hyperhidrosis: a comprehensive review dina hamadi, r.n., b.s.n. alverno college: alverno college:...
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HYPERHIDROSIS:HYPERHIDROSIS:A Comprehensive ReviewA Comprehensive Review
Dina Hamadi, R.N., B.S.N.Dina Hamadi, R.N., B.S.N.
Alverno College: Alverno College:
Master’s of Science in NursingMaster’s of Science in Nursing
Navigating the TutorialNavigating the Tutorial
will take you to the next slidewill take you to the next slide
will take you to the previous slidewill take you to the previous slide
will take you to the home pagewill take you to the home page
ObjectivesObjectives
Understand the pathophysiology of Understand the pathophysiology of sweatingsweating
Identify diagnostic criteria for Identify diagnostic criteria for HypherhidrosisHypherhidrosis
Identify treatment options for the Identify treatment options for the Hyperhidrosis patientHyperhidrosis patient
Choose the Topic!Choose the Topic!
Sweat glandsSweat glands What makes me sweat?What makes me sweat? What is Hyperhidrosis?What is Hyperhidrosis? Treatment OptionsTreatment Options
Sweat GlandsSweat Glands
The human body has 2-5 million sweat The human body has 2-5 million sweat glandsglands
Two main types:Two main types:
Click on the different sweat gland types to learn more!ECCRINE
APOCRINE
Click the “Home” button after viewing both types
Source: www.sweathelp.org
Eccrine Sweat GlandsEccrine Sweat Glands
Approximately 3 million Approximately 3 million eccrine sweat glandseccrine sweat glands
Secrete a clear, odorless Secrete a clear, odorless fluidfluid
Aid in regulating body Aid in regulating body temperaturetemperature
Areas of concentration:Areas of concentration:Facial, plantar, and axillaeFacial, plantar, and axillae
CLICK HERE
Source: www.sweathelp.org
Apocrine Sweat GlandsApocrine Sweat Glands
Inactive until pubertyInactive until pubertyProduce thick fluidProduce thick fluidSecretions come in Secretions come in contact with bacteria on contact with bacteria on the skin and produce the skin and produce characteristic “body characteristic “body odor”odor”Found in axillary and Found in axillary and genital areasgenital areas
CLICK HERE
Source: www.sweathelp.org
Sweating Sweating
The hypothalamus serves as the The hypothalamus serves as the thermoregulatory centerthermoregulatory center
It controls both blood flow and sweat It controls both blood flow and sweat output to the skin’s surfaceoutput to the skin’s surface
Source: www.sweathelp.org
SweatingSweating
The hypothalamus can be triggered by:The hypothalamus can be triggered by:
EXERCISE
TEMPERATURE CHANGE
STRESS
HORMONESSource: www.sweathelp.org
SweatingSweating
Once triggered, the hypothalamus sends messages down the
spinal cordvia neurotransmitters.
Source: www.sweathelp.org
SweatingSweatingThe neurostransmitters travel down the The neurostransmitters travel down the spine via spine via ganglionganglion or sympathetic nerves or sympathetic nerves
These ganglion travel to nerves, which These ganglion travel to nerves, which reach the skin’s surfacereach the skin’s surface
Photo used with permission: The Whiteley Clinic,2007
Source: www.sweathelp.org
NeurotransmittersNeurotransmittersNeurotransmitters act as “vehicles,” transmitting
information from the hypothalamus to the skin’s surface.
Photo used with permission: The Whiteley Clinic, 2007
NeurotransmittersNeurotransmittersThe neurotransmitters can “exit” at various The neurotransmitters can “exit” at various
places along the spinal cord.places along the spinal cord.
The “exit” determines the location of skin The “exit” determines the location of skin innervation.innervation.
Spinal Cord InnervationsSpinal Cord Innervations
T2 – T8 innervate the skin of the upper limbs
T2-T4 innervatethe skin of the face
T4-T12 innervate theskin of the trunk T10-T12 innervate the skin
of the lower limbs
Source: www.sweathelp.org
NeurotransmittersNeurotransmitters
Acetylcholine innervates
Eccrine Sweat Glands
Catecholaminesinnervate
Apocrine Sweat Glands
Source: www.sweathelp.org
SweatingSweating
Once innervated, the apocrine and eccrine Once innervated, the apocrine and eccrine glands will produce ….glands will produce ….
