​Surgery - Hyperhidrosis

​Surgery - Hyperhidrosis 
Definition 
a condition when eccrine glands overproduce sweat beyond what is necessary for survival. There are three types: localized, secondary generalized, and primary focal.

Etiology 
Neurogenic sympathetic hyperactivity on eccrine sweat glands is the primary focal cause.
Secondary generalization: Many conditions, including diabetes, thyrotoxicosis, hypoglycemia, gout, pheochromocytoma, menopause, infections (e.g., tuberculosis), medicine (propanolol, physostigmine, pilocarpine, tricyclic antidepressants, venlafaxine), alcoholism, and cancer, might be the cause of secondary generalized hyperhidrosis.
Localized: Riley-Day syndrome (familial dysautonomia), eccrine naevus, eccrine angiomatous hamartoma, gustatory stimulation (Frey's syndrome).

Epidemiology 
Palmoplantar hyperhidrosis is 20 times more common in Japanese ancestry, with an estimated incidence of 0.6-2.8%.

History 

Wet your hands, feet, and/or axillae. can lead to professional challenges and social shame. Patients may lament how often they have to change into new garments. Typically, primary focal hyperhidrosis starts around adolescence. When hyperhidrosis manifests later in life, it is important to look for underlying causes.

Examination 
Perceptible perspiration could be linked to tinea or dermatitis.
Minor's starch-iodine test: An iodine-starch combination formed in perspiration when starch is brushed onto skin that has previously been painted with 2% iodine. The light brown color of the iodine turns dark purple.


Investigational studies

Only pertinent in cases of widespread hyperhidrosis.
Blood: urinary catecholamines, LH/FSH, glucose, urate, and TFTs.
Imaging: CXR, CT, or MRI scanning, as necessary.

Management 

Primary focal: Topical first-line therapies, such as glycopyrrolate and aluminum chloride.
Ionophoresis: a daily 30-minute therapy that involves passing a direct current over the skin on the palm or sole (unclear mechanism of action). Intradermal injection of botulinum toxin; effective, long-lasting (4–12 months); less painful if reconstituted in lignocaine. Systemic agents: oxybutynin and other anticholinergics produce unpleasant side effects, such as dry mouth and eyes.
Surgery: A thorascopic sympathectomy entails cutting the sympathetic chain (T2/3 palmar hyperhidrosis, T3/4/5 axillary hyperhidrosis, and T1 face hyperhidrosis) in order to block the sympathetic ganglia.
Immediately effective (95–98% success rate).
Other methods for the axilla include subcutaneous liposuction combined with dermal curettage to eliminate eccrine sweat glands or axillary skin disconnection/excision (risk of scarring, skin necrosis).

Complications 
Skin irritation, physical, psychological, social, and occupational morbidity.
Referring to thorascopic sympathectomy: Recurrence, Horner's syndrome, pneumothorax, intercostal neuralgia, and compensatory sweating (up to 50–60%).

Prognosis 
No higher death rate, however it may have an impact on life quality. It was previously hard to control, but current therapies work well.