Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Wolosker, Nelson; Campos, João V.; Kauffman, Paulo; Oliveira, Laert Andrade de; Munia, Marco Antonio; Jatene, Fábio Biscegli

doi:10.1016/j.jvs.2011.07.097

Cited by 52 publications

(63 citation statements)

References 18 publications

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“…Seventeen studies, including the validation work, had a surgical intervention, 234,236,238-252 13 dermatology studies 55,57,60,[62][63][64][65][66][67]237,[253][254][255] and one quality-of-life review. 227 The tool was used in Austria (n = 6 [240][241][242]248,249,251 ), Brazil (n = 21 57,[60][61][62][63][64][65][66][67]234,[236][237][238][239]243,244,246,247,[252][253][254][255] ), Germany (n = 1 The survey response rate was 91% (344 patients). Patients included in the study suffered with either palmar and plantar (57.4%), palmar, axillary and plantar (25%), axillary (15.7%) or facial (6.5%) sweating.…”

Section: Hyperhidrosis Quality-of-life Questionnairementioning

confidence: 99%

“…The second, reported in Table 24, was used in sensitivity analysis. 252 Different utility assumptions associated with CS were made (see Network meta-analysis methods). The treatment following CS followed the same guideline as that for inadequate treatment response across all treatments.…”

Section: Different Levels Of Compensatory Sweating Following Endoscopmentioning

confidence: 99%

“…Change the distribution of severity of CS from that in Smidfelt and Drott 16 to that of Wolosker et al 252 11. Reduce the utility of people who regret having ETS due to severe CS from 0.49 to 0.21.…”

Section: Csmentioning

confidence: 99%

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Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Hyperhidrosis Quality-of-life Questionnairementioning

confidence: 99%

Section: Different Levels Of Compensatory Sweating Following Endoscopmentioning

confidence: 99%

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Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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“…Wolosker et al [7] have observed that, although these patients do not present any risk for death or organ failure, the reduction in QoL can have serious consequences. In some cases, it may not only cause anxiety and distress but can also be incapacitating and even pose high risks for some professionals, such as police officers, who manipulate weapons, and electricians, who handle electric material [7].…”

Section: Diagnosismentioning

confidence: 99%

Hyperhidrosis in children and review of its current evidence-based management

Shalaby¹,

Hay²

2015

Annals of Pediatric Surgery

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Hyperhidrosis (HH) is excessive sweating that usually interferes with the patient's social life. In more than 80% of the cases, the symptoms start in childhood. Early detection and management can significantly improve the patient's quality of life; however, HH remains widely underdiagnosed and undertreated, particularly among children. Many patients do not realize that they have a treatable condition and reports have shown that only 38% of the patients had discussed their condition with a healthcare professional. The aim of this article was to improve awareness on the significant sequel of HH in children and highlight its effects on their quality of life and various available treatment options.

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“…ETS has been used in the treatment of hyperhidrosis since the mid 1980's and several studies have shown it to be an effective treatment. 6,7 However, serious complications of this treatment occur infrequently and recurrence in the medium to long term is more common than previously believed. 6e11 The main complication of ETS is compensatory sweating reported as up to 70%, whereas, it is reported as only 5% for botulinum toxin therapy.…”

Section: Introductionmentioning

confidence: 99%

Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy – A quality of life and cost effectiveness analysis

et al. 2016

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Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Abstract: The patients had an immediate improvement in QoL after ETS, and this improvement was sustained until the fifth postoperative year.

Cited by 52 publications

References 18 publications

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Hyperhidrosis in children and review of its current evidence-based management

Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy – A quality of life and cost effectiveness analysis

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