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Clinical efficacy of microwave in the treatment of axillary osmidrosis and primary hyperhidrosis

Dermatol Ther. 2022 Jun 21:e15657. doi: 10.1111/dth.15657. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary osmidrosis(AO) and primary hyperhidrosis(PH) are common diseases, but there are still difficulties in treatment. Microwave therapy may become a new method.

OBJECTIVE: To evaluate long-time efficacy of patients with AO or PH treated by microwave. To discuss possible mechanism of microwave therapy by combining results of clinical and pathological.

METHODS: Ten AO or PH patients with moderate or severe level were selected as subjects, and each subject received microwave treatment of bilateral armpits. The follow-up period lasted two years,and the changes of perspiration and odor were evaluated in subjective and objective ways. Each subject took skin biopsy in the treatment area before and after treatment or each follow-up. HE and immunohistochemical staining were performed.

RESULTS: Both subjective and objective index reflected the significant improvement of AO and PH after treatment(P<0.05). Dermatology life quality index score decreased by 10.4±4.6(P<0.05). The number of apocrine glands decreased significantly after treatment, and most of them changed from secretory phase to quiescent phase.

CONCLUSIONS: Microwave therapy can destroy apocrine sweat glands, reduce number of functional glands, so as to improve symptoms of AO and PH and elevate quality of life, which is safe, effective and stable. This article is protected by copyright. All rights reserved.

PMID:35726636 | DOI:10.1111/dth.15657

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Hyperhidrosis in sleep disorders – A narrative review of mechanisms and clinical significance

J Sleep Res. 2022 Jun 15:e13660. doi: 10.1111/jsr.13660. Online ahead of print.

ABSTRACT

Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs that affects patients’ quality of life. It results from an excessive stimulation of eccrine sweat glands in the skin by the sympathetic nervous system. Hyperhidrosis may be primary or secondary to an underlying cause. Nocturnal hyperhidrosis is associated with different sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome/periodic limb movement during sleep and narcolepsy. The major cause of the hyperhidrosis is sympathetic overactivity and, in the case of narcolepsy type 1, orexin deficiency may also contribute. In this narrative review, we will provide an outline of the possible mechanisms underlying sudomotor dysfunction and the resulting nocturnal hyperhidrosis in these different sleep disorders and explore its clinical relevance.

PMID:35706374 | DOI:10.1111/jsr.13660

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Ipsilateral Facial Hyperhidrosis in a Patient With Squamous Cell Carcinoma of the Lung

Cureus. 2022 May 8;14(5):e24832. doi: 10.7759/cureus.24832. eCollection 2022 May.

ABSTRACT

While anhidrosis in Horner’s Syndrome is a well-documented result of apical lung malignancies impinging on the sympathetic pathway traveling through the upper lobe of the lung, its opposite effect, hyperhidrosis, is a seldom reported consequence. Hyperhidrosis occurs as a result of irritation of the sympathetic nervous system near the superior cervical ganglion. In this report, we examine a patient with known Stage IIIB squamous cell carcinoma of the lung presenting with right hemifacial hyperhidrosis, dyspnea, and right upper extremity swelling. Computed tomography angiography (CTA) of the chest re-demonstrated the intrathoracic neoplasm encroaching on his mediastinum. During admission, the patient had his first cycle with carboplatin and paclitaxel. His hyperhidrosis, as well as dyspnea and swelling improved post-treatment, and the patient was stable for discharge to follow up outpatient with oncology and radiation oncology to continue further treatment. As hemifacial hyperhidrosis is rarely reported, it becomes important to recognize this as a likely indicator of mediastinal invasion from malignancy.

PMID:35702464 | PMC:PMC9177234 | DOI:10.7759/cureus.24832

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THE PHARMACOLOGICAL TREATMENT AND MANAGEMENT OF HYPERHIDROSIS

Expert Opin Pharmacother. 2022 Jun 10. doi: 10.1080/14656566.2022.2083499. Online ahead of print.

ABSTRACT

INTRODUCTION: Idiopathichyperhidrosis is a dysfunctional disorder involving eccrine sweat glands and its impact on patients’ daily quality of life is well-known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options.

