Radiofrequência no tratamento da hiperidrose primária. Revisão sistemática
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Data
2017-02-15
Autores
Hasimoto, Fabio Nishida [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A hiperidrose primária (HP) é um distúrbio caracterizado pela sudorese excessiva, levando a uma piora na qualidade de vida de seus portadores. Objetivo: Determinar a efetividade da radiofrequência (RF) no tratamento da HP. Método: Revisão sistemática de ensaios clínicos randomizados, estudos controlados e estudos observacionais em indivíduos portadores de HP, nos quais foram realizados o tratamento por RF comparado com qualquer outra modalidade de tratamento ou em que foram comparados os resultados antes e após a intervenção no tratamento isolado por RF. Os desfechos avaliados foram: grau de intensidade da hiperidrose, qualidade de vida, sudorese compensatória e recorrência dos sintomas. Resultados: Foram selecionados dez estudos, oito deles (204 participantes) empregando somente a RF (74 microagulhamentos e 130 ablações) e dois (65 participantes) comparando a RF com a simpatectomia videotoracoscópica. Houve redução da intensidade da HP no subgrupo que aplicou microagulhamento (3 estudos, 74 participantes, diferença média -1,24, IC 95% -1,44 a -1,03, I2=50%). Em um estudo em que se realizou ablação simpática por RF (36 participantes) houve maior redução da intensidade da HP do que nos três estudos em que se realizou microagulhamento (-2,56, IC 95% -2,76 a -2,36 versus -1,24, IC 95% -1,44 a -1,03). Houve melhora na qualidade de vida após ablação simpática (2 estudos, diferença média -15,92, IC 95% -17,61 a -14,24, I²= 23%). No microagulhamento também houve melhora da qualidade de vida, mas menor que na ablação (2 estudos, -9,0, IC 95% -9,15 a -8,85, I²=0). Somente um estudo que comparou a ablação simpática por RF com a simpatectomia videotoracoscópica aplicou o questionário de qualidade de vida antes e após o tratamento. Na simpatectomia videotoracoscópica houve redução de 31,8 ± 15,4 para 7,6 ± 11,3, enquanto na ablação por RF a redução foi menor, de 27,8 ± 16,1 para 19,8 ± 12,7. Um dos dois estudos que compararam a sudorese compensatória na ablação por RF com a simpatectomia mostrou que a hiperidrose compensatória é maior na simpatectomia videotoracoscópica, mas o outro estudo não constatou essa diferença. Somente um estudo comparou a recorrência dos sintomas entre a simpatectomia videotoracoscópica e a ablação por RF, e mostrou ser maior no segundo. Conclusões: Há evidências de boa qualidade de que a RF é efetiva no tratamento da HP, existindo superioridade da ablação simpática sobre o microagulhamento. Devido à falta de estudo dos desfechos avaliados e o pequeno número de estudos, não foi possível emitir qualquer evidência sobre a comparação da ablação por RF com a simpatectomia videotoracoscópica.
