HYPERHIDROSIS: A Comprehensive Review Dina Hamadi, R.N., B.S.N. Alverno College: Alverno College:...

HYPERHIDROSIS:HYPERHIDROSIS:A Comprehensive ReviewA Comprehensive Review

Dina Hamadi, R.N., B.S.N.Dina Hamadi, R.N., B.S.N.

Alverno College: Alverno College:

Master’s of Science in NursingMaster’s of Science in Nursing

Navigating the TutorialNavigating the Tutorial

will take you to the next slidewill take you to the next slide

will take you to the previous slidewill take you to the previous slide

will take you to the home pagewill take you to the home page

ObjectivesObjectives

Understand the pathophysiology of Understand the pathophysiology of sweatingsweating

Identify diagnostic criteria for Identify diagnostic criteria for HypherhidrosisHypherhidrosis

Identify treatment options for the Identify treatment options for the Hyperhidrosis patientHyperhidrosis patient

Choose the Topic!Choose the Topic!

Sweat glandsSweat glands What makes me sweat?What makes me sweat? What is Hyperhidrosis?What is Hyperhidrosis? Treatment OptionsTreatment Options

Sweat GlandsSweat Glands

The human body has 2-5 million sweat The human body has 2-5 million sweat glandsglands

Two main types:Two main types:

Click on the different sweat gland types to learn more!ECCRINE

APOCRINE

Click the “Home” button after viewing both types

Source: www.sweathelp.org

Eccrine Sweat GlandsEccrine Sweat Glands

Approximately 3 million Approximately 3 million eccrine sweat glandseccrine sweat glands

Secrete a clear, odorless Secrete a clear, odorless fluidfluid

Aid in regulating body Aid in regulating body temperaturetemperature

Areas of concentration:Areas of concentration:Facial, plantar, and axillaeFacial, plantar, and axillae

CLICK HERE


Apocrine Sweat GlandsApocrine Sweat Glands

Inactive until pubertyInactive until pubertyProduce thick fluidProduce thick fluidSecretions come in Secretions come in contact with bacteria on contact with bacteria on the skin and produce the skin and produce characteristic “body characteristic “body odor”odor”Found in axillary and Found in axillary and genital areasgenital areas

CLICK HERE


Sweating Sweating

The hypothalamus serves as the The hypothalamus serves as the thermoregulatory centerthermoregulatory center

It controls both blood flow and sweat It controls both blood flow and sweat output to the skin’s surfaceoutput to the skin’s surface


SweatingSweating

The hypothalamus can be triggered by:The hypothalamus can be triggered by:

EXERCISE

TEMPERATURE CHANGE

STRESS

HORMONESSource: www.sweathelp.org

SweatingSweating

Once triggered, the hypothalamus sends messages down the

spinal cordvia neurotransmitters.


SweatingSweatingThe neurostransmitters travel down the The neurostransmitters travel down the spine via spine via ganglionganglion or sympathetic nerves or sympathetic nerves

These ganglion travel to nerves, which These ganglion travel to nerves, which reach the skin’s surfacereach the skin’s surface

Photo used with permission: The Whiteley Clinic,2007


NeurotransmittersNeurotransmittersNeurotransmitters act as “vehicles,” transmitting

information from the hypothalamus to the skin’s surface.

Photo used with permission: The Whiteley Clinic, 2007

NeurotransmittersNeurotransmittersThe neurotransmitters can “exit” at various The neurotransmitters can “exit” at various

places along the spinal cord.places along the spinal cord.

The “exit” determines the location of skin The “exit” determines the location of skin innervation.innervation.

Spinal Cord InnervationsSpinal Cord Innervations

T2 – T8 innervate the skin of the upper limbs

T2-T4 innervatethe skin of the face

T4-T12 innervate theskin of the trunk T10-T12 innervate the skin

of the lower limbs


NeurotransmittersNeurotransmitters

Acetylcholine innervates

Eccrine Sweat Glands

Catecholaminesinnervate

Apocrine Sweat Glands


SweatingSweating

Once innervated, the apocrine and eccrine Once innervated, the apocrine and eccrine glands will produce ….glands will produce ….

