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Rapid Responses: Rapid Responses published:
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Hyperhidrosis
- Alan E Cameron (17 May 2005)
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Response to article on management of hyperhidrosis
- Eamon Tierney (17 May 2005)
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Boosting salt intake - first do no harm
- Chris A. O'Callaghan (18 May 2005)
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Drawbacks of thoracoscopic sympathectomy
- Min-Huei Hsu, Yu-Chuan Li (22 June 2005)
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Alan E Cameron, Consultant Surgeon Ipswich Hospital
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I was disappointed in the 10-minute consultation for the following reasons. 1; The implication is that excess sweating is somehow a "psychological" condition. It is indeed associated with stress and anxiety, but these are usually secondary to the sweating. Support is important, and resources such as www.hyperhidrosisuk.org may help. 2; Aluminium compounds may be helpful in the axilla, but their use is limited by severe irritation which makes them totally unsuitable on the hands. 3; Botox is again useful in the axilla but in the hands the injections are so painful that nerve blocks may be needed. 4; However the most upsetting statement is that "sympathectomy is available mostly in the private sector". This is simply not correct;in fact the operation is part of the repetoire of most UK vascular surgeons and widely offered to NHS cases. It is listed as part of the curriculum for SpRs in vascular surgery. A more focussed operation helps reduce the side-effects but it is the only reliable and durable cure for distressing palmar sweating. Competing interests: Secretary of the International Society for Sympathetic Surgery. www.sweatfree.org.uk |
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Eamon Tierney, Consultant anaesthetist Wexford General Hospital, Wexford, Ireland
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I was surprised that Dr.Jo Piercy, when discussing the surgical management of hyperhidrosis, mentioned only sympathectomy. I recall a surgeon who dealt with axillary hyperhidrosis by identifying the most active part of the axillary skin with iodine, which coloured the starch in the sweat, and then by excising this area of skin. This operation avoided the considerable risks of a sympathectomy and had the rational basis of simply removing the offending end-organs Competing interests: None declared |
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Chris A. O'Callaghan, Hon Consultant Nephrologist Churchill Hospital, Oxford OX3 7LJ
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In the ten minute consultation on hyperhidrosis, the author suggests that patients consider boosting their salt intake. Patients may follow such advice for the rest of their lives and it is well established that blood pressure can be elevated by an increase in salt intake (1). Most patients seen in non-specialist clinics with excessive sweating will not develop sodium depletion and this advice is likely to be of no benefit to them. If most doctors seeing patients with excessive sweating gave this advice, then over time, some patients would probably have strokes that they would not otherwise have had. Advice to boost salt intake has the potential to do harm, albeit at a low probability, to most patients complaining of excessive sweating in non -specialist clinic settings. It would seem reasonable to restrict this advice to those with evidence of excessive sodium loss. 1. Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA. 2005. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev. 85(2):679-715 . Competing interests: None declared |
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Min-Huei Hsu, Neurosurgeon Taipei Municipal Wanfang Hospital, No. 111, Sec. 3, Shinglung Rd., Taipei City, Taiwan 116, Yu-Chuan Li
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Side effects after thoracoscopic sympathectomy have been discussed widely in Taiwan society in the past few months. Lots of people in Taiwan suffer from hyperhidrosis palmaris. Thoracoscopic sympathectomy is covered by our National Health Insurance, and yet patient billing for this operation does not exceed US$ 60. This is why this operation is so popular here (1). However, patients with serious compensatory sweating must change clothes several times a day (some complain they change as often as 10 times a day), resulting in a serious impact on work and social interaction. Patients suffering from such serious side effects in Taiwan have formed a support group based on an Internet discussion forum to request the government to take this problem seriously (http://home.pchome.com.tw/family/vivi12175/). Since October 2004, The Department of Health Executive, Yuan, Taiwan, has prohibited surgeons from performing this operation on patients under 20 years of age. To our knowledge, this type of Internet-based support group also exists in England (http://www.noetsuk.com/), Sweden (http://home.swipnet.se/sympatiska/index3.htm), Australia (http://www.ets- sideeffects.netfirms.com/), Spain (http://www.terra.es/personal8/hiperhidrosis/principal.htm) and Japan (http://www.geocities.jp/etscontroversialop/index.html). Thoracoscopic sympathectomy is a relatively safe and simple procedure, however, the side effects are potentially devastating. All surgeons who do the operation and individuals preparing to undergo this treatment should know this well. 1.Lin TS, Wang NP, Huang LC. Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases). Int J Surg Investig 2001; 2: 377- 85. Competing interests: None declared |
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