Background: Hyperhidrosis, or excessive sweating, is a physiological disorder that affects 1-3% of the population. Plantar hyperhidrosis, though not life-threatening, is nonetheless an extremely debilitating disorder in psychosocial and medical regards. It can negatively affect intimate relationships, prevent participation in barefoot activities, ruin shoes, and cause skin infections. Several options are available to manage this condition such as topical aluminum chloride solutions, oral anticholinergic medications, iontophoresis machines, and even botulinum toxin injections. However, these treatments are either temporary or ineffective. Recently, lumbar sympathectomy emerged as a cure for plantar hyperhidrosis. The purpose of this study is to provide a systematic review of the evidence thus far for providers and patients considering lumbar sympathectomy for plantar hyperhidrosis when conservative measures have failed.
Method: An extensive literature search was performed using MEDLINE, Web of Science, CINAHL, and Evidence Based Reviews Multifile. The following keywords were used: Lumbar sympathectomy, plantar hyperhidrosis, sympathectomy, hyperhidrosis, and foot.
Results: After removing duplicate and irrelevant studies during the literature search, a total of nine were found. One article is a randomized controlled trial and the remaining are case reports and observational studies. All studies point to successful treatment in the majority of patients with plantar hyperhidrosis by performing lumbar sympathectomy using a variety of techniques. Yet most of the authors admit occasional occurrence of side-effects such as compensatory sweating, post-operative neuralgia, and temporary sexual dysfunction in one man.
Conclusion: Lumbar sympathectomy appears to be a relatively safe and effective option for resolving plantar hyperhidrosis when conservative treatment is unsuccessful. Nevertheless, there are unwanted events that may occur. Ideally, prospective randomized controlled trials should be conducted to further confirm the efficacy and safety of lumbar sympathectomy, including which method is superior, in eradicating plantar hyperhidrosis while minimizing potential adverse effects.
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