SWEAT!SWEAT!

Click on the picture to take the “Sweating Quiz”

Click on the “Home” button to return to the topic choices


Question 1Question 1

What serves as the body’s thermoregulatory What serves as the body’s thermoregulatory center?center?

a.a. The hypothalamusThe hypothalamus

b.b. The adrenal cortexThe adrenal cortex

c.c. The frontal lobeThe frontal lobe

CONGRATULATIONS!CONGRATULATIONS!

The The hypothalamushypothalamus regulates sweat output regulates sweat output and blood flow to the skin’s surface!and blood flow to the skin’s surface!

Take me to question 2!

SORRY….TRY AGAIN!SORRY….TRY AGAIN!

What regulates blood flow and sweat What regulates blood flow and sweat output to the skin’s surface?output to the skin’s surface?

a.a. The hypothalamusThe hypothalamusb.b. The adrenal cortexThe adrenal cortexc.c. The frontal lobeThe frontal lobe


What neurotransmitter innervates eccrine What neurotransmitter innervates eccrine sweat glands?sweat glands?

a.a. AcetylcholineAcetylcholine

b.b. CatecholamineCatecholamine

c.c. GlucoseGlucose

You’re Right!!You’re Right!!

Take me to question 3!

Try Again!Try Again!

Hint:Hint: Catecholamines Catecholamines innervate innervate apocrineapocrine sweat glands!sweat glands!

Let me try question 2 again!


The hypothalamus can be triggered by all The hypothalamus can be triggered by all these these exceptexcept::

a.a. StressStress

b.b. ExerciseExercise

c.c. ObesityObesity

d.d. Temperature changeTemperature change

CORRECT!!CORRECT!!

You have successfully completed this section of the tutorial. Return home!


Return to question 3!Return to question 3!

HyperhidrosisHyperhidrosis

Hyperhidrosis is a state of Hyperhidrosis is a state of excessive sweating of the excessive sweating of the

axilla, palms, soles, or axilla, palms, soles, or face that interferes with face that interferes with

daily activitiesdaily activitiesHaider & Solish, 2004

Photo used with permission: University of Miami Cosmetic Center, 2007

Two TypesTwo Types

PrimaryPrimary oror idiopathic idiopathic

SecondarySecondary::Resulting from respiratory/heart failure,Resulting from respiratory/heart failure,

malignancy, drug/alcohol abuse,malignancy, drug/alcohol abuse,

hyperthyroidism, infectionhyperthyroidism, infectionHaider & Solish, 2004

Fun FactsFun Facts

Diagnosed in 2.8% of the U.S. populationDiagnosed in 2.8% of the U.S. population 70% of those with symptoms do not 70% of those with symptoms do not

consult a physicianconsult a physician Peaks in early adulthoodPeaks in early adulthood

Haider & Solish, 2004

Diagnostic Criteria:Diagnostic Criteria:Primary HyperhidrosisPrimary Hyperhidrosis

MUST HAVEMUST HAVE1. Focal, visible, excessive sweating1. Focal, visible, excessive sweating

2. 6 months duration2. 6 months duration

3. No apparent cause3. No apparent cause TWO OR MORE:

1. Bilateral and symmetric sweating2. Impairment of daily activities3. At least one episode per week4. Onset of less than 25 years5. Positive family history

Hornberger, 2004

What is Hyperhidrosis?What is Hyperhidrosis?

Involves the eccrine sweat glands, Involves the eccrine sweat glands, howeverhowever::

Sweat glands are Sweat glands are NORMALNORMAL

NoNo change in size change in sizeNoNo change in shape change in shape

NoNo change in number change in numberHaider & Solish, 2004Haider & Solish, 2004

CauseCause

Exact cause is unknownExact cause is unknown

Familial or genetic?Familial or genetic?

