Abstract
Primary palmar hyperhidrosis (HH) is a pathological condition of overperspiration caused by excessive secretion of the eccrine sweat glands, the etiology of which is unknown. This disorder affects a small but significant proportion of the young population all over the world. Neither systemic nor topical drugs have been found to satisfactorily alleviate the symptoms. Although the topical injection of botulinum has recently been reported to reduce the amount of local perspiration, long-term results are required before a definitive evaluation of this method can be made. Hypnosis, psychotherapy, and biofeedback have been beneficial in a limited-number of cases. While radiation achieves atrophy of the sweat glands, its detrimental effects prohibit its use. Iontophoresis has attained some satisfactory results but it has not been assessed long term. Percutaneous computed tomography-guided phenol sympathicolysis achieves excellent immediate results, but its long-term failure rate is prohibitive. Furthermore, percutaneous radiofrequency sympathicolysis may be an effective procedure, but its long-term results are not superior to surgical sympathectomy. On the other hand, surgical upper dorsal (T2-T3) sympathectomy achieves excellent long-term results and the thoracoscopic approach has supplanted the open procedures. Despite some sequelae, mainly in the form of neuralgia and compensatory sweating which cannot be predicted and may be distressing, surgical sympathectomy remains the best treatment for palmar hyperhidrosis.
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Ryan TJ (1987) Sweating. In: Weatherall DJ, Ledingham JGG, Warrell DA (eds) Oxford textbook of medicine, 2nd edn. Oxford University Press, Oxford, pp 20.56–20.57
Sato K, Kang WH, Saga K, Sato KT (1989) Biology of sweat glands and their disorders. I. Normal sweat gland function. J Am Acad Dermatol 20:537–563
Sato K, Kang WH, Saga K, Sato KT (1989) Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 20:713–725
Sato K (1991) Hyperhidrosis. JAMA 265:651
Tabet J-CM, Bay JW, Magdinec M (1986) Essential hyperhidrosis. Current therapy. Cleveland Clin Q 53:83–88
Dohn DF, Zraik O (1969) Essential hyperhidrosis — pathogenesis and treatment. Cleveland Clin Q 36:79–83
Borak J, Eller JJ, Eller WD (1949) Roentgen therapy for hyperhidrosis. Arch Dermatol Syphil 59:644–652
Adar R, Kurchin A, Zweig A, Mozes M (1977) Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 186:34–41
Chalmers TM, Keele CA (1952) The nervous and chemical control of sweating. Br J Dermatol 64:43–54
Shih C-J, Wu J-J, Lin M-T (1983) Autonomic dysfunction in palmar hyperhidrosis. J Auton Nerv Syst 8:33–43
Momose T, Kunimoto M, Nishikawa J, Kasaka N, Ohtaka T, Iio M (1986) N-isopropyl I-123 p-iodoamphetamine brain scans with single photon emission computed tomography: mental sweating and EEG abnormality. Radiat Med 4:46–50
Shoenfeld Y, Shapiro Y, Machtiger A, Magazanik A (1976) Sweat studies in hyperhidrosis palmaris and plantaris. Dermatologica 152:257–262
Carson MJ, Montgomery TA (1953) Congenital hyperhidrosis; therapy with hydergine and banthine. J Pediatr 43:274–277
Ellis H (1975) Hyperhidrosis and its surgical management. Postgrad Med 58:191–196
Greenhalgh RM, Rosengarten DS, Martin P (1971) Role of sympathectomy for hyperhidrosis. Br Med J 1:332–334
Conlon KC, Keaveny TV (1987) Upper dorsal sympathectomy for hyperhidrosis. Br J Surg 74:651
Sternberg A, Brickman S, Kott I, Reiss R (1982) Transaxillary thoracic sympathectomy for primary hyperhidrosis of the upper limbs. World J Surg 6:458–463
Kurchin A, Zweig A, Adar R, Mozes M (1977) Upper dorsal sympathectomy for palmar primary hyperhidrosis by the supraclavicular approach. World J Surg 1:667–674
