다한증의 제한적 교감신경절단술

박만실,서충헌,심재천,최봉춘,이영철 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.9

배경: 국소적 다한증의 흉강경을 이용한 통상적인 흉부교감신경절제술이나 교감신경절차단술은 효과적인 치료법이기는 하나 수술 후 심한 보상성 다한증이 많이 발생 하고 수장부 다한증의 경우 수술 후 얼굴에서 땀이 나지 않는 부작용이 발생한다. 저자들은 기존의 수술법을 개량해 제한적 흉부교감신경절단술을 고안하였다. 본 연구는 제한적 교감신경절단술의 결과를 분석하였다. 대상 및 방법: 1998년 5월부터 8월 까지 17명의 환자들에게 제한적 흉부교감신경절단술을 시행하였다. 9명의 안면부 다한증인 환자들에게 두 번째 교감신경절 위 아래의 교감신경을 절단하던 기존의 방법과는 달리 첫번째 와 두 번째 흉부교감신경절 사이의 신경절간신경만을 절단하였다. 8명의 수장부 다한증 환자에 대해서는 두 번째와 세 번째 흉부 교감신경절간신경을 절단하였다. 결과: 17명의 환자들 중 16명의 환자에서 수술 후 원하던 부위의 땀이 나지 않았으나 1명의 환자는 수술 1달 후 얼굴의 땀이 재발하였다. 안면부 다한증으로 수술을 받았던 9명의 환자들 보상성 다한증으로 4명이 심하게, 4명이 중등도로, 1명은 경미하게 불편을 호소 하였다. 그러나 수장부 다한증으로 수술을 받았던 8명의 환자들 중에서는 보상성 다한증을 3명에서 중등도로, 1명이 경미하게 호소하였으며 4명은 보상성 다한증이 없었다. 결론: 제한적 흉부교감신경절단술은 최소 침투 수술법으로 효과적인 치료법이며 특히 수장부 다한증에서는 수술 후 체간에서 발생하는 보상성 다한증의 발생을 줄이고 얼굴의 무한증을 막을 수 있을 것으로 사료된다. Background: Conventional thoracoscopic thoracic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively embarrassing compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection. The purpose of this study was to assess the result of the limited thoracoscopic sympathetic nerve transection in hyperhidrosis. Material and Method: From May to August 1998, 17 patients underwent limited transection of the sympathetic nerve. For 9 patients with facial hyperhidrosis, we transected only the interganglionic fiber between the first and the second ganglion, whereas the conventional method cuts two interganglionic fibers. Eight patients with palmar hyperhidrosis underwent limited transection of the interganglionic fiber between the second and third ganglion. Result: Sixteen patients had improved symptom postoperatively. There was a recurred facial sweating in 1 patient 1 month after the operation. Among the 9 facial hyperhidrosis patients, postoperative compensatory hyperhidrosis was severe in 4, moderate in 4 and minimal in 1. But in 8 cases of palmar hyperhidrosis compensatory hyperhidrosis was moderate in 3, and minimal in 1, none in 4. Facial sweating was not disturbed postoperatively in all of the palmar hyperhidrosis patients. Conclusion: Limited sympathetic nerve transection is a practical and less invasive method for the treatment of localized hyperhidrosis and may reduce the incidence of compensatory truncal hyperhidrosis and facial anhidrosis in case of palmar hyperhidrosis.

