guidance. A two year follow-up in patients with palmar and axillary hyperhidrosis.
Radiol Med (Torino), 104 (2002), pp. 421-425
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