Hashmonai M, Kopelman D, Klein O, Schein M (1992) Upper thoracic sympathectomy for primary palmar hyperhidrosis: longterm follow-up. Br J Surg 79:268–271
Shih CJ, Wang YC (1978) Thoracic sympathectomy for palmar hyperhidrosis. Report of 457 cases. Surg Neurol 10:291–296
Cloward RB (1969) Hyperhidrosis. J Neurosurg 30:545–551
Gruszkiewicz J, Doron Y, Guilburd JN, Zaaroor M (1986) Hyperhidrosis and its surgical treatment. Acta Neurochir 81:128–131
James WD, Schoomaker EB, Rodman OG (1987) Emotional eccrine sweating. A heritable disorder. Arch Dermatol 123:925–929
Cloward RB (1957) Treatment of hyperhidrosis palmaris (sweaty hands). A familial disease in Japanese. Hawaii Med J 16:381–387
Duller P, Gentry WD (1980) Use of biofeedback in treating chronic hyperhidrosis: a preliminary report. Br J Dermatol 103: 143–146
Cullen SI (1972) Management of hyperhidrosis. Postgrad Med 52:77–79
Manusov EG, Nadeau MT (1989) Hyperhidrosis: a management dilemma. J Fam Pract 28:412–415
Midtgaard K (1986) A new device for the treatment of hyperhidrosis by iontophoresis. Br J Dermatol 114:485–488
Stolman LP (1987) Treatment of excess sweating of the palms by iontophoresis. Arch Dermatol 123:893–896
Levine IM, Harris OJ (1955) Chemical sympathectomy. New approach to treatment of localized hyperhidrosis. Arch Dermatol Syphil 71:226–230
White JC, Smithwick RH, Simeone FA (1952) The autonomic nervous system. Macmillan, New York, pp 205–209
Hölzle E, Braun-Falco O (1984) Structural changes in axillary eccrine glands following long-term treatment with aluminium chloride hexahydrate solution. Br J Dermatol 110:399–403
Goh CL (1990) Aluminum chloride hexahydrate versus palmar hyperhidrosis. Evaporimeter assessment. Int J Dermatol 29:368–370
Schnider P, Binder M, Auff E, Kittler H, Berger T, Wolff K (1997) Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol 136:548–552
Naumann M, Hofmann U, Bergmann I, Hamm H, Toyka KV, Reiners K (1998) Focal hyperhidrosis. Effective treatment with intracutaneous botulinum toxin. Arch Dermatol 134:301–304
Naumann M, Bergmann I, Hofmann U, Hamm H, Reiners K (1998) Botulinum toxin for focal hyperhidrosis: technical considerations and improvements in application. Br J Dermatol 139:1123–1124
Hölzle E, Alberti N (1987) Long-term efficacy and side effects of tap water iontophoresis — the usefulness of home therapy. Dermatologica 175:126–135
Elgart ML, Fuchs G (1987) Tapwater iontophoresis in the treatment of hyperhidrosis. Use of the drionic device. Int J Dermatol 26:194–197
Akins DL, Meisenheimer JL, Dobson RL (1987) Efficacy of the drionic unit in the treatment of hyperhidrosis. J Am Acad Dermatol 16:828–832
Reinauer S, Neusser A, Schauf G, Hölzle E (1993) Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. Br J Dermatol 129:166–169
Ichihachi T (1938) Effect of drugs on the sweat glands by cataphoresis, and an effective method for suppression of local sweating; observations on the effect of diaphoretics and adiaphoretics. J Orient Med 25:101–102
Levit F (1968) Simple device for treatment of hyperhidrosis by iontophoresis. Arch Dermatol 98:505–507
Grice K (1988) Treating hyperhidrosis. Practitioner 232:953–956
Lemmens HAJ (1982) Importance of the second thoracic segment for the sympathetic denervation of the hand. Vasc Surg 16:23–26
Edmondson RA, Banerjee AK, Rennie JA (1992) Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis. Ann Surg 215:289–293
Goez RH, Marr JAS (1944) The importance of the second thoracic ganglion for the sympathetic supply of the upper extremities with a description of two new approaches for its removal. Clin Proc 3:102–114