Excessive Sympathetic Activity?Excessive Sympathetic Activity?

Click on the raindrops to learn more about this theory!

Excessive Sympathetic ActivityExcessive Sympathetic Activity

The eccrine sweat glands are excessively

stimulated by acetylcholine

Increased SWEAT production

Hornberger, 2004

Excessive Sympathetic ActivityExcessive Sympathetic Activity

Because the sweat glands are continuously Because the sweat glands are continuously stimulated, they are stuck in the stimulated, they are stuck in the

positionposition

Hornberger, 2004Hornberger, 2004

QUIZ TIME!QUIZ TIME!

Those diagnosed with hyperhidrosis have Those diagnosed with hyperhidrosis have abnormal eccrine sweat glands.abnormal eccrine sweat glands.

TRUETRUE

FALSEFALSE

GOOD JOB!GOOD JOB!

The sweat glands are normal, with no The sweat glands are normal, with no variance in size, shape, or number!variance in size, shape, or number!

Take me to Question 2!

SORRY!SORRY!

Try again….Try again….

Click on the sad face to try again!


Hyperhidrosis involves which sweat gland Hyperhidrosis involves which sweat gland type?type?

ApocrineApocrine

EccrineEccrine

Oops!Oops!

Take me back to the question!Take me back to the question!

YES!!YES!!

Hyperhidrosis involves the eccrine sweat Hyperhidrosis involves the eccrine sweat glands!glands!

You have successfully completed this section of the tutorial. You may return Home!

Treatment OptionsTreatment Options

Rules to Follow:Rules to Follow:

Different treatment for areas affectedDifferent treatment for areas affected

Always start with least invasive treatment Always start with least invasive treatment optionoption

Treatment OptionsTreatment OptionsTopical

Systemic

Iontophoresis

Botox

Local Excision

Thorascopic Sympathectomy

Click on the first treatmentoption to begin!

Topical TreatmentTopical TreatmentFirst line treatmentFirst line treatment

Aluminum Chloride HexahydrateAluminum Chloride Hexahydrate antiperspirant of choiceantiperspirant of choice

Most beneficial for axillary Most beneficial for axillary hyperhidrosishyperhidrosis

Can be used for plantar and palmarCan be used for plantar and palmar

Photos used with permission:www.feelbest.com

Hornberger, 2004

Topical Treatment:Topical Treatment:How Does it Work?How Does it Work?

The metal ions in the topical antiperspirant damage the lining of the sweat gland.

As damage continues, a PLUG is formed over the sweat gland.

www.sweathelp.org

Topical TreatmentTopical TreatmentSweat production never Sweat production never ceases, the gland is simply ceases, the gland is simply pluggedplugged

Sweating will return as the Sweating will return as the skin undergoes skin undergoes regeneration or sheddingregeneration or shedding

Therefore…topical Therefore…topical treatment is NOT a cure!treatment is NOT a cure!

Hornberger, 2004

Photo used with permission:Neurosurgical Medical Clinic, Inc

Topical Treatment:Topical Treatment:How to UseHow to Use

Best to apply before bedtimeBest to apply before bedtime

Allow to remain on skin for 6 – 8 hoursAllow to remain on skin for 6 – 8 hours

Apply every 24 – 48 hours until sweating Apply every 24 – 48 hours until sweating diminishesdiminishes

Maintenance applications needed every 1-Maintenance applications needed every 1-3 weeks3 weeks

Hornberger, 2004

Topical Treatment: Topical Treatment: Pros and ConsPros and Cons

Non – invasiveItching and burning of skin

at application site&Time-consuming&Temporary reliefHornberger, 2004

Topical Treatment:Topical Treatment:EffectivenessEffectiveness

66.6% stop using dueto the “CONS”

Naumann, Hamm, & Lowe, 2002

88% effective forAxillary Hyperhidrosis

QUICK REVIEW!QUICK REVIEW!

