Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

Abstract

Hyperhidrosis, or excessive sweating, negatively impacts patients both physically and psychologically. It may be primary or secondary: the primary form is a benign condition, with its growing prevalence reaching 5% recently. Its medical treatments are transitory. Objectives: Comparison of the outcomes of patients with primary palmar hyperhidrosis (PPH) after intradermal Botox injection (IBI) versus endoscopic thoracic sympathectomy (ETS). Methods: Forty patients were randomly divided into two equal groups. Patients in the IBI group received an intradermal injection of a botulinum toxin A. Patients in the EST group received endoscopic electrocautery of the sympathetic chain. The patients were evaluated biweekly for 12 weeks, and patient satisfaction by outcome was evaluated using a 4-point satisfaction score. Results: At 12 weeks, 60% of the IBI group patients had maintained an improvement. Meanwhile, 40% of the patients were improved compared to pre-intervention scores, despite deterioration after remarkable improvement. On the other hand, 80% of ETS group patients maintained their Hyperhidrosis Disease Severity Scale (HDSS) up until the end of follow-up. Patient satisfaction scores were significantly higher for the IBI group compared to the ETS group. Conclusions: Intradermal Botox injection is a simple, safe, non-invasive, and effective therapeutic modality for PPH and achieved higher patient satisfaction compared to ETS.

Innovative approaches to neutralizing sympathetic nerves in addressing focal hyperhidrosis

“…The accurate categorization and diagnosis of this type of hyperhidrosis are facilitated by considering specific criteria [8]. Instead of a list, the diagnostic criteria for primary sweating disorder are concisely summarized in the table below: (References: [9,10]). The sweating mechanism is utilized to regulate body temperature.…”

“…Among the diagnostic criteria, sweating must continue for more than six months and must be distinctly focal. Also, in patients who meet the diagnostic criteria, there must be at least two characteristics such as bilateral and symmetric sweating, impairment of daily activities, at least one episode per week, onset before the age of 25, absence of sweating during sleep, [9,10]. These four characteristics make the distinction between primary and secondary hyperhidrosis clearer.…”

“…Several sessions per week may be required. Iontophoresis is a treatment option utilized to control excessive sweating [4,10]. Iontophoresis devices facilitate the easy application of this treatment method.…”

“…Before deciding on iontophoresis treatment, the severity and the areas affected by excessive sweating are assessed. This treatment is usually effective in cases where excessive sweating ranges from mild to moderate [4,10]. Iontophoresis treatment involves the following steps: Prior to treatment, the excessively sweating areas are cleaned.…”

“…Sweating reduces due to the temporary blockade of sweat glands. The results can often be long-lasting [4,10]. Although iontophoresis treatment is generally safe, some potential complications may arise.…”