Treatment modalities and the neuropathology of palmar hyperhidrosis

Abstract

Abstract

Palmar Hyperhidrosis (PHH) is a largely idiopathic condition that leads to significant dermatological and socio-professional concerns.  This article will seek to review the method of treating PHH and define 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 still being optimized.  Currently consideration is being given to whether the T2 vs. the T2 - T3 - T4 ganglia should be excised and 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 pathological changes that may be observed in the PHH ganglia include neuronal cell death, lipofuscin accumulation and their association with inflammation.  At present the relationship of these findings to the clinical presentation and pathogenesis of PHH is unclear.