Chilean Experience in Facial Blushing

Transcription

1 Chilean Experience in Facial Blushing Experiencia Chilena en Rubor Facial C Suárez, M Fica, F Suárez, R Aparicio, V Linacre Cirugía Torácica, Departamento de Cirugía Clínica Santa María, Santiago de Chile

2 Our Conditions for ETS for FACIAL BLUSHING Severe Facial Blushing (degree 3-4 (0-4 scale)) Rapidly developing blush Psychiatric Evaluation To discard another mental disease Diagnosis of Social Phobia / SAD Sertraline treatment prior to ETS (60% efectiveness) Evaluate capacity to understand bad results (compensatory sweating, persistent blushing, harlequin syndrome) BMI max (< Compensatory sweating) Consider place of residence (climate)

3 Publications ETS & Blushing First publication ETS in Blushing: Drott et al. Br J Dermatol 1998;138: Succesful treatment of facial blushing by endoscopic transthoracic sympathicotomy. From there, many publications, none with control group until 2011 Telaranta T. Eur J Surg 1998; Suppl 580:27-32 Treatment of social phobia by ETS Diagnosis con DSM-IV. Confirmed by BSPS N 51, 88% satisfaction

4 Publications ETS & Blushing 2 Drott C, Claes G, Olsson-Rex L et al. Br J Dermatol 1998; 138(4): Succesful treatment of facial blushing by endoscopic transthoracic sympaticotomy N % satisfaction 2% initial regret But, long follow up/ PERO seguimiento a largo plazo Smidfelt K, Drott C. Br J Surg. 2011;98(12): Late results of ETS for hiperhydrosis an facial blushing N % satisfaction regret 13.5% Licht PB, Pilegaard HK, Ladegaard L. Ann. Thorac. Surg Aug;94(2): Sympathicotomy for isolated facial blushing: a randomized clinical trial. Randomize R2 vs R2-3, response rate 93%, compensatory sweating 93%, N % satisfaction regret 13%

5 Why there are differents results in Blushing and Hiperhydrosis? Por qué existe diferentes resultados entre Rubor e Hiperhidrosis? 75% Blushing vs 95,6% Hiperhydrosis Satisfaction. Smidfelt and Drott, Br J Surg 2011 in long term follow up

6 Simpatectomía Videotoracoscópica: Resultados en 661 pacientes operados por hiperhidrosis y rubor facial patológico. Pinto R, Campos D, Fernández P, Suárez F, Fica M, Aparicio R, Suárez C. Clínica Santa María Universidad de los Andes Noviembre 2012 NIVEL SVT SATISFACCION SUDOR COMPENSATORIO INICIAL LEVE MODERADO SEVERO T2 95,04% 74,78% 12,17% 13,04% T3 97,15% 75% 18,42% 5,92% T4 95,21% 92,54% 2,99% 4,48%

7 Surgical Selection & Satisfaction: Prospective, observational, open label clinical study comparing ETS vs Sertraline vs No treatment. Innov Clin Neurosci. 2011;8(11):24-35 FUNDING: There was no funding provided for this study. FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Dr. Enrique Jadresic, Department of Psychiatry, Clinical Hospital, University of Chile, Avenida La Paz 1003, Santiago de Chile; Phone: ; Fax: ; KEY WORDS: Blushing, anxiety disorder, sympathectomy, social phobia, sertraline ORIGINAL RESEARCH Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints: A Comparison with Sertraline and No Treatment Santiago de Chile by ENRIQUE JADRESIC, MD; CLAUDIO SÚAREZ, MD; ESTELA PALACIOS, MD; FERNANDA PALACIOS, PS; and PATRICIA MATUS, MD Dr. Jadresic is from the Departament of Psychiatry, Clinical Hospital, University of Chile, and Clínica las Condes, Santiago, Chile; Dr. Suarez is from the Department of Thoracic Surgery, Clínica Santa María, Santiago, Chile; Dr. E. Palacios is with the Society of Neurology, Psychiatry, and Neurosurgery, Santiago, Chile; Dr. F. Palacios is in private practice in Santiago, Chile; and Dr. Matus is from the Department of Public Health, Universidad del Desarrollo, Santiago, Chile. Innov Clin Neurosci. 2011;8(11):24 35 ABSTRACT Objective: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, openlabel, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. Method: Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1 64) after endoscopic thoracic sympathectomy or initiation of sertraline. Results: At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being severe or extreme. At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of 24 Innovations in CLINICAL NEUROSCIENCE [VOLUME 8, NUMBER 11, NOVEMBER 2011]

8 330 Blushers 88 excluded Data on treatment no available 29 Other drugs prescribed 20 Not T2 or T2-3 ETS 12 Refused participate 10 Already on antidepressants 9 Depressive symptoms 4 Flushing 3 Blushing in neck and chest only Blushers 22 pacients Did not fulfil criteria for SAD 220 Blushers + SAD Baseline Assessment ETS Sertraline No treatment Follow Up

9 Frequency of severe or extreme blushing (score 3-4) according the Brief Scale of Social Phobia ( ) % Pre-treat. Post-treat ETS Setraline No Treatment Follow-up: 11 months (range 1-59 months)

10 Compensatory Sweating in ETS patients (98,8%) Mild % Slight Severe 5 0 None Compensatory Sweating

11 Degree of satisfaction with ETS or Sertraline (n =193) Very satisfied 40 Someone helpful Satisfied % Sertralina STE 10 0 Regret No helpful Degree of Satisfaction

12 Results: Satisfied and very satisfied with different treatments 89% 59% STE Sertralina N = 97 N = 96

13 Final Results Jadresic, Suárez et al FB and SAD No treatment group: No satisfaction Sertraline group: 59% satisfaction, but no regret ETS group: 89% satisfaction regret rate 2% CS 99% (p 0,003 vs no treat) (severe 12%) Smidfelt K, Drott C. (long follow up) 75% satisfaction regret 13.5% CS 80% Licht PB et al (1 year follow up) 85% satisfaction regret 13 % CS 93% Our long term follow up (mean 32 months) Clinica Santa Maria % satisfaction regret CS 99% (severe 13%)

14 IRS recomendation (escitalopram) 2013 Open-Label Treatment With Escitalopram in Patients With Social Anxiety Disorder and Fear of Blushing Antoine Pelissolo, MD, PhD and Albert Moukheiber, PhD Department of Psychiatry, Hopital Pitie -Salpetriere, Paris, France. (J Clin Psychopharmacol 2013;33:) Our paper is cited as original publication NICE recomendation febrero Check it, is like our indication

15 Despues de estos resultados: Cuándo recomendar SVT-ETS por RUBOR FACIAL Dic 2011 Total ETS patients 1498, Total ETS in FB patients 330 Rubor Facial Severo Rapidamente progresivo Evaluación Psiquiátrica Dg Fobia Social /TAS (BSPS >20 - SPIN>19; Jadresic 2011) Tratar primero con Sertralina (50 mg/día al menos 3 meses) Capacidad de enfrentar malos resultados Descartar otras patologias mentales IMC max (sobrepeso y obesidad aumentan SC) Lugar de residencia (frío mejor que caluroso)