Fill in the Blank!Fill in the Blank!

Topical Treatments work by ________ Topical Treatments work by ________ sweat glands.sweat glands.

DestroyingDestroyingPluggingPluggingMeltingMelting

That’s Right!That’s Right!

Topical Treatments PLUG the sweat glandTopical Treatments PLUG the sweat gland

Take me to the next treatment option!

Sorry!Sorry!

HINT:HINT: Sweat production never stops, the Sweat production never stops, the output is simply blocked!output is simply blocked!

Take me back to the question!


Systemic

Iontophoresis

Botox

Local Excision


Click on the second treatmentoption!

Systemic TreatmentSystemic TreatmentAnticholinergics can be used in treating Anticholinergics can be used in treating

hyperhidrosishyperhidrosis

Most effective for cranio-facial hyerhidrosisMost effective for cranio-facial hyerhidrosis

RobinulRobinul – drug of choice – drug of choice


How Does it Work?How Does it Work?Anticholinergic

Blocks Acetylcholine transmission

Eccrine sweat glands no longer stimulated

Sweat production ceases!


AnticholinergicsAnticholinergics

Long term therapy is requiredLong term therapy is required

Major side effects:Major side effects:Dry mouthDry mouth

Dry eyesDry eyes

Constipation Constipation

Blurred visionBlurred vision

Difficulty with urinationDifficulty with urination

Thomas, Brown, & Vafaie, 2004

AnticholinergicsAnticholinergics

Limited use in treating Limited use in treating hyperhidrosishyperhidrosis

Only 21% effectiveOnly 21% effective

69.7% stop using due 69.7% stop using due to side effectsto side effects

Hamm, Naumann, & Kowalski, 2006

ReviewReview

Anticholinergics block transmission of Anticholinergics block transmission of

??

a.a. CatecholaminesCatecholamines

b.b. EpinephrineEpinephrine

c.c. AcetylcholineAcetylcholine

Yes!!Yes!!

Acetylcholine transmission is blocked!Acetylcholine transmission is blocked!


Sorry!Sorry!

Click on the picture to try again!


Systemic

Iontophoresis

Botox

Local Excision


Click on the third treatmentoption!

IontophoresisIontophoresis Used for palmar and Used for palmar and

plantar hyperhidrosisplantar hyperhidrosis

Passage of direct Passage of direct electrical current onto electrical current onto skin’s surfaceskin’s surface

Device can be Device can be purchased for home usepurchased for home use Photo used with permission: Beast Psoriasis, 2006

Thomas, Brown, & Vafaie, 200 4

IontophoresisIontophoresis

Sit with hands or feet in Sit with hands or feet in shallow tray of watershallow tray of waterAllow 15 – 20 milli-amps of Allow 15 – 20 milli-amps of electrical current to pass electrical current to pass through waterthrough waterUse for 10 days, 30 Use for 10 days, 30 minutes each dayminutes each dayMaintenance therapy Maintenance therapy neededneeded

Photo used with permission: Beat Psoriasis, 2006


Iontophoresis:Iontophoresis:Mechanism of ActionMechanism of Action

WATER

+

ELECTRICTY

= Thickening of skinAnd

Blocked sweat flow

www.sweathelp.org


Side effects:Side effects:Skin irritationSkin irritationSkin burnsSkin burnsVesicle formationVesicle formation

Time consuming treatmentTime consuming treatment

80% effective for palmar and/or plantar 80% effective for palmar and/or plantar hyperidrosishyperidrosis

Photo used with permission: Beat Psoriasis, 2006

Thomas, Brown, and Vafaie, 2004


Contraindicated in those:Contraindicated in those:

1.1. Who are pregnantWho are pregnant

2.2. Have pacemakersHave pacemakers

3.3. Have metal implantsHave metal implants

4.4. Have cardiac conditionsHave cardiac conditions

5.5. Have epilepsyHave epilepsy

Question….Question….

