Management of postsurgical hyperhidrosis with direct current and tap water: A case report.

摘要

Purpose This case study explores the treatment of excessive sweating, known as hyperhidrosis, using tap water galvanism, the process of using direct current submerged in tap water to treat the body part. In this case, the authors studied the effects of tap water galvanism on a 36-year-old male electrician with postsurgical hyperhidrosis of the left hand. Literature search Hyperhidrosis is a common disorder normally idiopathic involving the eccrine sweat glands resulting from neurogenic overactivity of the sweat glands. The use of electric stimulation to reduce or eliminate excessive sweating has been described in the literature since 1952. Before 1952, investigators claimed success with iontophoresis and chemicals such as aluminum chloride, potassium permanganate, and formaldehyde. Researchers in 1952 reasoned that because formaldehyde is not ionizable, positive outcomes for the treatment of hyperhidrosis with direct current depended simply on the passage of unidirectional current through the tissues without medicinal ions. The authors were unable to find any reference to treat hyperhidrosis after a traumatic incident. Case description The left hand of a 36-year-old male electrician was caught in a cable puller machine resulting in partial traumatic amputations of digits II to V and fracture of the distal radius and ulna. Thirty-four days after surgery, the patient began to notice excessive wetness of his hand that prevented him from maintaining grasp on tools and the steering wheel of his car. He was forced to carry a towel in his hand, and wore six pairs of cotton gloves daily, which decreased his dexterity. Tap water galvanism was administered two or three times per week for ten treatments using a direct-current generator. Both hands of the patient were submerged in separate trays of room-temperature tap water with one electrode immersed in each tray. Treatments were 30 minutes of tap water galvanism at 12 mA and the polarity was reversed after the first 15 minutes of treatment. After treatment, the hands were dried with a towel, and then measured by taking a 5-second imprint of the left hand on a dry paper towel. The area of hyperhidrosis was determined by tracing the borders of saturation and recorded to the nearest millimeter. Outcomes The area of hyperhidrosis was reduced from a 10.3 x 12.0-cm area to a 2.2- x 2.7-cm area. The patient returned to full-time work two weeks after starting tap water galvanism. He wore two pairs of absorbent gloves compared with the six pairs that he wore before intervention. After ten treatments, he did not need to wear absorbent gloves at work. Treatment was concluded. Side effects included temporary erythema and a slight burning during the treatment session. A two-year telephone follow-up call with the patient revealed no long-term sweating patterns. Discussion The choice of current and intervention used by the authors was based on reports in the literature that indicated that DC current minimized or abated hyperhidrosis, whereas AC current alone had no demonstrated intervention effect. The patient in this study had a significant decrease in sweating, and was a able to return to full time work as an electrician. Limitations of the study include accuracy of measurements, and uncertainty of not knowing the treatment effects of positive or negative polarity alone.