Centro Argentino de Hiperhidrosis y EritrofobiaERITROFOBIA
Director de Contenidos:
Dr. Joaquín García-Morato
.
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Phobia. Facial blushing or Erythrophobia
Social phobia
Facial blushing is one of the main symptoms of social phobia or Eritrophobia. Facial blushing is illogical and can occur without any real reason. In fact, Blushing is the only expression of emotion that cannot be feigned by actors. Many patients meet arrogance and trivialization when seeking relief and would prefer a more accepted diagnosis, even a more severe one, to be taken seriously by doctors. Patients turn red and feel that everybody's eyes are on them.

A vicious circle is triggered:

FOCUS OF ATTENTION > BLUSHING > EMBARRASSMENT > AVOIDANT
BEHAVIOR

Social phobia causes undesirable consequences on patient's work performance and augments avoidant behavior, which together will cause a severe negative impact on overall quality of life.

Many patients are in lower positions than their skill or education might be, probably because of their personal choice of a solitary lifestyle, or just to keep themselves on a backstage to minimize personal contacts.

Social phobia deserves attention as a decreasing life quality disease.

Social phobia
Main symptoms

Blushing and fear of blushing

Fear of being scrutinized by other people
Fear of performing in public
Feeling petrified and speechless
Sweating, palpitations, stuttering and trembling
Feeling humiliated

Post-blushing depression

Treatment | SurgeryEndoscopic thoracic sympathicotomy is today an established procedure for the cure of pathologic blushing.

Let's focus on the Endoscopic thoracic sympathicotomy (ETS©)
Is ETS surgery for me?
There isn't any objective method to quantify facial blushing. The indication for the operation is disabling facial redness as defined by the patients. The type of blushing which is uncontrollable and elicited by receiving attention from other people is the one with the best surgical results. People with Rosacea, a skin condition characterized by blemished skin and constant redness around the cheeks; don't receive great results from surgery.

About the surgery


We have a program for surgical treatment of social phobia, pioneer in Latin America. Since 1996, the procedure has been performed on an outpatient basis (6hs. in the clinic), or as an overnight stay. General anesthesia with an endotracheal tube is used. The thoracic cavity is entered under the armpit with an optic through a 1 cm incision. The sympathetic nerves are clamped by applying removable titanium clips through a second 5 mm skin incision next to the previous one. Both sides are operated on under the same anesthesia. The clip application, as opposed to the diathermia cutting, makes the procedure "potentially reversible" if excessive sweating of the trunk appears after surgery. We have been using the clipping method since 2001, and up to now no patient has asked to have the clips removed.

Results


Satisfaction rate after surgery is 85% to 90%. Due to a better selection of patients and refinements in the surgical technique in the past few years, the satisfaction rate is still higher. Successful surgery implies no blushing at all, or not as intense and frequent as before. We encourage the latter to keep on the improving tract with habitual therapeutic complements such as psychotherapy and medication.

Side effects


Compensatory sweating is an excessive sweating on the back, abdomen, thighs, and/or lower legs after surgery. This should be expected to a certain degree in most of the patients, and can be severe in 3% to 5% of patients. Compensatory sweating is not constant. This is likely to happen in hot environments. Those who sweat from the trunk prior to surgery are more prone to get severe compensatory symptoms following surgery.

A modest decrease in heart rate (approximate 10%) at rest and during high exercise demand may be experienced. If it occurs, it has no physiologic consequences.

Some patients (˂ 15 %) can experience increased sweating in the head and neck area while eating or smelling spicy food (gustatory sweating)

Excessive dryness of the palms even if their hands were not sweaty prior to surgery may appear. Application of hand lotion regularly will help to minimize this effect.

Possible complications



No operation is without risks. Complications are not common in this surgery, but they may include the following:

Bleeding
Pneumothorax
Horner's syndrome (droopy eye) 1%
Injury to surrounding organs
Infection
Neuritic pain
Anesthesic complications


Bibliografia:
Management or Facial Blushing
Thoracic Surgery Clinics May 2008. Vol 18 N°2 223-228
Peter B. Licht and Hans K. Pilegaard

Facial blushing treated by sympathetic devervation-long lasting benefits in 831 patients
Journal of Cosmetic Dermatology 2002;1:115-9
Drott C, Claës G and Rex

Successful treatment of facial blushing by endoscopic transthoracic sympathecotomy
British Journal of Dermatology 1998;138:639.643
Drott C, Claës G and Olsson-Rex L et al.