Atlas LN (1941) The role of the second thoracic spinal segment in the preganglionic sympathetic innervation of the human hand — surgical implications. Ann Surg 114:456–461
Hyndman OR, Wolkin J (1942) Sympathectomy of the upper extremity: evidence that only the second dorsal ganglion need be removed for complete sympathectomy. Arch Surg 45:145–155
Telford ED (1938) Sympathetic denervation of the upper extremity. Lancet 1:70–72
O’Riordain DS, Maher M, Waldron DJ, O’Donovan B, Brady MP (1993) Limiting the anatomic extent of upper thoracic sympathectomy for primary palmar hyperhidrosis. Surg Gynecol Obstet 176:151–154
Haxton HA (1949) Chemical sympathectomy. Br Med J 1:1026–1028
Walker PM, Key JA, MacKay IM, Johnston KW (1978) Phenol sympathectomy for vascular occlusive disease. Surg Gynecol Obstet 146:741–744
Von Schild H, Günther R, Hoffmann J, Goedecke R (1983) CTgesteuerte Blockade des Plexus coeliacus mit ventralem Zugang. Fortschr Röntgenstr 139:202–205
Dondelinger RF, Kurdziel JC (1987) Percutaneous phenol block of the upper thoracic sympathetic chain with computed tomography guidance. Acta Radiol 28:511–515
Adler OB, Engel A, Rosenberger A, Dondelinger R (1990) Palmar hyperhidrosis — CT guided chemical percutaneous thoracic sympathectomy. Fortschr Röntgenstr 153:400–403
Adler OB, Engel A, Saranga D (1994) Palmar hyperhidrosis treated by percutaneous transthoracic chemical sympathicolysis. Eur J Radiol 4:57–62
Wilkinson HA (1984) Percutaneous radiofrequency upper thoracic sympathectomy: a new technique. Neurosurgery 15:811–814
Chuang K-S, Liou N-H, Liu J-C (1988) New stereotactic technique for percutaneous thermocoagulation upper thoracic ganglionectomy in cases of palmar hyperhidrosis. Neurosurgery 22:600–604
Wilkinson HA (1984) Radiofrequency percutaneous upperthoracic sympathectomy: technique and review of indications. N Engl J Med 311:34–38
Wilkinson HA (1996) Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery 38:715–725
Kotzareff A (1920) Résection partielle du tronc sympathique cervical droit pour hyperhidrose unilatérale (régions faciale, cervicale, thoracique et brachiale droites). Rev Med Suisse Rom 40:111–113
Telford ED (1935) The technique of sympathectomy. Br J Surg 23:448–450
Soliman SM (1984) Modified supraclavicular approach for upper thoracic sympatectomy. J R Coll Surg (Edinb) 29:162–166
Bogokowsky H, Slutzki S, Bacalu L, Abramsohn R, Negri M (1983) Surgical treatment of primary hyperhidrosis. Arch Surg 118:1065–1067
Adson AW, Brown GE (1929) Raynaud’s disease of the upper extremities; successful treatment by resection of the sympathetic cervicothoracic and second thoracic ganglions and the intervening trunk. JAMA 92:444–449
White JC, Smithwick RH, Allen AW, Mixter WJ (1933) A new muscle splitting incision for resection of the upper thoracic sympathetic ganglia. Surg Gynecol Obstet 56:651–657
Smithwick RH (1940) The rationale and technic of sympathectomy for the relief of vascular spasm of the extremities. N Engl J Med 222:699–703
Lemmens HAJ (1982) Thoracic resympathectomy. Int Angiol 1:147–148
Atkins HJB (1954) Sympathectomy by the axillary approach. Lancet 1:538–539
Atkins HJB (1949) Peraxillary approach to the stellate and upper thoracic sympathetic ganglia. Lancet 2:1152
Roos DB (1971) Experience with first rib resection for thoracic outlet syndrome. Ann Surg 173:429–442
Ellis H (1979) Transaxillary sympathectomy in the treatment of hyperhidrosis of the upper limb. Am Surg 45:546–551
Linder F, Jenal G, Assmus H (1983) Axillary transpleural sympathectomy: indication, technique and results. World J Surg 7:437–439