SWEAT!SWEAT!
Click on the picture to take the “Sweating Quiz”
Click on the “Home” button to return to the topic choices
Source: www.sweathelp.org
Question 1Question 1
What serves as the body’s thermoregulatory What serves as the body’s thermoregulatory center?center?
a.a. The hypothalamusThe hypothalamus
b.b. The adrenal cortexThe adrenal cortex
c.c. The frontal lobeThe frontal lobe
CONGRATULATIONS!CONGRATULATIONS!
The The hypothalamushypothalamus regulates sweat output regulates sweat output and blood flow to the skin’s surface!and blood flow to the skin’s surface!
Take me to question 2!
SORRY….TRY AGAIN!SORRY….TRY AGAIN!
What regulates blood flow and sweat What regulates blood flow and sweat output to the skin’s surface?output to the skin’s surface?
a.a. The hypothalamusThe hypothalamusb.b. The adrenal cortexThe adrenal cortexc.c. The frontal lobeThe frontal lobe
Question 2Question 2
What neurotransmitter innervates eccrine What neurotransmitter innervates eccrine sweat glands?sweat glands?
a.a. AcetylcholineAcetylcholine
b.b. CatecholamineCatecholamine
c.c. GlucoseGlucose
You’re Right!!You’re Right!!
Take me to question 3!
Try Again!Try Again!
Hint:Hint: Catecholamines Catecholamines innervate innervate apocrineapocrine sweat glands!sweat glands!
Let me try question 2 again!
Question 3Question 3
The hypothalamus can be triggered by all The hypothalamus can be triggered by all these these exceptexcept::
a.a. StressStress
b.b. ExerciseExercise
c.c. ObesityObesity
d.d. Temperature changeTemperature change
CORRECT!!CORRECT!!
You have successfully completed this section of the tutorial. Return home!
Try Again!Try Again!
Return to question 3!Return to question 3!
HyperhidrosisHyperhidrosis
Hyperhidrosis is a state of Hyperhidrosis is a state of excessive sweating of the excessive sweating of the
axilla, palms, soles, or axilla, palms, soles, or face that interferes with face that interferes with
daily activitiesdaily activitiesHaider & Solish, 2004
Photo used with permission: University of Miami Cosmetic Center, 2007
Two TypesTwo Types
PrimaryPrimary oror idiopathic idiopathic
SecondarySecondary::Resulting from respiratory/heart failure,Resulting from respiratory/heart failure,
malignancy, drug/alcohol abuse,malignancy, drug/alcohol abuse,
hyperthyroidism, infectionhyperthyroidism, infectionHaider & Solish, 2004
Fun FactsFun Facts
Diagnosed in 2.8% of the U.S. populationDiagnosed in 2.8% of the U.S. population 70% of those with symptoms do not 70% of those with symptoms do not
consult a physicianconsult a physician Peaks in early adulthoodPeaks in early adulthood
Haider & Solish, 2004
Diagnostic Criteria:Diagnostic Criteria:Primary HyperhidrosisPrimary Hyperhidrosis
MUST HAVEMUST HAVE1. Focal, visible, excessive sweating1. Focal, visible, excessive sweating
2. 6 months duration2. 6 months duration
3. No apparent cause3. No apparent cause TWO OR MORE:
1. Bilateral and symmetric sweating2. Impairment of daily activities3. At least one episode per week4. Onset of less than 25 years5. Positive family history
Hornberger, 2004
What is Hyperhidrosis?What is Hyperhidrosis?
Involves the eccrine sweat glands, Involves the eccrine sweat glands, howeverhowever::
Sweat glands are Sweat glands are NORMALNORMAL
NoNo change in size change in sizeNoNo change in shape change in shape
NoNo change in number change in numberHaider & Solish, 2004Haider & Solish, 2004
CauseCause
Exact cause is unknownExact cause is unknown
Familial or genetic?Familial or genetic?
Excessive Sympathetic Activity?Excessive Sympathetic Activity?
Click on the raindrops to learn more about this theory!
Excessive Sympathetic ActivityExcessive Sympathetic Activity
The eccrine sweat glands are excessively
stimulated by acetylcholine
Increased SWEAT production
Hornberger, 2004
Excessive Sympathetic ActivityExcessive Sympathetic Activity
Because the sweat glands are continuously Because the sweat glands are continuously stimulated, they are stuck in the stimulated, they are stuck in the
positionposition
Hornberger, 2004Hornberger, 2004
QUIZ TIME!QUIZ TIME!
