During the intervention, the hyperhidrosis of patient of the left hand diminished of the full cushion of palm grove and of the phalangeal quilts next to a partial region to sweat reduced in the cushion of treatment for hyperhidrosis metacarpophalangeal of palm grove of the second digit. The impression of the role was saturated with the sweat before the first processing of TWG, with a stop hyperhidrosis designed area of 10.3×12.0 cm. After the 10 sessions of the processing, the area layout of the saturation of the left hand to be reduced to an area 2.2-×2.7-cm (the Figure), and the small area 1.0-×1.0-cm of the right hand was reduced to the normhidrosis.
The patient worked again to complete time 2 weeks after beginning TWG. At that time, he carried 2 peers of absorbent gloves, compared with 6 peers before the intervention. Following the tenth processing, the patient did not he need to carry absorbent gloves in the work. The processing for the hyperhidrosis was concluded at that time, with the agreement among the doctor that refers, the terapeuta, and the patient to continue in the orthopedic dispensary with regard to the position. The patient reinforces and the range of the program of the processing of the movement continued once a week for the next 2 months, with the subsequent discharge with a program of the exercise of home.
The side carries out observed during TWG included temporary erythema, lasting 1 to 2 hours after the intervention, as well as the minimum inconvenience, described as "a contempt that burn the sensation" during the session of the processing. The patient indicated that he perceived this sensation through hands to the waterline around wrists. These effects diminished by the last processing. We do not observe the adverse effects.
Two years after the last processing, we telephone the patient, and he said that he had not to sweat abnormal the guidelines. The he said also that had continued the reduction to be swollen and the treatment for hyperhidrosis erythema during the 2 years since the therapy. A 16-year-old girl presents to complain of axillary and excessive palm grove that sweat. The increases that sweat with the emphasis and they do not seem to be associated with the temperature environment or other factors. The patient denies any history of the family to sweat and excessive reports that stop hyperhidrosis she does not take the prescription neither the medicines without prescription in a regular base.
The exam of this patient is normal less clear sweat noted in palms and in the region of axillary bilateral. The routine investigation of the blood, inclusive treatment for hyperhidrosis a profile of thyroid, complete to count of corpuscle, and complete metabolic wall, reveals the normal results.
This patient has a medical condition he called hyperhidrosis primary. Approximately 0,6% to 1,0% of youths has this condition characterized by sweating excessive in several locations in the body -- the majority of the commonly the palms, the soles, the head, the face, or axillae. (1) the Incident appears to be equal among the sexes. Although benign, hyperhidrosis presents the patient with significant psychological and social concerns (sees "Hyperhidrosis Is not Small Problem," paginates 97).
Hyperhidrosis can be classified as or primary or secondary (sees Table 1, (2.3) paginates 94). Primary (or essential) hyperhidrosis is the most common cause to sweat of palmoplantar and often beginnings during the adolescence -- although, as is true in the case presented here, can begin in the childhood or still infancy Besides, a careful history of the family can provide an indication to this diagnosis, since hyperhidrosis primary often can be a disorder inherited. (2) To Sweat is located generally, and while the heat
and the emotional stimuli can precipitate to sweat, the patients with hyperhidrosis essential can exhibit the symptoms still without
These stimuli. (3)
Hyperhidrosis secondary should be excluded with care before arriving in a diagnosis of hyperhidrosis primary because is associated commonly with a fundamental medical problem (sees Table 2, the page 94) or the use of certain medicines (p.and., propranolol, pilocarpine, antidepressants of tricyclic, inhibiting selective of reuptake of serotonin, and venlafaxine). While hyperhidrosis secondary can present as located (p.and., palmoplantar), often is characterized for a more generalized guideline to sweat that occurs during so much hours during the day like night. (2)
Hyperhidrosis primary can be diagnosed based on the medical patient and the history of the family, in the presentation of the symptom, and in a recognition with normal conclusions. Although there is not the diagnostic tests to confirm hyperhidrosis primary, the stop hyperhidrosis contagious and metabolic disorders that can be responsible for hyperhidrosis secondary can be treatment for hyperhidrosis excluded carrying out the tests of the laboratory such as a complete count of corpuscle, a level of the hormone of thyroid-stimulating, the hormone of follicle-stimulating and levels of hormone of luteinizing, wall of chemistry, the level of sugar in the blood of fast, walls of Of plasma-freed. (4)
If a fundamental cause for the to sweat can be identifying, should be treated. If, on the other hand, any fundamental cause is identifying, there are several options to treat hyperhidrosis primary, inclusive trite solutions, the oral medicine, iontophoresis, toxin toxin injections botulínica, the liposuction, and the surgery.
Trite solutions. The preparations that contain chloride of aluminum and agents of brown color have been utilized to treat patients with temperate to moderate the symptoms. Although the exact mechanism because these products diminish hyperhidrosis is a stranger, some experts suggest that that chloride of aluminum blocks mechanically the pores of the sweat, having as a result the atrophy of the secretory cells. (5) the products without prescription that contain chloride of aluminum have been found to be especially successful in the processing of hyperhidrosis of axillary; nevertheless, the products that contain the highest percentages of chloride of aluminum can be required to treat moderate to severe cases. The solutions that contain 25% tánico acid or the solutions of glutaraldehyde and formaldehyde (5% to 20%) they are utilized to treat hyperhidrosis of the plant. The trite solutions have limited the utility in cases of hyperhidrosis severe.