Iontophoresis is NOT used in treating which Iontophoresis is NOT used in treating which type of hyperhidrosis?type of hyperhidrosis?

a.a. PalmarPalmar

b.b. Axillary Axillary

c.c. PlantarPlantar

Yes!Yes!

Iontophoresis can be Iontophoresis can be used in treating used in treating

PalmarPalmar and/or and/or PlantarPlantar hyperhidrosishyperhidrosis

Take me to the next treatment option

HINT: Look at these pictures….HINT: Look at these pictures….

Try Again!

Click on either picture to Try again!

Photos used with permission: Beat Psoriasis, 2006


Systemic

Iontophoresis

Botox

Local Excision


Click on the fourth treatmentoption!

BotoxBotox

Botox injections can be used to treat Botox injections can be used to treat axillary, palmar, and plantar hyperhidrosisaxillary, palmar, and plantar hyperhidrosis

Analgesic applied prior to injectionAnalgesic applied prior to injection Nerve block applied to ulnar or radial Nerve block applied to ulnar or radial

nerve prior to palmar injection nerve prior to palmar injection


BotoxBotox

Starch Iodine test Starch Iodine test done prior to injectiondone prior to injection

Delineates areas of Delineates areas of excess sweating with excess sweating with black-purple black-purple discoloration of the discoloration of the skinskin Photo used with permission:

Eisenach, Atkinson, & Fealey, 2005


BotoxBotoxBotox blocks the release of acetylcholine at the site of the neuromuscular junction.

Sweat glands are not stimulated, and sweat production ceases

Site of blockagePhoto used with permission: Whiteley Clinic, 2007


BotoxBotox

Cons:Cons:Very painful to the Very painful to the palms and soles of palms and soles of feetfeet

Expensive: $1400-Expensive: $1400-$1600 per treatment$1600 per treatment

Pros: Lasts 6-7 months 90% effective


Quick ReviewQuick Review

A Starch-Iodine test is done prior to botox A Starch-Iodine test is done prior to botox injection.injection.

True True

FalseFalse

Correct!Correct!

This test highlights areas of excessive This test highlights areas of excessive sweating!sweating!

Take me to the next treatment option


Hint: The test gives a “map,” highlighting Hint: The test gives a “map,” highlighting areas of excessive sweatingareas of excessive sweating

Click on the picture to try again!Click on the picture to try again!


Systemic

Iontophoresis

Botox

Local Excision



Local ExcisionLocal Excision

Used only for axillary Used only for axillary hyperhidrosishyperhidrosisStarch Iodine test done prior to Starch Iodine test done prior to excisionexcisionPerformed under local Performed under local anesthesia anesthesia Vasoconstrictor applied to Vasoconstrictor applied to axillary regionaxillary regionSmall incisions madeSmall incisions made

Eisenach, Atkinson, Foley, 2005

Photo used with permission:Gasparri, 2006


Eccrine sweat glands removed through:Eccrine sweat glands removed through:Liposuction – suctioned outLiposuction – suctioned out

Curettage – scraped outCurettage – scraped out

Excision – cut outExcision – cut out

Incisions suturedIncisions sutured

Pain and bruising to excision sitePain and bruising to excision site


Photo used with permission:Gasparri, 2006


Starch Iodine tests done post excision Starch Iodine tests done post excision show 80% - 90% decrease in sweatingshow 80% - 90% decrease in sweating

Has a potential for scarringHas a potential for scarring


Review!Review!

Local Excision is used for what type of Local Excision is used for what type of hyperhidrosis?hyperhidrosis?

a.a. PlantarPlantar

b.b. PalmarPalmar

c.c. AxillaryAxillary

Correct!Correct!

Local Excision is used for axillary Local Excision is used for axillary hyperhidrosis!hyperhidrosis!



