Chemical lumbar sympathectomy with phenol for treatment of plantar hyperidrosis

Abstract

The plantar hyperhidrosis is a condition which leads to social, mental and emotional embarrassment, interfering significantly in the quality of life of patients, especially in female. There is a strong association of plantar and palmar hyperhidrosis, reaching more than 80% of cases. We observe an improvement of plantar sweating in 85% of patients with palmar-plantar and axillary hyperhidrosis that under went thoracoscopic sympathectomy but it is not known the actual mechanism of this result. Lumbar chemical sympathectomy with phenol is a procedure performed since the early twentieth century for the treatment of cases of peripheral arterial insufficiency, mainly for pain relief in patients with critical limb ischemia. It has the advantage of being a simple, inexpensive, minimally invasive and safe procedure, more over, can be performed under local anesthesia and repeated as many times as deemed necessary. The disadvantages of the procedure are too few and the main one is the transient effect of the blockade, lasting six months to a year, temporary post sympathectomy neuralgia and loss of ejaculation in case of bilateral blocks. OBJECTIVE: To evaluate the results of lumbar chemical sympathectomy with phenol in the treatment of plantar hyperhidrosis in female patients suffering from hyperhidrosis palmar- axillary- plantar previously undergone thoracoscopic sympathectomy. MATERIAL AND METHODS: The study was approved by the Ethics Committee from Botucatu School of Medicine- UNESP and the calculated sample size based on a pilot project, was determined in 40. Female patients that previously undergone to thoracoscopic sympathectomy for palmar- axillary-plantar hyperhidrosis treatment without resolution of plantar sweating after three months of surgery will be invited to take part in study. The male patients will be excluded due to case reports in the literature where bilateral blockade after the 1st lumbar vertebra determined the loss of ejaculation. Initially, after the initial assessment and the signing of the consent a specific quality of life questionnaire for plantar hyperhidrosis will be applied, along with the validated questionnaire of quality of life developed by Campos et al. (2003) to assess quality of life related to hyperhidrosis, the measuring of temperature of the lower limbs with the use of cutaneous electronic thermometer and the transepidermal water loss measuring with Vapometer will be held. The questionnaires on quality of life, measuring of temperature from lower limbs and transepidermal water loss will be performed before, 7, 30, 90 and 180 days after the procedure. Lumbar chemical sympathectomy is performed with the patient in the lateral decubitus position according to the technique described by Reid et al. (1970).In the first procedure will be addressed the right leg and after seven days the contralateral lower limb, allowing the comparison of temperature and transepidermal water loss between the treated leg and the un treated one.