Those diagnosed with hyperhidrosis have Those diagnosed with hyperhidrosis have abnormal eccrine sweat glands.abnormal eccrine sweat glands.
TRUETRUE
FALSEFALSE
GOOD JOB!GOOD JOB!
The sweat glands are normal, with no The sweat glands are normal, with no variance in size, shape, or number!variance in size, shape, or number!
Take me to Question 2!
SORRY!SORRY!
Try again….Try again….
Click on the sad face to try again!
Question 2Question 2
Hyperhidrosis involves which sweat gland Hyperhidrosis involves which sweat gland type?type?
ApocrineApocrine
EccrineEccrine
Oops!Oops!
Take me back to the question!Take me back to the question!
YES!!YES!!
Hyperhidrosis involves the eccrine sweat Hyperhidrosis involves the eccrine sweat glands!glands!
You have successfully completed this section of the tutorial. You may return Home!
Treatment OptionsTreatment Options
Rules to Follow:Rules to Follow:
Different treatment for areas affectedDifferent treatment for areas affected
Always start with least invasive treatment Always start with least invasive treatment optionoption
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the first treatmentoption to begin!
Topical TreatmentTopical TreatmentFirst line treatmentFirst line treatment
Aluminum Chloride HexahydrateAluminum Chloride Hexahydrate antiperspirant of choiceantiperspirant of choice
Most beneficial for axillary Most beneficial for axillary hyperhidrosishyperhidrosis
Can be used for plantar and palmarCan be used for plantar and palmar
Photos used with permission:www.feelbest.com
Hornberger, 2004
Topical Treatment:Topical Treatment:How Does it Work?How Does it Work?
The metal ions in the topical antiperspirant damage the lining of the sweat gland.
As damage continues, a PLUG is formed over the sweat gland.
www.sweathelp.org
Topical TreatmentTopical TreatmentSweat production never Sweat production never ceases, the gland is simply ceases, the gland is simply pluggedplugged
Sweating will return as the Sweating will return as the skin undergoes skin undergoes regeneration or sheddingregeneration or shedding
Therefore…topical Therefore…topical treatment is NOT a cure!treatment is NOT a cure!
Hornberger, 2004
Photo used with permission:Neurosurgical Medical Clinic, Inc
Topical Treatment:Topical Treatment:How to UseHow to Use
Best to apply before bedtimeBest to apply before bedtime
Allow to remain on skin for 6 – 8 hoursAllow to remain on skin for 6 – 8 hours
Apply every 24 – 48 hours until sweating Apply every 24 – 48 hours until sweating diminishesdiminishes
Maintenance applications needed every 1-Maintenance applications needed every 1-3 weeks3 weeks
Hornberger, 2004
Topical Treatment: Topical Treatment: Pros and ConsPros and Cons
Non – invasiveItching and burning of skin
at application site&Time-consuming&Temporary reliefHornberger, 2004
Topical Treatment:Topical Treatment:EffectivenessEffectiveness
66.6% stop using dueto the “CONS”
Naumann, Hamm, & Lowe, 2002
88% effective forAxillary Hyperhidrosis
QUICK REVIEW!QUICK REVIEW!
Fill in the Blank!Fill in the Blank!
Topical Treatments work by ________ Topical Treatments work by ________ sweat glands.sweat glands.
DestroyingDestroyingPluggingPluggingMeltingMelting
That’s Right!That’s Right!
Topical Treatments PLUG the sweat glandTopical Treatments PLUG the sweat gland
Take me to the next treatment option!
Sorry!Sorry!
HINT:HINT: Sweat production never stops, the Sweat production never stops, the output is simply blocked!output is simply blocked!
Take me back to the question!
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the second treatmentoption!
Systemic TreatmentSystemic TreatmentAnticholinergics can be used in treating Anticholinergics can be used in treating
hyperhidrosishyperhidrosis
Most effective for cranio-facial hyerhidrosisMost effective for cranio-facial hyerhidrosis
RobinulRobinul – drug of choice – drug of choice
Haider & Solish, 2004
How Does it Work?How Does it Work?Anticholinergic
Blocks Acetylcholine transmission
Eccrine sweat glands no longer stimulated
Sweat production ceases!