Jochimsen PR, Hartfall WG (1972) Per axillary upper extremity sympathectomy: technique reviewed and clinical experience. Surgery 71:686–693
Palumbo LT (1956) Anterior transthoracic approach for upper thoracic sympathectomy. Arch Surg 72:659–666
Kux M (1978) Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 113:264–266
Drott C, Göthberg G, Claes G (1993) Endoscopic procedures of the upper-thoracic sympathetic chain. A review. Arch Surg 128:237–241
Göthberg G, Claes G, Drott C (1993) Electrocautery of the upper thoracic sympathetic chain: a simplified technique. Br J Surg 80:862
Malone PS, Cameron AEP, Rennie JA (1986) The surgical treatment of upper limb hyperhidrosis. Br J Dermatol 115:81–84
Robertson DP, Simpson RK, Rose JE, Garza JS (1993) Videoassisted endoscopic thoracic ganglionectomy. J Neurosurg 79:238–240
Appleby TC, Edwards WH Jr (1992) Thoracoscopic dorsal sympathectomy for hyperhidrosis: a new approach. J Vasc Surg 16:121–123
Chandler KE (1993) Video thoracoscopic dorsal sympathectomy: a new approach. Surg Laparosc Endosc 3:112–114
Hashmonai M, Kopelman D, Schein M (1994) Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomized trial. Eur J Surg Suppl 572:13–16
Hashmonai M, Kopelman D, Ehrehnreich M, Assalia A (1998) The learning curve of thoracoscopic sympathectomy. In: Montori A, Lirici MM, Montori J (eds) Sixth world congress of endoscopic surgery. Monduzzi, Bologna, pp 1147–1151
Chou S-H, Lee S-H, Kao E-L (1993) Thoracic endoscopic T2-T3 sympathectomy in palmar hyperhidrosis: experience of 112 cases. Surg Today 23:105–107
Kao M-C (1992) Video endoscopic sympathectomy using a fiberoptic CO2 laser to treat palmar hyperhidrosis. Neurosurgery 30:131–135
Byrne J, Walsh TN, Hederman WP (1990) Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 77:1046–1049
Claes G, Drott C, Göthberg G (1993) Endoscopic electrocautery of the thoracic sympathetic chain. A minimally invasive way to treat palmar hyperhidrosis. Scand J Plast Reconstr Hand Surg 27:29–33
Chao C, Tsai C-T, Hsiao H-C, Wu W-C, Lee C-K (1993) Transaxillary endoscopic sympathectomy — a report of experience in 150 patients with palmar hyperhidrosis. Surg Laparosc Endosc 3:365–369
Shachor D, Jedeikin R, Olsfanger D, Bendahan J, Sivak G, Freund U (1994) Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 129:241–244
Adar R (1979) Compensatory sweating after upper dorsal sympathectomy. J Neurosurg 51:424–425
Shelley WB, Florence R (1960) Compensatory hyperhidrosis after sympathectomy. N Engl J Med 263:1056–1058
Kurchin A, Mozes M, Walden R, Adar R (1977) Phantom sweating. Angiology 28:799–802
Bloor K (1969) Gustatory sweating and other responses after cervico-thoracic sympathectomy. Brain 92:137–146
Koikkalainen K, Luosto R, Keskitalo E, Melartin E (1974) Upper limb sympathectomy. Ann Chir Gynecol Fenn 63:318–325
Golueke PJ, Garrett WV, Thompson JE, Talkington CM, Smith BL (1988) Dorsal sympathectomy for hyperhidrosis — the posterior paravertebral approach. Surgery 103:568–572
Welch E, Geary J (1984) Current status of thoracic dorsal sympathectomy. J Vasc Surg 1:202–214
Ehrlich E, Alexander WF (1951) Surgical implications of upper thoracic independent sympathetic pathways. Arch Surg 62:609–614
Kuntz A (1927) Distribution of the sympathetic rami to the brachial plexus: its relation to sympathectomy affecting the upper extremity. Arch Surg 15:871–877
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Hashmonai, M., Kopelman, D. & Assalia, A. The treatment of primary palmar hyperhidrosis: A review. Surg Today 30, 211–218 (2000). https://doi.org/10.1007/s005950050047
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DOI: https://doi.org/10.1007/s005950050047