EFFECTS OF NONPHARMACOLOGICAL SYMPATHETIC SUDOMOTOR DENERVATION ON SWEATING IN HUMANS WITH ESSENTIAL PALMAR HYPERHIDROSIS

Objectives: Quantitative sweat production and -ionic composition in Es sential Hyperhidrosis (EH), and the effects of T2-T3 thoracoscopic sym pathicolysis (TS) hereon, are unknown. Standardised pilocarpine iontop horesis sweat tests were performed before and after TS in order to stu dy these issues. Design and Methods: Pilocarpine iontophoretic sweat t ests measuring maximal sweat production (mg) and sweat Na+, K+ and Cl- concentrations (mMol/L) were performed on both forearms of 10 EH pati ents, before and six weeks after TS, and in normal volunteers. Results : As compared to normals, preoperative maximal sweat production was 30 % higher (199.4 +/- 68.8 (SD) vs. 150.6 +/- 45.6 mg) in EH patients; d ue to type II error, however, statistical significance was not reached . Na+ and Cl- concentrations were similar, and K+ concentration was sl ightly lower in EH patients. After TS, sweat production had decreased to equal levels as in normals (149.1 +/- 52.1 mg), whereas the Na+ (fr om 33.6 +/- 6.9 to 51.0 +/- 6.4 mMol/L), Cl- (from 21.5 +/- 6.6 to 37. 2 +/- 7.1 mMol/L) and K+ (from 7.5 +/- 1.3 to 8.6 +/- 2.2 mMol/L) conc entrations had increased. Conclusions: EH patients present 30% higher maximal sweat production at their forearms. This increase may be due t o an increased activity of the adrenergic component of sweat gland inn ervation. The post-TS increase in Na+, Cl- and K+ concentrations sugge sts that the adrenergic component of sweat gland innervation in itself decreases sweat ion concentrations.