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Fractional CO(2) Laser-Assisted Delivery of Botulinum Toxin-A Versus Aluminum Chloride in Treatment of Primary Palmar Hyperhidrosis

Photodermatol Photoimmunol Photomed. 2024 Nov;40(6):e13006. doi: 10.1111/phpp.13006.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) constitutes a distressing dermatologic condition that greatly affects patients’ quality of life. Its management still needs to be addressed to find a suitable therapeutic modality that is readily available, cost effective, and gives patients a quite long disease-free period.

OBJECTIVE: To assess the efficacy of fractional CO2 laser as a delivery method for botulinum toxin-A (BTX-A) and aluminum chloride in treating PPH.

PATIENTS AND METHODS: Twenty-four subjects with PPH were treated on both hands with fractional CO2 laser followed on the right hand with topical BTX-A and on the left hand with topical aluminum chloride. Minor’s starch-iodine test and Hyperhidrosis Disease Severity Scale (HDSS) were used for evaluation of treatment response and for follow-up.

RESULTS: There was a significant improvement in HDSS in both groups, but there was no statistically significant difference in the therapeutic response for both modalities. There was a statistically significant longer disease-free period in the BTX-A-treated hands.

CONCLUSION: Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A and aluminum chloride, the two most widely used agents for treating PPH, with a comparable anhidrotic response.

PMID:39388586 | DOI:10.1111/phpp.13006

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Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study

J Cardiothorac Surg. 2024 Oct 4;19(1):590. doi: 10.1186/s13019-024-03086-y.

ABSTRACT

OBJECTIVE: This study aims to evaluate the long-term outcomes of compensatory hyperhidrosis (CH) after thoracoscopic sympathectomy and explore the risk factors affecting postoperative CH in primary palmar hyperhidrosis(PPH) patients.

METHOD: A retrospective analysis was conducted on patients who underwent thoracoscopic sympathectomy in the thoracic surgery department of our hospital from January 2015 to May 2022. Long-term follow-up surveys was conducted to collect data on post-operative satisfaction, PPH recurrence, and CH occurrence. Postoperative CH outcomes were assessed using the HDSS and satisfaction scores scale. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative CH.

RESULT: A total of 152 patients was included in the final study, with 113 cases in the CH group and 39 cases in the nCH group. The incidence of postoperative CH was 74.3% (113/152), within which 33.6% (38/113) were severe CH. The median follow-up time was 3.1 years(2.5-5.5y) and the median interval of CH onset after surgery was 30 days (14-90d). Univariate analysis showed that body mass index(BMI), surgical time, and transected nerve level are correlated with CH, with statistically significant differences. Multivariate logistic regression analysis indicated a higher BMI (OR = 0.864, 95% CI 0.755-0.989, P < 0.05) is the independent risk factor for the occurrence of CH. There was no statistically significant difference in HDSS scores among CH patients at 1 month, 1 year, and 3 years after surgery.

CONCLUSION: A higher BMI is the independent risk factor for postoperative CH after thoracoscopic sympathectomy. The incidence and severity of postoperative CH kept stable during a long term follow up.

PMID:39367483 | PMC:PMC11451246 | DOI:10.1186/s13019-024-03086-y

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The Influence of the COVID-19 Pandemic on the Addressability to Treatment of Children with Hyperhidrosis-A Retrospective Study and a Short Review

Life (Basel). 2024 Aug 10;14(8):995. doi: 10.3390/life14080995.

ABSTRACT

INTRODUCTION: This study was carried out to demonstrate the negative influence that the COVID-19 pandemic had on the ability of patients to treat hyperhidrosis with iontophoresis. The purpose of this study is to identify the annual distribution of patients with hyperhidrosis as well as elaborate a curve of cases within the time interval studied.

METHODS: It is a retrospective study initiated in the Department of Neuropsychomotor Rehabilitation of the “Sf. Ioan” Emergency Clinical Hospital for Children, Galati, Romania, in which we analyzed the electronic database, the treatment, and the consultation files of all the children who presented between January 2013 and December 2023. We found 111 patients who met the inclusion criteria.

RESULTS: During the 3 years of the pandemic, the number of patients who came to our clinic suddenly dropped to 0.