Systemic

Iontophoresis

Botox

Local Excision



Endoscopic Thoracic Endoscopic Thoracic Sympathectomy (ETS)Sympathectomy (ETS)

Last treatment optionLast treatment option

PERMANENT PERMANENT

Surgery performed under general Surgery performed under general anesthesiaanesthesia


ETSETS

Goal of surgery is to excise or ablate the Goal of surgery is to excise or ablate the ganglion that innervate the sweat glandsganglion that innervate the sweat glands

Performed most frequently for palmar Performed most frequently for palmar hyperhidrosishyperhidrosis

Performed throughPerformed through

thorascope or videothorascope or video

Minimally invasiveMinimally invasive


Han, Oren, & Gottfried, 2002

ETSETS

Small incision made laterally under each Small incision made laterally under each axillaaxilla

Incision made through intercostal spaceIncision made through intercostal space Surgery can be performed on outpatient Surgery can be performed on outpatient

basis basis However, some patients remain in hospital However, some patients remain in hospital

for one nightfor one night

Han, Oren, & Gottfried, 2002

ETSETS

Ganglion located along Ganglion located along the sympathetic chain the sympathetic chain Ganglion formed below Ganglion formed below each ribeach ribGanglion can be divided Ganglion can be divided = = sympathicotomysympathicotomyGanglion can be Ganglion can be removed = removed = sympathectomysympathectomy

www.sweathelp.org


ETSETSGanglion at T2 and T3 = palmar Ganglion at T2 and T3 = palmar hyperhidrosishyperhidrosis

Ganglion at T3 and T4 = axillary Ganglion at T3 and T4 = axillary hyperhidrosishyperhidrosis

Ganglion at L2-L4 = plantar hyperhidrosisGanglion at L2-L4 = plantar hyperhidrosiswww.sweathelp.org

Photos used with permission:Neurosurgical Medical Clinic, Inc

ETSETS

Cannot surgically excise or ablate L2-L4 Cannot surgically excise or ablate L2-L4 for plantar hyperhidrosis due to sexual for plantar hyperhidrosis due to sexual side effectsside effects

95% success rate in curing palmar 95% success rate in curing palmar hyperhidrosishyperhidrosis

Success rates slightly lower for axillary Success rates slightly lower for axillary hyperhidrosishyperhidrosisEisenach, Atkinson, & Fealey, 2005

ETSETS

Plantar hyperhidrosis resolves in 50% - Plantar hyperhidrosis resolves in 50% - 75% of cases when T2 and T3 are 75% of cases when T2 and T3 are excised, though L2-L4 ganglion are never excised, though L2-L4 ganglion are never surgically treatedsurgically treated

Mechanism is unknown!Mechanism is unknown!

Eisenach, Atkinson & Fealey, 2005

ETS: Side EffectsETS: Side Effects

Surgical complications:Surgical complications:Hemo-pneumothorax requiring chest tube Hemo-pneumothorax requiring chest tube placement – 1%placement – 1%

AtelectasisAtelectasis

Intercostal neuralgia – 1%Intercostal neuralgia – 1%

Horner’s Syndrome – 1%Horner’s Syndrome – 1%

Compensatory Sweating – 60%Compensatory Sweating – 60%


Horner’s SyndromeHorner’s Syndrome

Stellate ganglion – fusion of C8 and T1Stellate ganglion – fusion of C8 and T1Innervates the faceInnervates the face

If Stellate ganglion is damaged, Horner’s If Stellate ganglion is damaged, Horner’s Syndrome will occurSyndrome will occur

May be mistaken for T2 and T3 May be mistaken for T2 and T3

May receive electrical current from cautery of May receive electrical current from cautery of T2 and T3T2 and T3

www.sweathelp.org

Horner’s SyndromeHorner’s Syndrome

Signs and SymptomsSigns and SymptomsUnilateral upper eyelid ptosisUnilateral upper eyelid ptosis