수장부 다한증에 제한적 교감신경절간 절단술의 장기 고찰

채진호(Jin Ho Chai),최봉춘(Bong Chun Choi),이영철(Yong Chul Lee) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1

N/A Background: Conventional thoracoscopic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively compensatory hyper- hidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection (limited T3 sympathicotomy) since May 199S. However, there are many reports of a good short-term outcome of limited T3 sympathicotomy. Therefore, we reviewed long-term follow-up of limited T3 sympathicotomy based on outcomes analysis using a questionnaire. Methods: Fifty four patients with palmar hyperhidrosis underwent a limited T3 sympathicotomy between May 1998 and March 1999 and had a complete follow-up over two years using a questionnaire (the mean follow-up was 2.6 years). The patients' postoperative satisfaction was determined by their subjective responses to the questionnaires; the degree of compensatory hyperhidrosis, the effects on foot hyperhidrosis, gustatory hyperhidrosis and facial dryness, and recurrence, and patients satisfaction. Results: Of the total, 87% of patients had a compensatory hyperhidrosis and 3.7% of them were disabled. 31.5% of patients showed improvement in foot hyperhidrosis, while 68.5% of patients demonstrated no change or got worse. 31.5% of patients had gustatory hyperhidrosis and facial dryness and 22.2% of patients showed a mild palmar hyperhidrosis. The postoperative patients satisfaction was significantly in 96.3% of patients. Conclusions: The limited T3 sympathicotomy is a highly effective treatment of palmar hyperhidrosis and has a low rate of postoperative compensatory hyperhidrosis, gustatory hyperhidrosis, and facial dryness.

다한증 환자의 사상의학적 특성에 관한 연구

오현주,박민영,전현진,황민우 사상체질의학회 2018 사상체질의학회지 Vol.30 No.4

Objectives The purpose of this study was to analyze the clinical characteristics of patients with hyperhidrosis who visited a Korean medicine hospital, and provide information on treated hyperhidrosis, based on Sasang Constitutional medicine. Methods A retrospective review was made of the electronic medical record (EMR) charts for 157 Korean patients with hyperhidrosis (90 male, 67 female), who first visited hospital from January 1, 2013 to December 31, 2017. The following information was collected: sex, age, height, weight, body mass index (BMI) and clinical data (diagnosis, area of onset, duration of illness, aggravating factors, medication, healing process, et al). Results There were many patients with hyperhidrosis, in the other of So-Yang type (57.3%), Tae-Eum type (35.0%) and So-Eum type (7.6%). The proportion of male was higher than female. The most common area of hyperhidrosis was hands and feet (44.0%), followed by generalized whole body (27.4%) and head and face (25.5%). The cure rate of hyperhidrosis was 32.2%, and effectiveness rate of that was 72.7%. In individual patients, the better the usual health condition expressed by original symptoms, the higher the possibility of treatment success, with shortened duration of treatment and reduced total drug dose. The most frequent treatment modality in patients was that consistently improved, and this duration of treatment was statistically significantly shorter than that experienced worsening of excessive sweating during treatment period (p<0.001). Conclusions This study provides some original information on the Korean patients with hyperhidrosis, and suggests the suitability of Sasang Constitutional medicine as treatment methods for hyperhidrosis. Objectives The purpose of this study was to analyze the clinical characteristics of patients with hyperhidrosis who visited a Korean medicine hospital, and provide information on treated hyperhidrosis, based on Sasang Constitutional medicine. Methods A retrospective review was made of the electronic medical record (EMR) charts for 157 Korean patients with hyperhidrosis (90 male, 67 female), who first visited hospital from January 1, 2013 to December 31, 2017. The following information was collected: sex, age, height, weight, body mass index (BMI) and clinical data (diagnosis, area of onset, duration of illness, aggravating factors, medication, healing process, et al). Results There were many patients with hyperhidrosis, in the other of So-Yang type (57.3%), Tae-Eum type (35.0%) and So-Eum type (7.6%). The proportion of male was higher than female. The most common area of hyperhidrosis was hands and feet (44.0%), followed by generalized whole body (27.4%) and head and face (25.5%). The cure rate of hyperhidrosis was 32.2%, and effectiveness rate of that was 72.7%. In individual patients, the better the usual health condition expressed by original symptoms, the higher the possibility of treatment success, with shortened duration of treatment and reduced total drug dose. The most frequent treatment modality in patients was that consistently improved, and this duration of treatment was statistically significantly shorter than that experienced worsening of excessive sweating during treatment period (p<0.001). Conclusions This study provides some original information on the Korean patients with hyperhidrosis, and suggests the suitability of Sasang Constitutional medicine as treatment methods for hyperhidrosis.