Haider & Solish, 2004
AnticholinergicsAnticholinergics
Long term therapy is requiredLong term therapy is required
Major side effects:Major side effects:Dry mouthDry mouth
Dry eyesDry eyes
Constipation Constipation
Blurred visionBlurred vision
Difficulty with urinationDifficulty with urination
Thomas, Brown, & Vafaie, 2004
AnticholinergicsAnticholinergics
Limited use in treating Limited use in treating hyperhidrosishyperhidrosis
Only 21% effectiveOnly 21% effective
69.7% stop using due 69.7% stop using due to side effectsto side effects
Hamm, Naumann, & Kowalski, 2006
ReviewReview
Anticholinergics block transmission of Anticholinergics block transmission of
??
a.a. CatecholaminesCatecholamines
b.b. EpinephrineEpinephrine
c.c. AcetylcholineAcetylcholine
Yes!!Yes!!
Acetylcholine transmission is blocked!Acetylcholine transmission is blocked!
Take me to the next treatment option!
Sorry!Sorry!
Click on the picture to try again!
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the third treatmentoption!
IontophoresisIontophoresis Used for palmar and Used for palmar and
plantar hyperhidrosisplantar hyperhidrosis
Passage of direct Passage of direct electrical current onto electrical current onto skin’s surfaceskin’s surface
Device can be Device can be purchased for home usepurchased for home use Photo used with permission: Beast Psoriasis, 2006
Thomas, Brown, & Vafaie, 200 4
IontophoresisIontophoresis
Sit with hands or feet in Sit with hands or feet in shallow tray of watershallow tray of waterAllow 15 – 20 milli-amps of Allow 15 – 20 milli-amps of electrical current to pass electrical current to pass through waterthrough waterUse for 10 days, 30 Use for 10 days, 30 minutes each dayminutes each dayMaintenance therapy Maintenance therapy neededneeded
Photo used with permission: Beat Psoriasis, 2006
Thomas, Brown, & Vafaie, 2004
Iontophoresis:Iontophoresis:Mechanism of ActionMechanism of Action
WATER
+
ELECTRICTY
= Thickening of skinAnd
Blocked sweat flow
www.sweathelp.org
IontophoresisIontophoresis
Side effects:Side effects:Skin irritationSkin irritationSkin burnsSkin burnsVesicle formationVesicle formation
Time consuming treatmentTime consuming treatment
80% effective for palmar and/or plantar 80% effective for palmar and/or plantar hyperidrosishyperidrosis
Photo used with permission: Beat Psoriasis, 2006
Thomas, Brown, and Vafaie, 2004
IontophoresisIontophoresis
Contraindicated in those:Contraindicated in those:
1.1. Who are pregnantWho are pregnant
2.2. Have pacemakersHave pacemakers
3.3. Have metal implantsHave metal implants
4.4. Have cardiac conditionsHave cardiac conditions
5.5. Have epilepsyHave epilepsy
Question….Question….
Iontophoresis is NOT used in treating which Iontophoresis is NOT used in treating which type of hyperhidrosis?type of hyperhidrosis?
a.a. PalmarPalmar
b.b. Axillary Axillary
c.c. PlantarPlantar
Yes!Yes!
Iontophoresis can be Iontophoresis can be used in treating used in treating
PalmarPalmar and/or and/or PlantarPlantar hyperhidrosishyperhidrosis
Take me to the next treatment option
HINT: Look at these pictures….HINT: Look at these pictures….
Try Again!
Click on either picture to Try again!
Photos used with permission: Beat Psoriasis, 2006
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the fourth treatmentoption!
BotoxBotox
Botox injections can be used to treat Botox injections can be used to treat axillary, palmar, and plantar hyperhidrosisaxillary, palmar, and plantar hyperhidrosis
Analgesic applied prior to injectionAnalgesic applied prior to injection Nerve block applied to ulnar or radial Nerve block applied to ulnar or radial
nerve prior to palmar injection nerve prior to palmar injection
Haider & Solish, 2004
BotoxBotox
Starch Iodine test Starch Iodine test done prior to injectiondone prior to injection
Delineates areas of Delineates areas of excess sweating with excess sweating with black-purple black-purple discoloration of the discoloration of the skinskin Photo used with permission:
Eisenach, Atkinson, & Fealey, 2005
Haider & Solish, 2004
BotoxBotoxBotox blocks the release of acetylcholine at the site of the neuromuscular junction.