Pupil constrictionPupil constriction

Facial anhidrosisFacial anhidrosis

www.sweathelp.org

Compensatory SweatingCompensatory Sweating

Most frequent Most frequent complication – 60% of complication – 60% of post-op patientspost-op patients

Severe sweating noted Severe sweating noted to abdomen, chest, back, to abdomen, chest, back, and thighsand thighsMore severe for those More severe for those who live in a hot climatewho live in a hot climate

www.sweathelp.org

Photo used with permission: ETS Discussion Forum and Reversals, 2005

Compensatory SweatingCompensatory SweatingMechanism poorly understoodMechanism poorly understood

Theory states:Theory states:After excision of T2 and T3, 40% of After excision of T2 and T3, 40% of body’s sweat function is lostbody’s sweat function is lost

Body tries to compensate for this loss Body tries to compensate for this loss Andrews & Rennie, 1997

Photo used with permission: ETS Discussion Forum and Reversals, 2005

Compensatory SweatingCompensatory SweatingMost patients feel compensatory Most patients feel compensatory sweating is a minor draw-back to sweating is a minor draw-back to surgerysurgery

Sweating to abdomen/trunk = Sweating to abdomen/trunk = less interference with daily less interference with daily activitiesactivities

Able to write/handle objectsAble to write/handle objects

Gossot, Galetta, & Pascal, 2003 Photo used with permission: ETS Discussion Forum and Reversals, 2005

Let’s ReviewLet’s Review

ETS is performed most often for what type ETS is performed most often for what type of hyperhidrosis:of hyperhidrosis:

a.a. AxillaryAxillary

b.b. PalmarPalmar

c.c. PlantarPlantar

CORRECT!CORRECT!

ETS is performed for palmar hyperhidrosis!ETS is performed for palmar hyperhidrosis!

Take me to the next question!

TRY AGAIN!TRY AGAIN!



What is the most significant side effect of What is the most significant side effect of ETS?ETS?

a.a. Hemo-pneumothoraxHemo-pneumothorax

b.b. Horner’s SyndromeHorner’s Syndrome

c.c. Compensatory SweatingCompensatory Sweating

That’s Right!That’s Right!

Compensatory Sweating can occur in 60% Compensatory Sweating can occur in 60% of post-op patients!of post-op patients!

Take me to the next activity!

Sorry!Sorry!

Horner’s Syndrome and Hemo-Horner’s Syndrome and Hemo-pneumothorax only occur in 1% of the pneumothorax only occur in 1% of the

cases!cases!

Click on the face to try again!Click on the face to try again!

Treatment Option ReviewTreatment Option Review

Hyperhidrosis

Topical Treatment

Botox

Iontophoresis

Local Excision

Iontophoresis

Botox

ETS

AXILLARY PALMOPLANTAR

Hornberger, 2004

Treatment Option ReviewTreatment Option Review

Photo used with permission: The Whiteley Clinic, 2007

Systemic – blocks acetylcholine

CONGRATUALTIONS!!CONGRATUALTIONS!!

YOU HAVE SUCCESSFULLY YOU HAVE SUCCESSFULLY COMPLETED THIS TUTORIAL!!COMPLETED THIS TUTORIAL!!

ReferencesReferencesAndrews, B. T. & Renni, J. A. (1997). Predicting changes in the distribution of Andrews, B. T. & Renni, J. A. (1997). Predicting changes in the distribution of

sweating following thorascopic sympathectomy. sweating following thorascopic sympathectomy. The British Journal of The British Journal of Surger, Surger, 8484(12)(12), 1702-1704., 1702-1704.

Beat Psoriasis. (2006). Beat Psoriasis. (2006). What is hyperhidrosis or excessive sweating?What is hyperhidrosis or excessive sweating? Retrieved Retrieved March 22, 2007, from www.beatpsoriasis.com.March 22, 2007, from www.beatpsoriasis.com.

