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Familial primary hyperhidrosis: a disabling social disease

Aini IF, Zamrin DM, Joanna OS, Hairulfaizi H, Ramzisham AR

Clin Ter, 2010;161(5):459-60.
PMID: 20949244

The incidence of primary hyperhidrosis ranges between 2-5%. This condition is more common than previously thought of and has been linked to a familial predisposition. It is socially disabling to the affected individuals. In the current era of minimally invasive surgery, the video assisted thoracoscopic sympathectomy has become the definitive treatment with minimal complications. We report on a case of two siblings with primary hyperhidrosis that was treated successfully at our institution with the aim to share our experience and attract awareness among medical practitioners of the availability of a cure for this condition.

Matched MeSH terms: Hyperhidrosis/genetics*; Hyperhidrosis/psychology
Fulltext The man with sweaty palms and soles

Jamani NA, Puteri Shanaz JK, Azwanis AH

Malays Fam Physician, 2018;13(1):52-54.
PMID: 29796213 MyJurnal

A 21-year-old male college student presented with excessive severe bilateral sweating of his palms and
soles for the past 3 years, which has progressively worsened. His symptoms occur throughout the day
but worsened during exams or whenever he felt anxious. The condition has caused him difficulty in
holding objects and writing assignments, and has resulted in public embarrassment on several occasions.
He has to wipe his hands with a handkerchief each time they sweat. He also needs to change his socks
frequently. No other area of his body is similarly affected. He denied any associated symptoms, such as
pungent body odour, changes in weight, fever, heat intolerance, or changes in bowel habits. He has no
known medical illness and is not on any medication. (Copied from article).

Matched MeSH terms: Hyperhidrosis*
Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy

Ho YL, Fauzi M, Sothee K, Basheer A

Med J Malaysia, 2020 09;75(5):555-560.
PMID: 32918426

INTRODUCTION: Hyperhidrosis is a disorder of excessive and uncontrollable sweating beyond the body's physiological needs. It can be categorised into primary or secondary hyperhidrosis based on its aetiology. Detailed history review including onset of symptoms, laterality of disease and family history are crucial which may suggest primary hyperhidrosis. Secondary causes such as neurological diseases, endocrine disorders, haematological malignancies, neuroendocrine tumours and drugs should be adequately examined and investigated prior to deciding on further management. The diagnosis of primary hyperhidrosis should only be made only after excluding secondary causes. Hyperhidrosis is a troublesome disorder that often results in social, professional, and psychological distress in sufferers. It remains, however, a treatment dilemma among some healthcare providers in this region.
METHODS: The medical records and clinical outcomes of 35 patients who underwent endoscopic thoracic sympathectomy for primary hyperhidrosis from 2008 to 2018 in Department of Cardiothoracic Surgery were reviewed.
RESULTS: The mean age of the patients was 27±10.1years, with male and female distribution of 18 and 17, respectively. Fifty-one percent of patients complained of palmar hyperhidrosis, while 35% of them had concurrent palmaraxillary and 14% had palmar-plantar-axillary hyperhidrosis. Our data showed that 77% (n=27) of patients were not investigated for secondary causes of hyperhidrosis, and they were not counselled on the non-surgical therapies. All patients underwent single-staged bilateral endoscopic thoracic sympathectomy. There was resolution of symptoms in all 35 (100%) patients with palmar hyperhidrosis, 13(76%) patients with axillary hyperhidrosis and only 2 (50%) patients with plantar hyperhidrosis. Postoperatively 34.3% (n=12) of patients reported compensatory hyperhidrosis. There were no other complications such as pneumothorax, chylothorax, haemothorax and Horner's Syndrome.
CONCLUSION: Clinical evaluation of hyperhidrosis in local context has not been well described, which may inadvertently result in the delay of appropriate management, causing significant social and emotional embarrassment and impair the quality of life of the subjects. Detailed clinical assessment and appropriate timely treatment, be it surgical or non-surgical therapies, are crucial in managing this uncommon yet distressing disease.

