Treatment Modalities and the Neuropathology of Palmar Hyperhidrosis

Mark S. Ballard, G.R. Wayne Moore, Thomas J. Zwimpfer

ABSTRACT

Palmar Hyperhidrosis (PHH) is a largely idiopathic condition that leads to significant dermatological and socio-professional concerns. This article reviews the method of treating PHH and defines the role of the neuropathologist, which is poorly illustrated in current literature. PHH is treated with the stepwise use of aluminum salts, iontophoresis, Botox injections, systemic drugs and finally endoscopic thoracic sympathectomy (ETS). ETS is currently saved for medically refractory PHH and the procedure is being optimized. Currently consideration is being given to whether the T2 vs. the T2 T3 T4 ganglia should be excised or whether they should be reversibly clamped or permanently excised. Although during ETS the surgeon can correctly identify the ganglion, the pathologist still plays a role in studying the histopathology to gain further understanding of the pathophysiology of PHH. Some of the pathohistological changes that may be observed in the PHH ganglia include neuronal cell death, lipofuscin accumulation, and inflammation. At present the relationship of these findings to the clinical presentation and pathogenesis of PHH is unclear, and without an animal model, research will be slow. Thus, the neuropathologist and surgeon should take special note of the clinical picture and correlate the number of pathohistological findings with the degree of clinical symptoms. Finally, the neuropathologist may assess the type of inflammation (i.e. monocytic vs. lymphocytic) via immunohistochemical stains and continue the search for non-documented and undiscovered pathohistologic markers of PHH.

KEYWORDS: hyperhidrosis; sympathectomy; pathology; treatment; ganglia; ganglion

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Ballard MS, Moore GRW, Zwimpfer TJ. Treatment Modalities and the Neuropathology of Palmar Hyperhidrosis. UBCMJ. 2010 2(1):20-234-29