Hiperhidrosis esencial, recomendaciones para su tratamiento / Essential hyperhidrosis, recommendations for its treatment

La hiperhidrosis esencial, más que un aumento profuso y desproporcionado en la producción y excreción de sudor, de manos y pies, u otras zonas, es una entidad clínica propia, con una sintomatología específica y una manera de sudar cuyas características la hacen patonegmónica. Etiológicamente no está confirmado su origen, pero sí está claro que constituye un problema de salud más frecuente, y a su vez desconocido y subvalorado, que otras tantas enfermedades. Afortunadamente en la actualidad existe un interés científico internacional en el tema y la cirugía se ha convertido en una herramienta útil, considerada esta la mejor opción de tratamiento. Algunos efectos indeseables en su evolución posoperatoria ensombrecen el pronóstico y motivan a los investigadores a buscar variantes técnicas que permitan mejorar los resultados que se tienen hoy. Con este mismo interés se celebra en el Centro Nacional de Cirugía de Mínimo Acceso un taller nacional e internacional de hiperhidrosis cada año. En los últimos 3 años se han realizado reuniones de consensos al final de estos eventos científicos, con los profesares nacionales y foráneos invitados. Las conclusiones de estas reuniones constituyen el motivo de esta presentación, y tiene el objetivo de protocolizar su tratamiento para evitar al máximo efectos indeseables o resultados negativos(AU)

The essential hyperhidrosis more than a profuse and disproportionate increase in production and excretion of sweat in hands and feet and other sites, is an own clinical entity with a specific symptomatology and a way of to sweat whose features becomes pathognomonic. From the etiological point of view its origin is not confirmed but it is clear that it is a frequent health problem and in turn unknown and undervalued than many other diseases. Fortunately nowadays there is an international scientific interest on this subject and surgery becomes a useful tool, considered it as the better option of treatment. Some undesirable effects in its postoperative evolution cast a shadow on the prognosis and motivate researchers to look for techniques variants allowing for improve the current results. With this same interest in the National Center of Minimal Access a national and international workshop on hyperhidrosis is held each year. In past three years at the end of these scientific events consensus meeting have been held together with the invited national and foreign professors. Conclusions from these meeting are the objective of present paper to add its treatment to protocol avoiding most of undesirable effects or the negative effects(AU)

MMPI Analysis of Patients with Essential Hyperhisrosis / 대한통증학회지

BACKGROUND: Although the cause of hyperhidrosis has not been the subject of close investigation, there are cases for which excessive sweating happens at the hands, feet and armpits due to hyperactivity of the sympathetic nervous system. This usually occurs in people less than 25 years old and it often causes difficulties for their social and occupational life and there is a decrease in the quality of life. Therefore, this should also be examined according to the mental state of the patient who suffers from hyperhidrosis. METHODS: The Minnesota Multiple Personality Inventory was administered to 59 patients in the Hyperhidrosis Center from March, 2006 to March, 2007. The MMPI's validity and 10 clinic standards were analyzed. The results were compared according to gender and age. RESULTS: Of the standard clinical items, psychopathy and conversion hysteria were 21.1% and 17.5%, respectively. On comparison between males (47.5%) and females (52.5%), the females had a higher score for the hypochondriasis item. The patients above 18 years old had a significantly higher level of hypochondriasis and hypomania compared to the patients below 18 years old. CONCLUSIONS: When analyzing the personality of the patients with essential hyperhidrosis with using the MMPI, it was difficult to look for relations with the mental factor. Therefore, it is necessary to develop diagnostic tests for younger people with considering the relations with the period of morbidity.

Compensatory Hyperhidrosis after Thoracoscopic Sympathectomy in Essential Hyperhidrosis

OBJECTIVE: Essential hyperhidrosis is a pathological condition of excessive sweating beyond that required to cool the body, though poorly understood, originating from a dysfunction of the sympathetic nervous system. Thoracoscopic sympathectomy is the most popular treatment for upper limb hyperhidrosis, because it is a safe, effective, minimally invasive, and time-saving method. However, the common complication is the compensatory hyperhidrosis in other areas of the body, notably on the back, chest, abdomen, and buttocks. Compensatory hyperhidrosis is severe enough for some people, especially those living in a warm climate or engaging in heavy physical activities, to regret ever having had operation. The pathophysiological mechanisms underlying compensatory hyperhidrosis are incompletely understood, even though it is thought to be a truly compensatory feature related to thermoregulation of the body. MATERIALS AND METHODS: we studied the clinical features of total 233 patients who were diagnosed as essential hyperhidrosis and treated with thoracoscopic sympathectomy or sympathicotomy from March 1992 to July 2000. RESULTS: The success rate of thoracoscopic sympathetic surgery(sympathectomy or sympathicotomy) was 98.7%. The global rate of compensatory hyperhidrosis was 77%; 84% in group T2, 3 sympathectomy, 76% in group T2 sympathectomy, 43% in group T2, 3 sympathicotomy and 59% in group T2 sympathicotomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathectomy and in T2, 3 sympathectomy than in T2 sympathicotomy and T2, 3 sympathicotomy with significancy in statistic analysis(p<0.01). The precipitating factors of compensatory hiperhidrosis, including heat(warm weather), anxiety, stress, and exertion were noted. The compensatory hyperhidrosis was the main cause of patient dissatisfaction after thoracoscopic sympathectomy. CONCLUSION: The degree of compensatory hyperhidrosis is closely related to the extent of thoracic sympathectomy.

Thoracic Sympathectomy for Essential Hyperhidrosis

Essential hyperhidrosis is a condition with excessive secretion of sweat, which may be localized in any part of the body. Most common is palmar or plantar hyperhidrosis. Severe hyperhidrosis may cause serious psychological and occupational problems. Of the Numerous treatment recommended for this condition, only surgical removal of the sympathetic nerve supply seems permanently effective. Fifty-three patients were operated on for hyperhidrosis of the upper extrimity during the period from 1989 to 1992. Resection of the upper thoracic ganglia and the connecting sympathetic chain was carried out using a posterior approach. All hands of patients were dry immediately after the operation. During a follow up period of between three months to three years, there was no recurrence of palmar sweating. Fifteen of the patients showed compensatory hyperhidrosis in trunk, mild Hornor syndrome was noted in two cases. Most of the patients were satisfied with the surgical result.