DÄ internationalArchive26/2009Hyperhidrosis—Causes and Treatment of Enhanced Sweating: In reply

Correspondence

Hyperhidrosis—Causes and Treatment of Enhanced Sweating: In reply

Dtsch Arztebl Int 2009; 106(26): 448. DOI: 10.3238/arztebl.2009.0448b

Schlereth, T

LNSLNS We thank the correspondents for their detailed comments and valuable additions. We have found contradictory citations for the first paragraph. Some studies—for example that by Leséche et al (1)—investigated endoscopic transthoracic sympathectomy (ETS) at different levels (from T1 to T5) and to different extents (2, 3, or more ganglia) and found no difference in the rates of compensatory hyperhidrosis. Recent studies have indeed shown that after ETS below T3 the rate of compensatory hyperhidrosis is reduced (2). Neurophysiologically, the reduced compensatory hyperhidrosis can be explained only with the fact that the sweat elimination below T3 is not as complete after ETS as at the level as T3 or above. More detailed studies are needed to clarify the advantages and disadvantages of ETS below T3. For reasons of space, we did not discuss the local surgical procedures in any detail; however, as for the newer techniques that are less aggressive, the success rate depends on the fact that the sweat glands are removed as completely as possible. Since the radical removal of axillary skin is recommended by the German society for dermatosurgery for individual cases only owing to the substantial side effects, we did not mention this in any detail in our article (3). However, we understood liposuction as an overriding term since the technique can be performed with or without curettage. DOI: 10.3238/arztebl.2009.0448b


Dr. med. Tanja Schlereth
Klinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Langenbeckstr. 1
55101 Mainz, Germany
schleret@uni-mainz.de

Conflict of interest statement
The authors of both the letter and of the reply declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Leseche G et al.: Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg 2003; 37: 124–8. MEDLINE
2.
Li X, Tu YR, Lin M, Lai FC, Chen JF, Dai ZJ: Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg 2008; 85: 1747–51. MEDLINE
3.
Worle B, Rapprich S, Heckmann M: Definition and treatment of primary hyperhidrosis. J Dtsch Dermatol Ges 2007; 5: 625–8.
4.
Schlereth T, Dieterich M, Birklein F: Hyperhidrosis—causes and treatment of enhanced sweating [Hyperhidrose – Ursachen und Therapie von übermäßigem Schwitzen]. Dtsch Arztebl Int 2009; 106: 32–7.
1. Leseche G et al.: Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg 2003; 37: 124–8. MEDLINE
2. Li X, Tu YR, Lin M, Lai FC, Chen JF, Dai ZJ: Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg 2008; 85: 1747–51. MEDLINE
3. Worle B, Rapprich S, Heckmann M: Definition and treatment of primary hyperhidrosis. J Dtsch Dermatol Ges 2007; 5: 625–8.
4. Schlereth T, Dieterich M, Birklein F: Hyperhidrosis—causes and treatment of enhanced sweating [Hyperhidrose – Ursachen und Therapie von übermäßigem Schwitzen]. Dtsch Arztebl Int 2009; 106: 32–7.