When does it appropriate, these products should be applied to intact, drought skin. Advise patients to spread the agents in the skin two or three times a week in the hour to be gone to bed and then clarifies the solution of in the morning. It is also important to inform patients that these solutions can irritate and to be able to stain the skin stop hyperhidrosis, and can stain also clothes and bed linen.
Oral processing. Some few medicines sistémicas have been utilized to treat hyperhidrosis, inclusive diazepam, anticholinergics, the drugs of treatment for hyperhidrosis anti-inflammatory of nonsteroidal (p.and., indomethacin), and calcium channel blockers (hydrochlorate of diltiazem and clonidine). (2) does not only it do these drugs that all have the potentially significant adverse effects, they have not been especially successful in reducing to sweat.
Iontophoresis. This therapy implies applying a temperate electric current to the area of skin that produces the excessive sweat. The patients often need to be dealt with this electric current every other day for four to six sessions. The electric stimulus has been found to be cash in reduce the symptoms of hyperhidrosis of palm grove and foot and less so in the processing of hyperhidrosis of axillary. (6)
Toxin toxin injections botulínica. The injections of Intracutaneous of toxin of toxin botulínica (BTX) has been found to diminish to sweat blocking the liberation of acetylcholine in the junction of neuromuscular and inhibiting cholinergic the broadcast in the postganglionic nice fibers of cholinergic to glands sudaríparas. (7) before administering this therapy (as well as the surgical options), the specialist should identify the excessive area of sweating utilizing the test of the starch-iodine of less than colorimetric. (8.9)
The effects adverse associates with BTX bruise, the inconvenience, and the weakness of muscle in the places of injection. The injections of BTX in the palms have been associates with some weakness of hand, but this generally is moderated and transitory. Although these injections be treatment for hyperhidrosis not curative, the majority of the patients they experience anhidrosis by a period from three to eight months. (10) The cost of the therapy of BTX is approximately $700 to $1.000 by the processing.
Liposuction. The liposuction has been utilized to treat hyperhidrosis of axillary that is persisted to more conservative processing. During this procedure, two or three incisions are facts in the axillae so that a cannula can be put and can be manipulated in a wiper as the fashion to scrape the lower surface of the dermis and to aspire the glands sudaríparas. (9.11)
Surgery. Since the eighties, the surgery of thoracoscopic has replaced gradually a number-nice and older focus. During the surgery, a thoracoscope is put in the cavity pleural and specific ganglions are resected, depending on where the patient experiences the to sweat. The reports indicate that this procedure is cash 94% to 98% of the time with approximately 1% of rate of stop hyperhidrosis. Nevertheless, this surgical intervention has been associated effective adverse serious, inclusive to sweat compensatory, pneumothorax, the collapse segmental of the lung, and of the infections of injury. (12.13)
This report of the case describes the use of TWG in a patient that maintained the amputation digital traumatic, with the subsequent beginning of hyperhidrosis that implies the left hand. The current protocol election and intervention adapted of Stolman11 that we utilize we were based on reports in the literature, that indicated that DC reduced or hyperhidrosis diminished, while AC had only not intervention effect shown. 12 in spite of the fact that the mechanism by which electric stimulus they affect hyperhidrosis is not understood, our patient is sweated diminished, and he could return at work to complete time as an electrician. During the time that the patient received each one of the 10 processing of iontophoresis, he experienced only rojez and to feel swarming in hands, both that diminished 2 hours after each processing. These results are consistent with those of Stolman, 11 that reported the reduction marked to sweat after 9 processing with water iontophoresis current.
Our beginning of the patient of hyperhidrosis occurred after the surgery. During the period of 3 months before TWG, the patient had hyperhidrosis and physiotherapy received to reinforce and range of the movement, and he he received ultrasonido for improve the mobility of the scar. The ultrasonido was utilized in the areas of the left forearm to fly and in the phalangeal next the surgical places of the closing. These interventions appeared to have no effect to reduce the hyperhidrosis of palm grove during the period of 3 months before the initiation of TWG, although we not to measure the hyperhidrosis. During the intervention with TWG, the treatment for hyperhidrosis diminished, suggesting that TWG should have had an effect. With regard to the potential irritation of the skin during TWG, a suggestion to diminish the negative effects of the side of the inconvenience in stop hyperhidrosis the waterline are of apply petrolatum, an insulating one of the electricity, around the wrists. 17The limitations of our report of the case include the certainty of our method to determine the extension to sweat and the uncertainty of not educated the effects of the processing of the positive polarity neither refusal only. Future investigation is needy to study the effects of TWG in the hyperhidrosis. Certainly, the studies of the future that utilize TWG for the hyperhidrosis would be able to improve the measures of the changes to sweat and to reckon the certainty and the validity of data obtained with this method of the measure. The improvements would be able to determine also which combinations of the polarity or the polarity are very cash in maintaining the reduction of hyperhidrosis.
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