Sweat glands are not stimulated, and sweat production ceases
Site of blockagePhoto used with permission: Whiteley Clinic, 2007
Haider & Solish, 2004
BotoxBotox
Cons:Cons:Very painful to the Very painful to the palms and soles of palms and soles of feetfeet
Expensive: $1400-Expensive: $1400-$1600 per treatment$1600 per treatment
Pros: Lasts 6-7 months 90% effective
Thomas, Brown, & Vafaie, 2004
Quick ReviewQuick Review
A Starch-Iodine test is done prior to botox A Starch-Iodine test is done prior to botox injection.injection.
True True
FalseFalse
Correct!Correct!
This test highlights areas of excessive This test highlights areas of excessive sweating!sweating!
Take me to the next treatment option
Try Again!Try Again!
Hint: The test gives a “map,” highlighting Hint: The test gives a “map,” highlighting areas of excessive sweatingareas of excessive sweating
Click on the picture to try again!Click on the picture to try again!
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the fourth treatmentoption!
Local ExcisionLocal Excision
Used only for axillary Used only for axillary hyperhidrosishyperhidrosisStarch Iodine test done prior to Starch Iodine test done prior to excisionexcisionPerformed under local Performed under local anesthesia anesthesia Vasoconstrictor applied to Vasoconstrictor applied to axillary regionaxillary regionSmall incisions madeSmall incisions made
Eisenach, Atkinson, Foley, 2005
Photo used with permission:Gasparri, 2006
Local ExcisionLocal Excision
Eccrine sweat glands removed through:Eccrine sweat glands removed through:Liposuction – suctioned outLiposuction – suctioned out
Curettage – scraped outCurettage – scraped out
Excision – cut outExcision – cut out
Incisions suturedIncisions sutured
Pain and bruising to excision sitePain and bruising to excision site
Eisenach, Atkinson, & Fealey, 2005
Photo used with permission:Gasparri, 2006
Local ExcisionLocal Excision
Starch Iodine tests done post excision Starch Iodine tests done post excision show 80% - 90% decrease in sweatingshow 80% - 90% decrease in sweating
Has a potential for scarringHas a potential for scarring
Eisenach, Atkinson, & Fealey, 2005
Review!Review!
Local Excision is used for what type of Local Excision is used for what type of hyperhidrosis?hyperhidrosis?
a.a. PlantarPlantar
b.b. PalmarPalmar
c.c. AxillaryAxillary
Correct!Correct!
Local Excision is used for axillary Local Excision is used for axillary hyperhidrosis!hyperhidrosis!
Take me to the next treatment option!
Try Again!Try Again!
Click on the picture to try again!Click on the picture to try again!
Treatment OptionsTreatment OptionsTopical
Systemic
Iontophoresis
Botox
Local Excision
Thorascopic Sympathectomy
Click on the fourth treatmentoption!