Contraindications for surgery



Severe previous or current illness (particularly cardio-respiratory or pleural disease) could be a contraindication for the procedure (See preoperative test).

Treatment alternatives


Cognitive behavioral therapy could have an effect on social phobia, but the results are not very conclusive. Some patients refuse psychiatric consultation.

Some studies have shown that the use of certain drugs (eg. serotonin reuptake inhibitors) has helped to reduce facial redness due to social phobia, but its results are seldom effective, and some undesirable side effects could appear.

How to arrange the surgery. Practical aspects


All previous arrangements can be done by e-mail, Skype or telephone.
We will ask you to fill out a preoperative questionnaire that will allow us to know more about you.
Before we schedule your surgery, you need your preoperative test done.
We schedule surgery 2 to 4 weeks in advance.

For foreign patients living abroad, we usually proceed as follows:

Day 1

Consultation and examination with the doctor. You'll get an individual, written treatment plan with a medical consent.
The Surgery will be done at "Clínica del Sol". After surgery you will be monitored for 4 to 6 hours in the outpatients facility before leaving the Clinic.


Day 2

Postoperative control at the Doctor's office and check out. You can travel home back or you can spend some days enjoying our country. www.buenosaires.gov.ar www.argentina.gov.ar
In order to have surgery as an outpatient basis (the patient spends about four to six hours in the recovery room and then is able to return to his hotel/apartment), we recommend coming with somebody else (a relative or friend). If you come alone, we recommend that you stay overnight in the Clinic.


FAQ


Who performs the surgery?
Dr. García-Morato himself performs all the procedures (more than 650 Simpathicotomies), with the collaboration of a second surgeon, the anesthesiologist and the scrub nurse. In the operating room there will also be a cardiologist and nurses.

Where is the procedure performed?
The surgery is performed at the Clínica del Sol, a state-of-the-art facility, in Recoleta neighborhood. It is about 25 block from Buenos Aires down town. www.cdelsol.com.ar

How long does it takes to return to normal activities?
Return to daily activities or work can be accomplished in 2 to 3 days.

Do the clamps set off alarms in airport metal detectors?
The titanium clips will not set off any metal detectors.

It is possible to know in advance who will have compensatory sweating?
No. Those who sweat from the trunk before surgery have more chances of having compensatory sweating. It doesn't mean that those who don't sweat from the trunk before surgery have no risk of compensatory sweating.

What is the cost of ETS©?
There is an inclusive charge that covers the facility, anesthesia, and the surgical fees. After receiving your preoperative questionnaire, we will be able to inform you of the total price of ETS© surgery.

The surgeon | Dr. Joaquín García-Morato1980
M.D. Buenos Aires University
1982-85
Resident. General Surgery. Buenos Aires University
1987-88
Resident. Thoracic and Vascular Surgery. Avignon, France
1986
Argentinean Board in General Surgery. Buenos Aires License
1988
Argentinean Board in General Surgery. Argentine Association of Surgery
1991/Present
Teaching Position. Thoracic Surgery. Buenos Aires Medical School
1993
Argentinean Board in Thoracic Surgery. National Healthwellfare
1993
Recertification - Board in General Surgery. Argentinean Association of Surgery
2000/Present Chief Thoracic Surgery. Institute of Medical Research, Buenos Aires University
2003
Member of International Society of Sympathetic Surgery
2004
Member International society of Hyperhidrosis
2004
Recertification - Argentinean Board in Thoracic Surgery. Argentinean Society of Thoracic Surgery

ISSS International Society of Sympathetic SurgeryNational and International | Articles about Hyperhidrosis and Eritrophobia
"Primary Craneofacial Hyperhidrosis. Surgical Treatment". Medicina Vol.60, Supl. 1- 2000 pag.123.

"Argentinean Experience from a Single Surgical Group in Endoscopic Thoracic Sympathicotomy". Clinical Autonomic Research 2003, 13:158

"Hemodinamic and Gasometrical Changes during General Anesthesia for sympathicothomy". Clinical Autonomic Research 2003, 13: 160

"Gasometrical Changes during Bilateral Thoracoscopic Simpathicotomy". Archivos de Bronconeumología, Vol. 40, Sup. 4 - 2004, pag.113.

