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Ann Thorac Surg 2007;83:1578-1579
© 2007 The Society of Thoracic Surgeons

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Correspondence

Amelioration of Specific Phobias After Thoracic Sympathetic Block in Patients With Localized Hyperhidrosis

^a Department of Vascular Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, A-6020 Austria
^b Department of General and Transplant Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, A-6020 Austria
^c Department of Psychiatry and Psychosocial Medicine, Medical University Innsbruck, Anichstrasse 35, Innsbruck, A-6020 Austria

(Email: helmut.biedermann{at}uibk.ac.at).

To the Editor:

Primary localized hyperhidrosis has an incidence of 0.15% to 1% in the general population [1, 2] and is frequently the cause for severe social, emotional, and occupational handicaps [1]. The reference treatment for essential palmar or facial hyperhidrosis is endoscopic upper thoracic sympathetic block between Th2 and Th4 [1–3], terminating this hyperhidrosis in 95% to 99% of patients [2]. Scant data regard hyperhidrosis and psychopathology; however most patients lack overt psychopathology. Instead, the often associated anxiety, depression, or social isolation seems to be a reaction to rather than the cause of the hyperhidrosis.

We routinely evaluate phobic behavior in all patients with localized essential hyperhidrosis scheduled for bilateral thoracic sympathicotomy before and after surgery through a standardized questionnaire. This includes irritability, avoidance behavior, sleeping disorders, social (International Classification of Diseases [ICD]-10: F40.1) and specific phobias (ICD-10: F40.2; 4 subtypes: animal, environment, blood-syringe-injury, and situation [flight and narrowness]).

In a consecutive series of 36 patients, specific phobias prior to sympathicotomy were reported by 47.2%, mostly environment type (41.2%), animal type (41.2%), and fear of narrowness (41.2%), followed by fear of flight (23.5%), and blood syringe injury type (23.5%). Concomitant social phobias were present in 28.6%, irritability in 41.2%, avoidance behavior in 29.4%, and sleeping disorders in 11.8%. Postoperative control showed a remarkable change in the pattern of specific phobias: sixty percent of patients with preoperative phobias reported lasting amelioration (33%) or complete relief (67%) of one or several of their phobias after a mean follow-up of 6 months (range, 4–37 months).

Not based on any underlying physical disease, primary hyperhidrosis is conceived as "an anxiety phenomenon mediated by the automomic nervous system" [1]. Surgery substantially ameliorates social phobias in many hyperhidrosis patients, a phenomenon also reported after topical blockage of the sudoferic glands by Botulinum toxin A [4]. Such amelioration of social fears has mostly been related to the loss of cause (through less sweating); however, improvement of social phobias through sympathicotomy has also been reported in patients without preoperative hyperhidrosis [5]. Unlike social phobias, the revealed relief of specific phobias is not to be explained through less sweating alone.

Serotonin-reuptake inhibitors are the actual mainstay in phobia treatment. However, with interruption of the sympathetic chain, specifically at the thoracic level, apparently terminating phobic behavior in these patients, the sympathetic chain itself seems to maintain a relevant feedback mechanism involved in development and perpetuation of specific phobias. The alteration of the level of perception of such specific phobias through a surgical intervention at a remote site seems interesting and the mechanism warrants further investigation.

	References

Top References

 

1. Ruchinskas RA, Nayrayan RK, Meagher RJ, Furukawa S. The relationship of psychopathology and hyperhidrosis Br J Dermatol 2002;147:733-735.[Medline]
2. Reisfeld R, Nguyen R, Pnini A. Endoscopic thoracic sympathicotomy for hyperhidrosis: experience with both cauterization and clamping methods Surg Laparosc Endosc Percutan Tech 2002;12:255-267.[Medline]
3. Kux E. The transpleural endoscopic approach to the autonomic nervous system and its therapeutic possibilities Dis Chest 1949;16:625.[Medline]
4. Weber A, Heger S, Sinkgraven R, Heckmann M, Elsner P, Rzany B. Pyschosocial aspects of patients with focal hyperhidrosisMarked reduction of social phobia, anxiety and depression and increased quality of life after treatment with botulinum toxin A. Br J Dermatol 2005;152:342-345.[Medline]
5. Pohjavaara P, Teleranta T. Endoscopic sympathetic block as treatment of social phobia Eur Surg 2005;37:137-142.

This article has been cited by other articles:

				H. Sugimura, E. H. Spratt, C. G. Compeau, D. Kattail, and Y. Shargall Thoracoscopic sympathetic clipping for hyperhidrosis: Long-term results and reversibility. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1370 - 1378. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gustav Fraedrich Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Biebl, M. O. Articles by Biebl, W. Search for Related Content PubMed PubMed Citation Articles by Biebl, M. O. Articles by Biebl, W. Related Collections Mediastinum