Endoscopic Thoracic Endoscopic Thoracic Sympathectomy (ETS)Sympathectomy (ETS)
Last treatment optionLast treatment option
PERMANENT PERMANENT
Surgery performed under general Surgery performed under general anesthesiaanesthesia
Haider & Solish, 2004
ETSETS
Goal of surgery is to excise or ablate the Goal of surgery is to excise or ablate the ganglion that innervate the sweat glandsganglion that innervate the sweat glands
Performed most frequently for palmar Performed most frequently for palmar hyperhidrosishyperhidrosis
Performed throughPerformed through
thorascope or videothorascope or video
Minimally invasiveMinimally invasive
Photo used with permission:Neurosurgical Medical Clinic, Inc
Han, Oren, & Gottfried, 2002
ETSETS
Small incision made laterally under each Small incision made laterally under each axillaaxilla
Incision made through intercostal spaceIncision made through intercostal space Surgery can be performed on outpatient Surgery can be performed on outpatient
basis basis However, some patients remain in hospital However, some patients remain in hospital
for one nightfor one night
Han, Oren, & Gottfried, 2002
ETSETS
Ganglion located along Ganglion located along the sympathetic chain the sympathetic chain Ganglion formed below Ganglion formed below each ribeach ribGanglion can be divided Ganglion can be divided = = sympathicotomysympathicotomyGanglion can be Ganglion can be removed = removed = sympathectomysympathectomy
www.sweathelp.org
Photo used with permission:Neurosurgical Medical Clinic, Inc
ETSETSGanglion at T2 and T3 = palmar Ganglion at T2 and T3 = palmar hyperhidrosishyperhidrosis
Ganglion at T3 and T4 = axillary Ganglion at T3 and T4 = axillary hyperhidrosishyperhidrosis
Ganglion at L2-L4 = plantar hyperhidrosisGanglion at L2-L4 = plantar hyperhidrosiswww.sweathelp.org
Photos used with permission:Neurosurgical Medical Clinic, Inc
ETSETS
Cannot surgically excise or ablate L2-L4 Cannot surgically excise or ablate L2-L4 for plantar hyperhidrosis due to sexual for plantar hyperhidrosis due to sexual side effectsside effects
95% success rate in curing palmar 95% success rate in curing palmar hyperhidrosishyperhidrosis
Success rates slightly lower for axillary Success rates slightly lower for axillary hyperhidrosishyperhidrosisEisenach, Atkinson, & Fealey, 2005
ETSETS
Plantar hyperhidrosis resolves in 50% - Plantar hyperhidrosis resolves in 50% - 75% of cases when T2 and T3 are 75% of cases when T2 and T3 are excised, though L2-L4 ganglion are never excised, though L2-L4 ganglion are never surgically treatedsurgically treated
Mechanism is unknown!Mechanism is unknown!
Eisenach, Atkinson & Fealey, 2005
ETS: Side EffectsETS: Side Effects
Surgical complications:Surgical complications:Hemo-pneumothorax requiring chest tube Hemo-pneumothorax requiring chest tube placement – 1%placement – 1%
AtelectasisAtelectasis
Intercostal neuralgia – 1%Intercostal neuralgia – 1%
Horner’s Syndrome – 1%Horner’s Syndrome – 1%
Compensatory Sweating – 60%Compensatory Sweating – 60%
Eisenach, Atkinson, & Fealey, 2005
Horner’s SyndromeHorner’s Syndrome
Stellate ganglion – fusion of C8 and T1Stellate ganglion – fusion of C8 and T1Innervates the faceInnervates the face
If Stellate ganglion is damaged, Horner’s If Stellate ganglion is damaged, Horner’s Syndrome will occurSyndrome will occur
May be mistaken for T2 and T3 May be mistaken for T2 and T3
May receive electrical current from cautery of May receive electrical current from cautery of T2 and T3T2 and T3
www.sweathelp.org
Horner’s SyndromeHorner’s Syndrome
Signs and SymptomsSigns and SymptomsUnilateral upper eyelid ptosisUnilateral upper eyelid ptosis
Pupil constrictionPupil constriction
Facial anhidrosisFacial anhidrosis
www.sweathelp.org
Compensatory SweatingCompensatory Sweating
Most frequent Most frequent complication – 60% of complication – 60% of post-op patientspost-op patients
Severe sweating noted Severe sweating noted to abdomen, chest, back, to abdomen, chest, back, and thighsand thighsMore severe for those More severe for those who live in a hot climatewho live in a hot climate
www.sweathelp.org
Photo used with permission: ETS Discussion Forum and Reversals, 2005
Compensatory SweatingCompensatory SweatingMechanism poorly understoodMechanism poorly understood
Theory states:Theory states:After excision of T2 and T3, 40% of After excision of T2 and T3, 40% of body’s sweat function is lostbody’s sweat function is lost
Body tries to compensate for this loss Body tries to compensate for this loss Andrews & Rennie, 1997
Photo used with permission: ETS Discussion Forum and Reversals, 2005
Compensatory SweatingCompensatory SweatingMost patients feel compensatory Most patients feel compensatory sweating is a minor draw-back to sweating is a minor draw-back to surgerysurgery
Sweating to abdomen/trunk = Sweating to abdomen/trunk = less interference with daily less interference with daily activitiesactivities
Able to write/handle objectsAble to write/handle objects
Gossot, Galetta, & Pascal, 2003 Photo used with permission: ETS Discussion Forum and Reversals, 2005
Let’s ReviewLet’s Review
ETS is performed most often for what type ETS is performed most often for what type of hyperhidrosis:of hyperhidrosis:
a.a. AxillaryAxillary
b.b. PalmarPalmar
c.c. PlantarPlantar
CORRECT!CORRECT!
