Background The current epidemiologic data on hyperhidrosis are scarce and insufficient to provide precise prevalence or impact estimates. Objective We sought to estimate the prevalence of hyperhidrosis in the US population and assess the impact of sweating on those affected by axillary hyperhidrosis. Methods A nationally representative sample of 150,000 households was screened by mailed survey for hyperhidrosis and projected to the US population based on US census data. Ascertainment of hyperhidrosis was based on a question that asked whether participants experienced excessive or abnormal/unusual sweating. Results The prevalence of hyperhidrosis in the survey sample was 2.9% (6800 individuals). The projected prevalence of hyperhidrosis in the United States is 2.8% (7.8 million individuals), and 50.8% of this population (4.0 million individuals) reported that they have axillary hyperhidrosis (1.4% of the US population). Only 38% had discussed their sweating with a health care professional. Approximately one third of individuals with axillary hyperhidrosis (0.5% of the US population or 1.3 million individuals) reported that their sweating is barely tolerable and frequently interferes, or is intolerable and always interferes, with daily activities. Conclusion Hyperhidrosis affects a much larger proportion of the US population than previously reported. More than half of these individuals have axillary hyperhidrosis, in which sweating can result in occupational, emotional, psychological, social, and physical impairment.

https://www.sweathelp.org/pdf/Strutton_2004.pdf

US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey ☆

Recognition, diagnosis, and treatment of primary focal hyperhidrosis

BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.

https://www.sweathelp.org/pdf/dermatologic-su7-gdlines.pdf

A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee

https://www.annalsthoracicsurgery.org/article/S0003-4975(11)00467-X/pdf

The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis.

Objectives: To evaluate the safety and efficacy of botulinum toxin type A in the treatment of bilateral primary axillary hyperhidrosis. Design: Multicentre, randomised, parallel group, placebo controlled trial. Setting: 17 dermatology and neurology clinics in Belgium, Germany, Switzerland, and the United Kingdom. Participants: Patients aged 18-75 years with bilateral primary axillary hyperhidrosis sufficient to interfere with daily living. 465 were screened, 320 randomised, and 307 completed the study. Interventions: Patients received either botulinum toxin type A (Botox) 50 U per axilla or placebo by 10-15 intradermal injections evenly distributed within the hyperhidrotic area of each axilla, defined by Minor9s iodine starch test. Main outcome measures: Percentage of responders (patients with ≥50% reduction from baseline of spontaneous axillary sweat production) at four weeks, patients9 global assessment of treatment satisfaction score, and adverse events. Results: At four weeks, 94% (227) of the botulinum toxin type A group had responded compared with 36% (28) of the placebo group. By week 16, response rates were 82% (198) and 21% (16), respectively. The results for all other measures of efficacy were significantly better in the botulinum toxin group than the placebo group. Significantly higher patient satisfaction was reported in the botulinum toxin type A group than the placebo group (3.3 v 0.8, P 0.05). Conclusion: Botulinum toxin type A is a safe and effective treatment for primary axillary hyperhidrosis and produces high levels of patient satisfaction. What is already known on this topic Primary hyperhidrosis is a chronic disorder that can affect any part of the body, especially the axillas, palms, feet, and face Current treatments are often ineffective, short acting, or poorly tolerated What this study adds Botulinum toxin type A was significantly better than placebo on all measures of sweating Patient satisfaction was high and few adverse events were reported Effects of treatment remained apparent at 16 weeks

https://www.bmj.com/content/bmj/323/7313/596.full.pdf

Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial

ObjectiveThis evaluated the long-term outcome after endoscopic thoracic sympathectomy (ETS) from below D1 to D4, using a single-site access technique for primary hyperhidrosis of the upper limbs.Summary Background DataPrimary hyperhidrosis of the upper limbs is a distressing and often socially disab

Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations

A report is presented on 105 patients who underwent laparoscopic cholecystectomy because of symptomatic gallstone disease. Preoperative and intraoperative findings, complications and results were prospectively documented. In four (3.8%) patients the laparoscopic procedure had to be converted into open cholecystectomy. There were only minor surgical complications such as wound infection and a subhepatic haematoma. On average, patients were discharged on the second postoperative day. The operating time decreased from a median of 98 minutes in the first half to 73 minutes in the second half of the study, despite augmentation of the number of surgeons and of the indications to include patients with acute cholecystitis (n = 11), previous upper abdominal surgery (n = 7) and cirrhosis (n = 2).

[Laparoscopic cholecystectomy--evaluation of a prospective follow-up study].

121 patients with acute necrotizing pancreatitis were treated according to a surgical regimen of necrosectomy, drainage by laparostomies and repeated revisions. Changing the protocol from revisions on demand to scheduled reexplorations resulted in an improvement of mortality from 53% to 28%. The high incidence of gastrointestinal fistulas (30%) associated with this regimen could be decreased to 5% by a more individual protocol with longer intervals of revisions in the later course. Mortality was 21% following this regimen.

Necrosectomy and laparostoma as a surgical therapy concept of acute necrotizing pancreatitis

The technique of Laparoscopic resection of the colon sigmoideum was practised in an experimental model before starting a clinical program of laparoscopic colonic surgery. Until now, two resections of the colon sigmoideum, one ileocecal resection, one right colectomy, one Hartmann's procedure and one transversostomy have been performed laparoscopically. Three patients had colonic carcinoma. One sigmoid resection had to be converted to open surgery and this patient underwent relaparotomy because of postoperative ileus. The postoperative course of the other patients was uncomplicated. The promising initial experience demonstrates that laparoscopic colonic surgery is feasible, although further studies have to prove advantages and indications, especially with respect to oncology.

[Laparoscopic colon surgery--from experiment to initial clinical experience].

Von 323 Patienten, bei denen seit 1965 wegen Hyperhidrosis eine transthorakale endoskopische Sympathektomie durchgefuhrt wurde, konnten 270 (83,7%) bezuglich postoperativer Komplikationen und des Langzeitergebnisses untersucht werden. Bei 98,1% konnte die palmare oder axillare Hyperhidrosis beseitigt werden. Spater auftretende Nebenwirkungen wie kompensatorisches oder gustatorisches Schwitzen beeintrachtigen allerdings die Zufriedenheit der Patienten.

Spätergebnisse der endoskopischen thorakalen Sympathektomie bei Hyperhidrosis

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