LIMITATIONS: This study was conducted on a relatively small number of patients in a Neuropsychomotor Recovery clinic. This study includes only patients with palmar and/or plantar hyperhidrosis who presented to the clinic for iontophoresis.

CONCLUSION: Although it is a disease that significantly influences the quality of life, patients and their families do not consider hyperhidrosis to be an urgent problem that can be improved by treatment.

PMID:39202737 | DOI:10.3390/life14080995

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Cluster analysis identifies clinical phenotypes of primary hyperhidrosis

Skin Pharmacol Physiol. 2024 Aug 28. doi: 10.1159/000540516. Online ahead of print.

ABSTRACT

Introduction Identifying subgroups of patients with primary hyperhidrosis (PHH) can improve the understanding of the disease pathophysiology. The study objective is to determine the naturally occurring subgroups of patients with PHH based on clinical characteristics. Methods In this retrospective cohort study, data was collected from participants included in a clinical trial. The data was collected between January 2020 and June 2021 from outpatients with PHH attending a dermatologic department in Denmark. Overall, 84 patients with PHH were screened for inclusion in the clinical trial. Of these, 41 met the eligibility criteria. Four participants were excluded because of missing data. The main outcome was the identification of subgroups of patients with PHH using an unsupervised hierarchical cluster analysis. Results Overall, 37 patients were included (28 [76.7%] females; median age at inclusion 28.0 [interquartile range (IQR) 24.0-38.3]; median body mass index 24.9 [IQR 20.9-27.4); median age of onset 13.0 [IQR 9.5-18.5]; and 26 [70.3%] had a familial disposition towards PHH). Two clusters of 18 and 17 patients were identified. The first cluster had, when compared to the second, a younger age of onset (median age 11.0 [IQR 0-13.0] vs. 17.0 [IQR 15.0-21.0], p=0.003) and higher sweat rates on gravimetry (median 175.0 [IQR 121.2-252.5] vs. 40.0 [IQR 20.0-60.0] milligrams of sweat/5 minutes, p&lt;0.001) and transepidermal water loss (median 93.7 [IQR 91.2-97.8] vs. 59.0 [IQR 44.4-73.2] grams/meter2/hour, p&lt;0.001). No differences were observed for the other variables. Conclusions This study identifies two subgroups of patients with PHH. The patients with an onset of PHH during childhood had a substantially higher sweat and evaporation rate in adulthood than those with an onset during adolescence. These findings may imply a changed understanding of the pathophysiology of PHH, by indicating that an early disease onset can lead to a worse disease course.

PMID:39197424 | DOI:10.1159/000540516

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Epidemiology and health care of hyperhidrosis in Germany: claims data analysis

BMJ Open. 2024 Aug 12;14(8):e085862. doi: 10.1136/bmjopen-2024-085862.

ABSTRACT

BACKGROUND AND OBJECTIVES: Data on the population-based epidemiology of hyperhidrosis (HH) are scarce. This study investigated the epidemiology and healthcare of HH in Germany.

DESIGN AND SETTING: Claims data of adult persons insured by a German statutory health insurance (DAK-Gesundheit) between 2016 and 2020 were analysed. Included were persons aged 18 years and older with a diagnosis of HH (confirmed inpatient or outpatient diagnosis in the observation year) who were continuously insured. Following outcomes were measured: prevalence and incidence rates, severity of hyperhidrosis and inpatient and outpatient care by a group of specialists.

RESULTS: In 2020, 0.70% of insured adults were confirmed to have HH (mean age 59.5 years, SD 18.9, 61.6% female), with 9.24% having a ‘localised’ form, 8.65% a ‘generalised’ form and 84.80% an ‘unspecified’ form. 0.04% of the total population had a severe form. The incidence was 0.35%. Localised HH was more common in younger age groups (18 to <30 years), while older age groups (70 to <80 years) were significantly more likely to suffer from generalised HH. Systemic anticholinergics were used in 4.55%, and botulinum toxin injection therapy in 0.81%. General practitioners were most frequently involved in care. Inpatient stays due to HH were very rare, with 0.14% in 2019 and 0.04% in 2020.

CONCLUSION: Multisource data analysis connecting primary and secondary data will be needed for a complete picture of the healthcare and epidemiology of HH.

PMID:39134433 | DOI:10.1136/bmjopen-2024-085862