ETS is performed for palmar hyperhidrosis!ETS is performed for palmar hyperhidrosis!
Take me to the next question!
TRY AGAIN!TRY AGAIN!
Click on the picture to try again!Click on the picture to try again!
Question 2Question 2
What is the most significant side effect of What is the most significant side effect of ETS?ETS?
a.a. Hemo-pneumothoraxHemo-pneumothorax
b.b. Horner’s SyndromeHorner’s Syndrome
c.c. Compensatory SweatingCompensatory Sweating
That’s Right!That’s Right!
Compensatory Sweating can occur in 60% Compensatory Sweating can occur in 60% of post-op patients!of post-op patients!
Take me to the next activity!
Sorry!Sorry!
Horner’s Syndrome and Hemo-Horner’s Syndrome and Hemo-pneumothorax only occur in 1% of the pneumothorax only occur in 1% of the
cases!cases!
Click on the face to try again!Click on the face to try again!
Treatment Option ReviewTreatment Option Review
Hyperhidrosis
Topical Treatment
Botox
Iontophoresis
Local Excision
Iontophoresis
Botox
ETS
AXILLARY PALMOPLANTAR
Hornberger, 2004
Treatment Option ReviewTreatment Option Review
Photo used with permission: The Whiteley Clinic, 2007
Systemic – blocks acetylcholine
CONGRATUALTIONS!!CONGRATUALTIONS!!
YOU HAVE SUCCESSFULLY YOU HAVE SUCCESSFULLY COMPLETED THIS TUTORIAL!!COMPLETED THIS TUTORIAL!!
ReferencesReferencesAndrews, B. T. & Renni, J. A. (1997). Predicting changes in the distribution of Andrews, B. T. & Renni, J. A. (1997). Predicting changes in the distribution of
sweating following thorascopic sympathectomy. sweating following thorascopic sympathectomy. The British Journal of The British Journal of Surger, Surger, 8484(12)(12), 1702-1704., 1702-1704.
Beat Psoriasis. (2006). Beat Psoriasis. (2006). What is hyperhidrosis or excessive sweating?What is hyperhidrosis or excessive sweating? Retrieved Retrieved March 22, 2007, from www.beatpsoriasis.com.March 22, 2007, from www.beatpsoriasis.com.
Canada’s Largest Online Health and Beauty Aids. (n.d.). Retrieved April 12, Canada’s Largest Online Health and Beauty Aids. (n.d.). Retrieved April 12, 2007, from 2007, from www.feelbest.comwww.feelbest.com..
Eisenach, J., Atkinson, J., & Fealey, R. (2005). Hyperhidrosis: Evolving Eisenach, J., Atkinson, J., & Fealey, R. (2005). Hyperhidrosis: Evolving therapies for a well-established phenomenontherapies for a well-established phenomenon. Mayo Clinic Proceedings, . Mayo Clinic Proceedings, 8080(5)(5), 657-666., 657-666.
ETS Discussion Forum and Reversals. (2005). ETS Discussion Forum and Reversals. (2005). Compensatory sweating after Compensatory sweating after ets.ets. Retrieved March 22, 2007, from Retrieved March 22, 2007, from http://p069.ezboard.com/fetsandreversalsfrm37.showMessage?http://p069.ezboard.com/fetsandreversalsfrm37.showMessage?topicID=1.topictopicID=1.topic
Gasparri, M. (2006). Photography, Medical College of Wisconsin.Gasparri, M. (2006). Photography, Medical College of Wisconsin.Gossot, D., Galetta, D., & Pascal, A. (2003). Long-term results of endoscopic Gossot, D., Galetta, D., & Pascal, A. (2003). Long-term results of endoscopic
thoracic sympathectomy for upper limb hyperhidrosis. thoracic sympathectomy for upper limb hyperhidrosis. The Society of The Society of Thoracic Surgeons, Thoracic Surgeons, 75, 1075-1079.75, 1075-1079.
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ReferencesReferencesHamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal hyperhidrosis: Disease Hamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal hyperhidrosis: Disease
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