"Primary Palmar Hyperhidrosis. Surgical Treatment in 172 Patients". Medicina Vol. 66 (Supl I), 2006, pag. 54

"Arterial Oxigenation during Bilateral Toracoscopic Simpathectomy at T2-T3 Level" Medicina Vol. 68 (Supl. I) 2008, pag. 45.

"Videothoracoscopic Simpathectomy in Severe Vascular Disorders of the Upper Limb" Medicina Vol. 68 (Supl. I) 2008 pag. 62

Congresses

Second Inernational Symposium on Thoracoscopic Sympathicotomy. Boräs, Suecia, 1997.

"Sympathectomy in Hyperhidrosis". Speaker. Argentinean Congress of Dermatology. Buenos Aires, 1998

Speaker: "Surgery of primary Hyperhidrosis". II International Symposium. Proceedings in Surgery and Dermatology. Buenos Aires, 1998.

"Surgery of Social Phobia". Speaker. II Symposium. Argentinean Society of Anxiety Disorders. Buenos Aires, 1998

"Results of Surgery in Primary Hyperhidrosis. II Symposium. Argentinean Society of Anxiety Disorders. Buenos Aires, 1998.

Speaker: "Sympathicotomy in Primary Hyperhidrosis". Annual Course of Pediatric Dermatology. Ramos Mejía Hospital, 1999.

Speaker: "Primary Craniofacial Hyperhidrosis. Surgical Treatment". 8° International Congress of Internal Medicine. Hospital de Clínicas, 2000.

Attending: "5° International Symposium of Sympathetic Surgery" Erlangen. Germany 2003.

Speaker: "Argentinean experience from a single surgical group in endoscopic thoracic sympathicotomy". 5° International Symposium on Sympathetic Surgery" Erlangen. Germany 2003.

Speaker: "Hemodynamic and gasometrical changes during general anesthesia for sympathicothomy". 5° International Symposium of Sympathetic Surgery. Erlangen, Germany 2003.

Speaker: "Surgery of the Autonomic Nervous System". Workshop. Hospital de Clínicas. Buenos Aires, 2004

Attending: "6° International Symposium of Sympathetic Surgery". Vienna, Austria. 2005.

Course: "Thoracoscopic Reconstruction of Sympathetic nerve" Vienna, Austria, 2005.

Presentation: "Bilateral Thoracoscopic Sympathectomy with single lumen endotracheal tube in Palmar Hiperhidrosis". South American Congress of Thoracic Surgery. Concepción, Chile 2005.

Speaker: Surgical treatment of somatic manifestations of Anxiety Disorders. Regional meeting World Psythiatric Asociation .. Buenos Aires 2006.

Speker: "Primary Palmar Hyperhidrosis. Surgycal treatment in 172 patients". 11° International Congress of Internal Medicine. Buenos Aires 2006.

Chairman "Anesthesic Proceedings in Sympathectomy". 7° International Symposium of Sympathetic Surgery". Recife, Brazil. 2007.

Attending: 7° International Symposium of Sympathetic Surgery. Recife, Brazil 2007.

Training: Lumbar Sympathectomy for plantar Hyperhidrosis. Merano and Brescia, Italy 2009.

Training: Reconstruction "reversal" of Thoracic Sympathetic Nerve. Merano and Brescia, Italy 2009.

La institución
Mission: The aim of this Web site is to spread general information and possibly treatments about primary Hyperhidrosis and Eritophobia o Social Phobia.



Receiver: The Centro Argentino de Hiperhidrosis y Eritrofobia Website is for patients and their families and friends. Gives information about diagnostic and treatment of excessive sweating (Hyperhidrosis) and social phobia (Blushing). The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.



Bibliography: The information of this site is based on international medical references and links to scientific societies.



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Privacy and Confidentiality: This site honors or exceeds the legal requirements regarding medical information privacy in the República Argentina. This site does not have mirrors. The patient’s testimonials published, where authorized for its publication by the authors by written consent. The originals of theses consents are under the author’ responsibility.







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Erick -18 años- La Paz-Bolivia

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