두한증 및 수족다한증 환자의 비내시경, 체성분 검사를 통한 특성비교분석

박의근,백현정,김관일,이범준,정승기,정희재,Park, Eui-keun,Baek, Hyun-jung,Kim, Kwan-il,Lee, Beom-joon,Jung, Sung-ki,Jung, Hee-jae 대한한방내과학회 2015 大韓韓方內科學會誌 Vol.36 No.3

Objectives This study was designed to analyze the characteristics of craniofacial hyperhidrosis and palmar/plantar hyperhidrosis by nasal endoscopy and body composition test. Methods The study sample consisted of 20 and 22 patients with craniofacial hyperhidrosis and palmar/plantar hyperhidrosis, respectively, who answered questionnaires and underwent nasal endoscopy and body composition test. The questionnaires estimated the quality of life by Dermatology Life Quality Index score (DLQI), and the degree of obesity was evaluated using body mass index (BMI), percent body fat (PBF), and waist-hip ratio (WHR). The state of nasal cavity was evaluated by color, humidity, and swelling of the mucous membranes, and runny nose. Results BMI, PBF, and WHR were higher in patients with craniofacial hyperhidrosis than in patients with palmar/plantar hyperhidrosis. Rhinitis score was not significantly different between craniofacial hyperhidrosis and palmar/plantar hyperhidrosis. There was a positive correlation between rhinitis score and DLQI. Conclusions The degree of obesity was higher in patients with craniofacial hyperhidrosis than in those with palmar/plantar hyperhidrosis. The state of nasal cavity was not significantly different between craniofacial hyperhidrosis and palmar/plantar hyperhidrosis, but was associated with quality of life of hyperhidrosis patients.

다한증(多汗症) 환자(患者)의 양도락(良導絡)측정 영역별 교감신경(交感神經)활성 상태에 대한 연구

김재환,정승기,정희재,Kim, Jae-Hwan,Jung, Sung-Ki,Jung, Hee-Jae 대한한방내과학회 2010 大韓韓方內科學會誌 Vol.31 No.1

Objective : Hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed for thermoregulation. Ryodoraku is a physiological function test using electric current, and is closely related to skin sympathetic tone. The aim of this study was to investigate the characteristics of Ryodoraku and association of Ryodoraku with hyperhidrosis. Methods : For this study, we conducted Ryodoraku on 56 people, comprising 33 with palmar-plantar hyperhidrosis and 23 with head-face hyperhidrosis, who visited the 5th Internal Department of the Oriental Medicine Hospital of Kyung Hee University during the period from March 1, 2008 to May 31, 2009. Ryodoraku scores were evaluated and compared by 7 indices(upper, lower, left, right, yin, yang, total score). Results : Ryodoraku scores were significantly higher in hyperhidrosis patients than the normal group. Ryodoraku scores of palmar-plantar hyperhidrosis patients were significantly higher than of head-face hyperhidrosis patients and the normal group. The difference of Ryodoraku indices among palmar-plantar hyperhidrosis patients were insignificant. In head-face hyperhidrosis patients, the upper index was significant higher than the lower index. Conclusions : In hyperhidrosis patients, all indices were significant higher than lower. The upper/lower ratio was significant higher in head-face hyperhidrosis patients.

Topical Glycopirrolate for the Management of Hyperhidrosis in Herpetic Neuralgia

Nebojsa Gojko Ladjevic,Ivana Spasoje Likic-Ladjevic 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.2

Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia. Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia.