AREAS COVERED: The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatments flow-chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar and craniofacial hyperhidrosis.

Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis can represent an additive therapeutic option for patients with insufficient response to topical treatment according to a step wise therapeutic approach. Until the pathophysiological mechanisms underlying hyperhidrosis are clear, and the etiological therapeutic approach become realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms.

PMID:35686667 | DOI:10.1080/14656566.2022.2083499

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Factors associated with efficacy of botulinum toxin A injections in primary axillary hyperhidrosis: a retrospective study of ninety patients

Dermatol Ther. 2022 Jun 6:e15620. doi: 10.1111/dth.15620. Online ahead of print.

ABSTRACT

INTRODUCTION: Primary focal hyperhidrosis (PFH) is a frequent condition which can seriously affect the quality of life. Intradermal injections of botulinum toxin A (BTA) is a safe temporary treatment. The objective was to assess the factors associated with the efficacy of the axillary injections of abobotulinumtoxinA in PFH.

MATERIALS AND METHODS: Among a cohort of 236 patients followed for axillary injections of BTA between 2001 and 2020 for severe PFH, we included patients treated with 150 units per armpit of abobotulinumtoxinA with a minimum follow-up of three years. We described the characteristics of the patients and then searched for association between variables (sex, age, multifocal PFH and duration of efficacy of the first injection [<6 or ≥ 6 months]) and the number of injections received in three years, counted at the second injection date, by univariate and multivariate logistic regression.

RESULTS: Ninety patients were included (62 women, median age of 29 years and 12.2% of multifocal PFH). The median duration of efficacy of the first injection was six months (interquartile range 3-9). The duration of efficacy of the first injection ≥ 6 months was significantly associated with less injections during the 3-year follow-up in univariate (odds ratio [OR]: -1.18 [95% confidence interval (CI): -1.80 – -0.55] ; p<0.01) and multivariate (OR: -1.16 [95% CI: -1.79 – -0.53] ; p<0.01) logistic regression. There was no significant difference with female sex, age, or multifocal PFH.

CONCLUSION: A duration of efficacy of the first injection greater than six months seems to indicate a better response profile to BTA.

PMID:35669995 | DOI:10.1111/dth.15620

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Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities

Postepy Dermatol Alergol. 2022 Apr;39(2):251-257. doi: 10.5114/ada.2022.115887. Epub 2022 May 9.

ABSTRACT

Hyperhidrosis is a disorder of sweat glands characterized by overproduction of sweat, which is inadequate to the thermoregulatory needs of the body system. Owing to the heavy social and economic burden of the disproportionate perspiration, current treatment methods still do not seem to be sufficient enough to reach patients’ expectations. Therefore, the researchers continue a robust pursuit of novel therapy modalities such as topical treatment methods, oral agents, minimally-invasive medical approach and surgical techniques. In this review article authors summarise the disease outline with the emphasis on the new era of hyperhidrosis treatment methods.

PMID:35645673 | PMC:PMC9131949 | DOI:10.5114/ada.2022.115887

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Patient experience and prognostic factors of compensatory hyperhidrosis and recurrence after endoscopic thoracic sympathicotomy

Surg Endosc. 2022 May 9. doi: 10.1007/s00464-022-09284-w. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to investigate compensatory hyperhidrosis (CH) and recurrence based on an online survey of patients who underwent endoscopic thoracic sympathicotomy(ETS) for palmar and/or axillary hyperhidrosis.

METHODS: We enrolled 231 patients who underwent ETS for palmar and/or axillary hyperhidrosis from January 2008 to April 2021. Patients responded to an online questionnaire regarding CH and recurrence, their electronic medical records were reviewed. Logistic regression was performed to find the risk factors related to CH and recurrence.

RESULTS: The median time of survey from surgery was 20 months. Although 94% of patients were satisfied with the surgery, 86.1% experienced CH; of them, it was severe in 30.7%. Three months after surgery, there was no long-term change in the severity of CH. The development of CH showed a close relationship with age of 20 years or more (OR: 2.73). Recurrence occurred in 44(19.0%) patients, and the use of anti-adhesive agents was a significant preventive factor against recurrence after ETS (OR: 0.42).

