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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

Mol Pharm. 2019 Oct 15;:

Authors: Shim DH, Nguyen TT, Park PG, Kim MJ, Park BW, Jeong HR, Kim DS, Joo HW, Choi SO, Park JH, Lee JM

Abstract
Hyperhidrosis is a disorder that produces excess amount of sweat. The botulinum neurotoxin A (BoNT/A) has been used to treat hyperhidrosis through multiple intradermal injections at the site of condition. However, due to its toxicity, it is important to precisely deliver the proper dose of toxin to the target site. In addition, the use of conventional hyperdermic needle for multiple injections in the palm makes the approach undesirable and painful. Here, we designed a BoNT/A-coated microneedle (BoNT-MN) array and tested its efficacy as a substitute pain-free method to treat hyperhidrosis. BoNT-MNs were prepared by coating BoNT/A formulation on poly-lactic acid microneedles and were found to successfully penetrate in vitro thick skin. The coating formulations were then tested for its stability at 4°C, 25°C, and 37°C for 24 h. BoNT-MNs were found to be much more stable than its liquid state. Additionally, we carried out in vivo experiments by treating the right paw of mice with BoNT-MNs and found that the treatment induced a significant reduction of sweating response in the mouse’s foot pads. Thus, BoNT/A treatment with microneedles is beneficial and may be used as a more efficient and less painful approach to treat hyperhidrosis.

PMID: 31613636 [PubMed – as supplied by publisher]

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

Dermatol Surg. 2019 Oct 04;:

Authors: Awaida CJ, Rayess YA, Jabbour SF, Abouzeid SM, Nasr MW

PMID: 31592920 [PubMed – as supplied by publisher]

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Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use.

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use.

Clin Drug Investig. 2019 Sep 30;:

Authors: Lamb YN

Abstract
Glycopyrronium tosylate (Qbrexza™) is available as single-use, pre-moistened cloths and has been approved in the USA for the topical treatment of primary axillary hyperhidrosis in adults and children ≥ 9 years of age. Glycopyrronium tosylate is effective in reducing patient-reported severity of disease and gravimetrically measured sweat production in this patient population; improvements have been shown to be maintained throughout long-term treatment (up to 48 weeks). Glycopyrronium tosylate is generally well tolerated, with most adverse events being mild to moderate in severity. Glycopyrronium tosylate thus provides a self-administered, non-invasive alternative to topical antiperspirant therapy and clinic-based treatments in adults with primary axillary hyperhidrosis, and is the only alternative to topical antiperspirants specifically approved in children and adolescents ≥ 9 years of age.

PMID: 31571127 [PubMed – as supplied by publisher]

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Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

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Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

Clin Auton Res. 2019 Sep 24;:

Authors: Hasimoto FN, Cataneo DC, Hasimoto EN, Ximenes AMG, Cataneo AJM

Abstract
PURPOSE: To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH).
METHODS: Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment.
RESULTS: Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF.
CONCLUSIONS: RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.

PMID: 31552511 [PubMed – as supplied by publisher]

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Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.

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Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.

Gen Thorac Cardiovasc Surg. 2019 Sep 21;:

Authors: Dogru MV, Sezen CB, Girgin O, Cansever L, Kocaturk CI, Metin M, Dincer SI

Abstract
BACKGROUND: The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications.
METHODS: 165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life.
RESULTS: Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy.
CONCLUSION: Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.

PMID: 31542862 [PubMed – as supplied by publisher]

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Video-Assisted Bilateral Thoracoscopic Sympathotomy for Palmar Hyperhidrosis.

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Video-Assisted Bilateral Thoracoscopic Sympathotomy for Palmar Hyperhidrosis.

World Neurosurg. 2019 Sep 13;:

Authors: ReFaey K, Grewal SS, Segura-Duran I, Thomas M, Wharen RE

Abstract
In this video, we demonstrate a case of a 21-year-old right-handed male who presented with palmar hyperhidrosis. His symptoms started at the age of 4 and progressively worsened throughout his life. Multiple medical treatments were used without significant benefit. His symptoms worsened to the limit that it affected his work, and lifestyle. The patient was taken to the operating room in a supine position with both arms abducted 90 degrees. The right and left chest were prepped and draped in a sterile fashion. The skin incision was done on the left side first, the left lung was isolated and two 5 mm thoracoports were placed in the 6th and 3rd intercostal spaces, respectively. CO2 insufflation was used to pressure of 6 mmHg for exposure. The chest was visualized and the sympathetic chain was identified. Ribs were counted and then using cautery at a low setting was used. The sympathetic chain was transected at the level of the head of the 2nd rib. Accessory nerves of Kuntz were identified and resected. CO2 was then evacuated from the left chest using a bronchial tube exchanger and Valsalva maneuver. The lung was completely re-inflated and skin was closed in normal fashion. The same procedure was repeated on the right side. A chest X-ray was obtained intraoperatively, and no pneumothorax was observed. At the end of the procedure, both upper extremities temperature probes showed a significant increase from baseline. Informed patient consent was obtained.

