Abnormal modulation of electrodermal activity by thermoalgesic stimuli in patients with primary palmar hyperhidrosis.

BACKGROUND: The authors examined the effects of thermal stimulation on electrodermal activity (EDA) in patients with primary palmar hyperhidrosis (PPH). The authors hypothesised that temperature changes may induce abnormal sudomotor reactions because of simultaneous activation of sudomotor centres through thermal and emotional pathways, and compared patients before and after thoracoscopic sympathectomy. METHODS: The authors studied 18 PPH patients and 20 controls. Patients reported subjective evaluation of their symptoms using a visual analogue scale for palmar sweating and for body sweating (bs-VAS). The authors applied focal thermal stimulation to quantify sensory perception and measure ongoing changes in EDA recorded from the palm of the hands. RESULTS: Before sympathectomy, patients had lower sensory perception thresholds and higher EDA levels than controls. Increased EDA occurred along the whole test, with no significant modulation by changes in thermal stimulation. Sensory perception normalised after sympathectomy, but thermal modulation of EDA remained abnormal whenever sudomotor activity was present after surgery. There was a significant positive correlation between EDA levels before treatment and the bs-VAS (from r=0.45 to r=0.57). CONCLUSIONS: Patients with PPH show perceptual abnormalities and exaggerated sudomotor reactions to thermoalgesic stimulation, consistent with central sensitisation of sympathetic circuits. The reduced sympathetic outflow after thoracoscopic sympathectomy induced normalisation of sensory perception, but it did not modify the abnormal control of efferent sudomotor activity.

A medical alternative to the treatment of compensatory sweating.

Compensatory sweating after sympathectomy does not have a satisfactory, free-of-secondary-effects treatment. Glycopyrrolate has been successfully used to treat other types of hyperhidrosis. Compensatory sweating after sympathectomy could respond to the topical application of glycopyrrolate. Ten patients were selected with compensatory sweating after sympathectomy. One milliliter of a 2% water solution of topical glycopyrrolate was applied once a day over the affected area and massaged for 30 seconds. Treatment was maintained for 6 weeks. The results were rated using a scale from 1 to 10 of satisfaction at the end of the study. Eight of the 10 treated patients dramatically improved with the topical application of glycopyrrolate. Two patients quit the treatment due to secondary effects (accommodative failure and dry mouth). The results of the study demonstrated that local application of glycopyrrolate might be the treatment of choice for compensatory hyperhidrosis.

Glucopirrolato tópico en la hiperhidrosis craneofacial / No disponible

No disponible

Topical atropine sulfate for the treatment of axillary hyperhidrosis.

BACKGROUND: Axillary hyperhidrosis does not have a low-cost, free of secondary effects, satisfactory treatment. Eccrine hidrocystomas have been successfully treated with topical atropine solution. Hypothesis Axillary hyperhidrosis could respond to the topical application of atropine solution. METHODS: Ten patients were selected. Eight with mild pure primary axillary hyperhidrosis and two with compensatory sweating after sympathectomy. One milliliter of a water solution of atropine sulfate at 1% was applied twice a day over the affected area and massaged for 30 s. Treatment was maintained for 15 days. The results were rated using a scale from 1 to 10 of satisfaction. RESULTS: Only 2 of the 10 treated patients responded partially to the topical application of atropine sulfate. No local or systemic secondary effects were observed. CONCLUSIONS: The results of the study demonstrated that focal hyperhidrosis does not improve after the local application of anticholinergic drugs such as atropine sulfate.