Introduction: Primary hyperhidrosis (PH) is a disorder characterized by excessive sweating, leading to a worsening of the quality of life of its carriers. Objective: To determine the effectiveness of radiofrequency (RF) in the treatment of PH. Method: Systematic review of randomized clinical trials, controlled studies, and observational studies in individuals with PH in which RF treatment and any other treatment modality or the results before and after treatment intervention by RF alone were compared. The evaluated outcomes were the following: degree of severity of hyperhidrosis, quality of life, compensatory sweating and recurrence of symptoms. Results: Ten studies were selected, eight of which (204 participants) using RF alone (74 microneedle and 130 ablations) and two (65 participants) comparing RF with the videothoracoscopic sympathectomy. There was a reduction in the severity of PH in the subgroup that applied microneedling (3 studies, 74 participants, mean difference -1.24, 95% CI -1.44 to -1.03, I2 = 50%). In a study in which sympathetic RF ablation was performed (36 participants), there was a greater reduction in PH severity than in the three studies using microneedling (-2.56, 95% CI -2.76 to -2.36 versus -1.24, 95% CI -1.44 to -1.03). There was improvement in quality of life after sympathetic ablation (2 studies, mean difference -15.92, 95% CI -17.61 to -14.24, I² = 23%). There was also an improvement in quality of life in the microneedling treatment, but to a lesser extent when compared with the ablation (2 studies, -9.0, 95% CI -9.15 to -8.85, I² = 0). Only one study comparing sympathetic RF ablation with videothoracoscopic sympathectomy applied the quality of life questionnaire before and after treatment. In the videothoracoscopic sympathectomy, there was a reduction from 31.8 ± 15.4 to 7.6 ± 11.3, whereas in the RF ablation the reduction was lower, from 27.8 ± 16.1 to 19.8 ± 12.7. One of the two studies comparing compensatory sweating in RF ablation with sympathectomy showed that compensatory hyperhidrosis is greater in videothoracoscopic sympathectomy, but the other study did not find this difference. Only one study compared the recurrence of symptoms between videothoracoscopic sympathectomy and RF ablation, which demonstrated to be greater in the latter. Conclusions: There is good evidence that RF is effective in the treatment of PH, and that the sympathetic ablation is superior when compared with the microneedling. Due to a lack of study of the evaluated outcomes and scarcity of research, it was not possible to provide any evidence on the comparison between the RF ablation and the videothoracoscopic sympathectomy.
Introduction: Primary hyperhidrosis (PH) is a disorder characterized by excessive sweating, leading to a worsening of the quality of life of its carriers. Objective: To determine the effectiveness of radiofrequency (RF) in the treatment of PH. Method: Systematic review of randomized clinical trials, controlled studies, and observational studies in individuals with PH in which RF treatment and any other treatment modality or the results before and after treatment intervention by RF alone were compared. The evaluated outcomes were the following: degree of severity of hyperhidrosis, quality of life, compensatory sweating and recurrence of symptoms. Results: Ten studies were selected, eight of which (204 participants) using RF alone (74 microneedle and 130 ablations) and two (65 participants) comparing RF with the videothoracoscopic sympathectomy. There was a reduction in the severity of PH in the subgroup that applied microneedling (3 studies, 74 participants, mean difference -1.24, 95% CI -1.44 to -1.03, I2 = 50%). In a study in which sympathetic RF ablation was performed (36 participants), there was a greater reduction in PH severity than in the three studies using microneedling (-2.56, 95% CI -2.76 to -2.36 versus -1.24, 95% CI -1.44 to -1.03). There was improvement in quality of life after sympathetic ablation (2 studies, mean difference -15.92, 95% CI -17.61 to -14.24, I² = 23%). There was also an improvement in quality of life in the microneedling treatment, but to a lesser extent when compared with the ablation (2 studies, -9.0, 95% CI -9.15 to -8.85, I² = 0). Only one study comparing sympathetic RF ablation with videothoracoscopic sympathectomy applied the quality of life questionnaire before and after treatment. In the videothoracoscopic sympathectomy, there was a reduction from 31.8 ± 15.4 to 7.6 ± 11.3, whereas in the RF ablation the reduction was lower, from 27.8 ± 16.1 to 19.8 ± 12.7. One of the two studies comparing compensatory sweating in RF ablation with sympathectomy showed that compensatory hyperhidrosis is greater in videothoracoscopic sympathectomy, but the other study did not find this difference. Only one study compared the recurrence of symptoms between videothoracoscopic sympathectomy and RF ablation, which demonstrated to be greater in the latter. Conclusions: There is good evidence that RF is effective in the treatment of PH, and that the sympathetic ablation is superior when compared with the microneedling. Due to a lack of study of the evaluated outcomes and scarcity of research, it was not possible to provide any evidence on the comparison between the RF ablation and the videothoracoscopic sympathectomy.
Descrição
Palavras-chave
Hiperidrose, Metanálise, Radiofrequência, Revisão, Simpatectomia, Hyperhidrosis, Meta-analysis, Radiofrequency, Review, Sympathectomy