Canada’s Largest Online Health and Beauty Aids. (n.d.). Retrieved April 12, Canada’s Largest Online Health and Beauty Aids. (n.d.). Retrieved April 12, 2007, from 2007, from www.feelbest.comwww.feelbest.com..

Eisenach, J., Atkinson, J., & Fealey, R. (2005). Hyperhidrosis: Evolving Eisenach, J., Atkinson, J., & Fealey, R. (2005). Hyperhidrosis: Evolving therapies for a well-established phenomenontherapies for a well-established phenomenon. Mayo Clinic Proceedings, . Mayo Clinic Proceedings, 8080(5)(5), 657-666., 657-666.

ETS Discussion Forum and Reversals. (2005). ETS Discussion Forum and Reversals. (2005). Compensatory sweating after Compensatory sweating after ets.ets. Retrieved March 22, 2007, from Retrieved March 22, 2007, from http://p069.ezboard.com/fetsandreversalsfrm37.showMessage?http://p069.ezboard.com/fetsandreversalsfrm37.showMessage?topicID=1.topictopicID=1.topic

Gasparri, M. (2006). Photography, Medical College of Wisconsin.Gasparri, M. (2006). Photography, Medical College of Wisconsin.Gossot, D., Galetta, D., & Pascal, A. (2003). Long-term results of endoscopic Gossot, D., Galetta, D., & Pascal, A. (2003). Long-term results of endoscopic

thoracic sympathectomy for upper limb hyperhidrosis. thoracic sympathectomy for upper limb hyperhidrosis. The Society of The Society of Thoracic Surgeons, Thoracic Surgeons, 75, 1075-1079.75, 1075-1079.

Haider, A. & Solish, N. (2004). Hyperhidrosis: An approach to diagnosis and Haider, A. & Solish, N. (2004). Hyperhidrosis: An approach to diagnosis and management. management. Dermatology Nursing,Dermatology Nursing, 16 16((6), 515-523.6), 515-523.

ReferencesReferencesHamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal hyperhidrosis: Disease Hamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal hyperhidrosis: Disease

characteristics and functional impairment. characteristics and functional impairment. Dermatology, 212Dermatology, 212. 343-353. . 343-353.

Hornberger, J. (2004). Recognition, diagnosis, and treatment of primary focal Hornberger, J. (2004). Recognition, diagnosis, and treatment of primary focal hyperhidrosis. hyperhidrosis. Journal of the American Academy of Dermatology, Journal of the American Academy of Dermatology, 5151(2(2), 274-286.), 274-286.

International Hyperhidrosis Society. (2007). International Hyperhidrosis Society. (2007). About hyperhidrosis: Physiology of normal About hyperhidrosis: Physiology of normal sweatingsweating. Retrieved March 7, 2007, from http://www.sweathelp.org.. Retrieved March 7, 2007, from http://www.sweathelp.org.

Naumann, M. K., Hamm, H., & Lowe, J. (2002). Effects of botulinim toxin type A on Naumann, M. K., Hamm, H., & Lowe, J. (2002). Effects of botulinim toxin type A on quality of life measures in patients with excessive axillary sweating: A randomized quality of life measures in patients with excessive axillary sweating: A randomized controlled trial. controlled trial. British Journal of Dermatology, 147,British Journal of Dermatology, 147, 1218-1226. 1218-1226.

Neurosurgical Medical Clinic, Inc. (n.d.). Neurosurgical Medical Clinic, Inc. (n.d.). Neurosurgical Diseases: Hyperhidrosis. Neurosurgical Diseases: Hyperhidrosis. Retrieved March 23, 2007, from Retrieved March 23, 2007, from www.sd-neurosurgeon.com/diseases/hyperhidrosis.html.www.sd-neurosurgeon.com/diseases/hyperhidrosis.html.

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HYPERHIDROSIS: A Comprehensive Review Dina Hamadi, R.N., B.S.N. Alverno College: Alverno College:...

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