PMID: 31525484 [PubMed – as supplied by publisher]

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Primary hyperhidrosis prevalence and characteristics among medical students in Rio de Janeiro.

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Primary hyperhidrosis prevalence and characteristics among medical students in Rio de Janeiro.

PLoS One. 2019;14(9):e0220664

Authors: Ribeiro Santos Morard M, Betanho Martins R, Lopes Ribeiro AC, Guimarães Rocha Lima P, Dos Santos Carvalho B, Junior JCBS

Abstract
BACKGROUND: Hyperhidrosis is a pathological condition defined by excessive sweating beyond thermoregulatory physiological needs, which can cause substantial psychological impact and impairment of daily activities. Studies regarding its prevalence, however, are scarce and vary widely in their findings. The population of medical students is a particularly interesting subset for its recurring demand of physical contact during patient examination or procedures, and the potential for professional adversity. We aimed at furthering the comprehension of this disease prevalence and characteristics among medical students.
METHODS: Questionnaires inquiring about the presence and characteristics of Primary Hyperhidrosis (PH) were applied through either written or digital means to all eligible medical students enrolled in three Medical Schools in the State of Rio de Janeiro who agreed to take part in the study. Demographic data regarding gender, ethnicity, current age, weight and height was collected in addition to clinical data (sweat site, age of onset, familial history, severity and previous treatments). Severity was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS) and a symptoms survey.
FINDINGS: Our response rate was roughly 1/3 of all eligible students (900/2700). PH prevalence was 20.56% (185/900). It was similar between men and women (23.08% and 19.41%, respectively) and strongly associated with family history of the disease (Prevalence Ratio of 4.27). Regarding ethnicity, of the total sample 73.78% (664/900) self-declared white, among which 19.28% (128/664) had PH. Mixed-race and other ethnicities encompassed 26.22% (236/900) of the sample, among which 24.15% (57/236) had PH. Most positive subjects (64.32%) presented associated forms of PH. Overall involvement of each site (both associated and isolated) was: 63.78% axillary, 50.81% palmar, 43.24% plantar, 20.54% craniofacial, 18.38% facial flushing and 2.16% gustatory sweating. Mean current age was 23.11(±4.04) years for PH patients, and age of onset was ≤18 years in 93.94% of cases. Regarding body mass index (BMI), 71.09% of PH patients had BMI<25kg/m2 and only 4.69% presented BMI≥30kg/m2, none ≥35kg/m2. Some degree of life quality impairment was reported by 89.20% of PH patients, and 23.89% had HDSS 3 or 4 (moderate to severe).
CONCLUSIONS: PH prevalence among Rio de Janeiro medical students was 20.56%, similar between men and women, predominating associated presentations, axillary, palmar and plantar sites, strong familial history, age of onset before 18 years, and some degree of life impairment.

PMID: 31518360 [PubMed – in process]

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Analysis of the results of videotoracoscopic sympathectomy in the treatment of hyperhidrosis in patients 40 years or older.

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Analysis of the results of videotoracoscopic sympathectomy in the treatment of hyperhidrosis in patients 40 years or older.

Ann Vasc Surg. 2019 Sep 05;:

Authors: Faustino CB, Milanez de Campos JR, Kauffman P, Leiderman D, Tedde M, Cucato G, Fernandes PP, Leão PP, Wolosker N

Abstract
OBJECTIVE: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (VATS) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40 years or older compared to those of young adult patients (19-40 years).
METHODS: We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: a group <40 years old (1760 patients) and a group ≥40 years (142 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one month after surgery.
RESULTS: We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the two groups of patients. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups.
CONCLUSIONS: Patients 40 years of age or older benefit just as much as younger patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results.

PMID: 31494263 [PubMed – as supplied by publisher]

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[Video-assisted thoracoscopic treatment for two ports for idiopathic palmar and axillary hyperhidrosis in children].

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[Video-assisted thoracoscopic treatment for two ports for idiopathic palmar and axillary hyperhidrosis in children].

Cir Pediatr. 2019 Jul 29;32(3):115-120

Authors: González López SL, Díaz Juárez M, Cabrera Machado CA, García González M, Cortiza Orbe GM, Quintero Delgado Z

Abstract
JUSTIFICATION: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy.
OBJECTIVES: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse.
METHOD: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described.
RESULTS: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment.
CONCLUSIONS: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery.

PMID: 31486302 [PubMed – in process]