CONCLUSIONS: We observed that CH and recurrence after ETS for palmar and/or axillary hyperhidrosis were relatively common. Age at the time of surgery was associated with CH, and the use of anti-adhesive agents showed to lower the risk of recurrence after ETS.

PMID:35534737 | DOI:10.1007/s00464-022-09284-w

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Open-Label Cohort Study to Evaluate Efficacy and Safety of Application of Glycopyrronium Cloth, 2.4% for Palmar Hyperhidrosis

J Drugs Dermatol. 2022 May 1;21(5):488-495. doi: 10.36849/JDD.6688.

ABSTRACT

BACKGROUND: Hyperhidrosis of the palms has a significant negative impact on quality of life. There is no FDA-approved treatment; however, clinicians often use glycopyrronium cloth off-label for this indication despite the lack of published guidance on optimal method of application for treatment of palms.

OBJECTIVE: To compare the safety and efficacy of 4 different methods of application of glycopyrronium cloth to give clinicians guidance when treating palmar hyperhidrosis.

STUDY DESIGN: This study, conducted completely virtually using live interactive telemedicine, compared application times of 15 minutes, 30 minutes, and overnight without occlusion and 30 minutes under occlusion. The primary endpoint was a decrease in the mean of the Hand Severity Score (HHS) after 4 weeks of once-daily application. Safety data, including local skin reactions and other adverse events, were tabulated by cohort.

RESULTS: Of the application times and methods tested, 30 minutes without occlusion produced the greatest decrease in the HHS with an acceptable safety profile. The most common adverse event was unilateral mydriasis, which presumably occurred from inadvertent introduction of study drug into the eye despite multiple warnings to the subjects to avoid eye contact. A few subjects had adverse events presumably due to systemic absorption of the drug similar to those seen in the pivotal trials for treatment of axillary hyperhidrosis.

CONCLUSION: Glycopyrronium cloth can be used successfully to treat palmar hyperhidrosis. Occlusion for 30 minutes had the poorest response presumably due to the increased sweating causing dilution of the study drug.

CLINICALTRIALS: gov: NCT04906655 J Drugs Dermatol. 2022;21(5):488-494. doi:10.36849/JDD.6688.

PMID:35533035 | DOI:10.36849/JDD.6688

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Transfersomal eosin topical delivery assisted by fractional CO2 laser for photodynamic treatment of palmar hyperhidrosis: case study

Drug Deliv Transl Res. 2022 Apr 20. doi: 10.1007/s13346-022-01164-z. Online ahead of print.

ABSTRACT

Hyperhidrosis is a condition in which the cholinergic receptors on the eccrine glands are overstimulated, resulting in excessive sweating. It is considered a serious cosmetic and psychological problem that affects the patient’s quality of life. Searching for novel treatment modalities is required to minimize the side effects and to attain better patient satisfaction.Photodynamic therapy (PDT), using eosin as a photosensitizer, is developed as a promising modality of the treatment of palmar and axillary hyperhidrosis. In this study, we treated six cases suffering palmar hyperhidrosis by applying the fractional CO2 laser prior to PDT session. For PDT, a hydrogel of eosin loaded in a transfersomes as a nano-delivery carrier was applied for 5 min, followed by irradiation by intense pulsed light (IPL). The prepared transfersomes loaded by eosin were spherical in shape with encapsulation efficiency of 33 ± 3.5%, particle size 305.5 ± 5.7 nm, average zeta potential of – 54 ± 7.6 mV with 80 ± 4% of the loaded eosin was released after 3 h. Two cases achieved 90% improvement after four sessions, three patients needed six sessions to show 75% improvement, while one patient showed only 25% improvement after six sessions. This resulted in shortening the time of PS application and decreasing the number of sessions required to achieve acceptable improvement. More clinical studies on large number of patients are required to optimize the results.

PMID:35441986 | DOI:10.1007/s13346-022-01164-z