Matched MeSH terms: Hyperhidrosis/diagnosis*; Hyperhidrosis/surgery*
Fulltext Thoracoscopic sympathectomy for primary palmar hyperhydrosis: the Penang Hospital experience

Gooi BH, Manjit S, Premnath N

Med J Malaysia, 2002 Mar;57(1):66-9.
PMID: 14569720 MyJurnal

Background: Primary palmar hyperhidrosis is a functionally and socially disabling condition. The choice of treatment is controversial.
Objective: To examine the clinical presentation of primary palmar hyperhidrosis and the results of treatment with thoracoscopic sympathectomy in a local setting.
Materials and Methods: A retrospective study of 7 patients involving 10 sympathectomies between October 1997 and October 2000 was undertaken.
Results: The duration of anaesthesia ranged from 55 to 130 minutes with the majority being 1 hour. The immediate results were good, with all operated limbs dry soon after operation. There was no mortality or serious morbidity in this study. All were satisfied with the results of surgery.
Conclusions: Primary palmar hyperhidrosis is not uncommon but rather underdiagnosed. Thoracoscopic sympathectomy is an effective treatment with minimal complications.

Matched MeSH terms: Hyperhidrosis/surgery*
Unilateral hemihyperhidrosis in a stroke patient and literature review on its clinicoanatomical correlation

May, Honey Ohn, Khin, Maung Ohn, Khin, Nyein Yin, Teh, Yong Guang, Ng, Pey Luen, Chin, Li Bing

Borneo Journal of Medical Sciences, 2020;14(2):41-47.
MyJurnal

Contralateral hyperhidrosis from the cardiovascular accident has been infrequently described in the stroke literature. The clinical significance and pathogenesis are yet well understood. This is a case of a 60-year-old man who developed excessive sweating of the paralyzed side with a pure division along the midline of the body secondary to a subcortical stroke, which region is supplied by branches of middle cerebral artery territory known as deep perforating lenticulostriate. To the best of our knowledge, a precise clinicoanatomic correlation between hyperhidrosis and subcortical stroke has not been widely reported. In this review, we summarize the existing literature of post-stroke hyperhidrosis to evaluate the correlation between clinical manifestation and its neuroanatomical location. According to the location of the infarction and clinical features, it can be concluded that both tracks en route through the ipsilateral internal capsule, after originating in the opercular cortex before crossing the brain stem and terminal connections with the contralateral thoracic spinal cord. Therefore, the phenomenon of hyperhidrosis in anterior circulation stroke might be postulated as due to the disruption of the sympathoinhibitory pathway that controls sweat glands, similarly like posterior circulation stroke.

Matched MeSH terms: Hyperhidrosis
Fulltext Cold allodynia as the presenting symptom in a case of acquired neuromyotonia (Isaacs syndrome) with multiple autoantibodies

Goh KJ, Abdullah S, Wong WF, Yeap SS, Shahrizaila N, Tan CT

Neurology Asia, 2014;19(4):409-412.
MyJurnal

We report a patient who presented with severe cold-induced allodynia and hyperhidrosis, and found to have acquired neuromyotonia (Isaacs syndrome) with high voltage-gated potassium channel (VGKC) antibody titre,positive contactin-associated protein 2 (CASPR2) and leucine-rich glioma-inactivated 1 (LGI1) antibodies. The patient also had positive anti-dsDNA and acetylcholine receptor (AChR) antibodies without clinical features of SLE or myasthenia gravis, suggesting a strong underlying autoimmune tendency. CT thorax showed no thymoma. Her symptoms improved with intravenous immunoglobulin infusion but recurred despite maintenance oral corticosteroids and carbamazepine. She has since been on regular IVIG infusions. Cold allodynia is an unusual presentation in acquired neuromyotonia.

Matched MeSH terms: Hyperhidrosis