본태성 다한증의 후흉추 접근법 및 내시경수술의 임상고찰

전효철,김재휴,이정길,김태선,정신,김수한,강삼석,이제혁,Cheon, Hyo Cheol,Kim, Jae Hyoo,Lee, Jung Kil,Kim, Tae Sun,Jung, Shin,Kim, Soo Han,Kang, Sam Suk,Lee, Je Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

일차성 다한증 환자 26명의 한의학적 치료 후 삶의 질 변화에 대한 임상적 평가

이성헌,노영래,황준호,정승연,정승기,정희재,Lee, Sung-Hun,Roh, Young-Lae,Hwang, Joon-Ho,Jeong, Seung-Yeon,Jeong, Sung-Ki,Jung, Hee-Jae 대한한방내과학회 2007 大韓韓方內科學會誌 Vol.28 No.3

Backgrounds and Objectives: Primary hyperhidrosis deeply affect a patient's quality of life, resulting in impairments of daily activities, social interactions and occupational activities. The objectives of the study were to assess quality of life(QOL) in patients with primary hyperhidrosis before and after treatment with oriental medicine. Methods : Between December 2006 and July 2007, 26 patients underwent oriental medicine treatment. which consisted of herb medicine. acupuncture and iontophosis (if palmar/plantar hyperhidrosis) treatment. QOL questionnaires comprised of dermatology life quality index (DLQI) and visual analogue scale (VAS) were employed before and after treatment Results : All 26 patients were evaluated. The treatment controlled primary hyperhidrosis in 84.6% of cases. The mean of DLQI score before treatment was 16.65 after treatment mean DLQI score was 8.18. The mean of VAS before treatment was 91.35 after treatment mean VAS was 49.92. QOL in patients with primary hyperhidrosis significantly improved after oriental medicine treatment. The improvements in QOL were similar in patientswith palmar/plantar, head, and systemic hyperhidrosis. Conclusions : Oriental medicine treatment leads to significantly improved QOL in patients with primary hyperhidrosis. Further studies are needed to evaluate the objective efficacy in patients with primary hyperhidrosis before and after oriental medicine treatment.

Treatment of Palmar Hyperhidrosis with Tap Water Iontophoresis: A Randomized, Sham-Controlled, Single-Blind, and Parallel-Designed Clinical Trial

( Do Hun Kim ),( Tae Han Kim ),( Seung Ho Lee ),( Ai Young Lee ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.6

Background: Palmar hyperhidrosis is a common disorder of excessive sweating. A number of studies have demonstrated the effectiveness of iontophoresis in the treatment of palmar hyperhidrosis. However, controlled clinical studies on iontophoresis for palmar hyperhidrosis have been limited. Objective: To determine the efficacy and safety of iontophoresis in the treatment of palmar hyperhidrosis with a randomized, sham-controlled, single-blind, and parallel-designed study. Methods: Twenty nine patients with significant palmar hyperhidrosis were enrolled in this study. They received active iontophoresis treatment (group A) or sham treatment (group B). Iontophoresis was performed 20 minutes each time, five times per week, for 2 weeks. Its efficacy was assessed with starch-iodine test, mean sweat secretion rate, and hyperhidrosis disease severity scale. Results: Twenty-seven of the 29 patients completed the 2-week treatment. After completion of 10 times of treatment, results of the starch-iodine test showed clinical improvement in 92.9% of patients in group A and 38.5% of patients in group B (p=0.001). The mean sweat secretion rate was reduced by 91.8% of patients in group A and by 39.1% of patients in group B (p<0.001). Improvement in quality of life was reported by 78.6% of patients in group A and by 30.8% of patients in group B (p=0.028). In group A, one case of localized adverse event was noted, although no adverse event was encountered in group B. Conclusion: Tap water iontophoresis could be used as an effective and safe treatment modality for palmar hyperhidrosis. (Ann Dermatol 29(6) 728∼734, 2017)

본태성 다한증 환자의 상흉추 교감신경 절제범위의 결정

윤영설,김영수,조용은,조경기 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.4