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December 12, 2020

Craniofacial hyperhidrosis: clinical characteristics and response to treatment in a cohort of 97 patients treated with oral oxybutynin.

Craniofacial hyperhidrosis: clinical characteristics and response to treatment in a cohort of 97 patients treated with oral oxybutynin.

Dermatol Ther. 2020 Dec 10;:

Authors: García-Souto F, Del Boz J, Colmenero-Sendra M, Polo-Padillo J

Abstract
The term craniofacial hyperhidrosis (HH) refers to HH that affects the face and/or scalp. Few studies have focused on this specific location, and even fewer distinguish between the two areas. Our study aims are to describe the clinical characteristics of patients with craniofacial HH, specifying whether the condition affects the scalp, face or both, and to compare these cases with those recorded at other locations. As secondary objectives, we determine the effectiveness and adverse effects of oral oxybutynin (OOx), and assess patients’ adherence to treatment. This prospective observational study was carried out with respect to the period 2007-2019. All patients diagnosed with HH of the scalp and/or face and who were treated with OOx at our HH unit were included in the study group. Of 292 patients treated with OOx, 97 (33.2%) had craniofacial HH. Of these, four (4.1%) presented HH exclusively on the scalp, 56 (57.7%) exclusively on the face and 37 (38.1%) in both locations. The patients in the latter category (compared to those with exclusively facial HH) were significantly older than the others, had a later onset of HH, a greater frequency of secondary HH, less simultaneous involvement of the classical areas of primary focal HH (the palms, soles and armpits) and greater generalised HH and of the trunk. No significant differences were observed between the three locations (face, scalp or both) regarding the efficacy and side effects of OOx. The patients with exclusively facial HH presented greater adherence to treatment. This article is protected by copyright. All rights reserved.

PMID: 33301207 [PubMed – as supplied by publisher]

November 28, 2020

Differences in subjective and objective evaluation of hyperhidrosis. Study among medical students.

Differences in subjective and objective evaluation of hyperhidrosis. Study among medical students.

Postepy Dermatol Alergol. 2020 Oct;37(5):700-704

Authors: Dobosz Ł, Stefaniak T, Halman J, Piekarska A

Abstract
Introduction: Hyperhidrosis is a condition that significantly impairs patients’ quality of life. Qualification for treatment in most cases is based only on subjective evaluation of symptoms without objective confirmation.
Aim: To evaluate the differences between subjective and objective evaluation of sweating among medical students.
Material and methods: There were 179 participants involved in the study. Subjective evaluation of sweating was conducted using the Hyperhidrosis Disease Severity Scale and Numeric Rating Scale in 4 body areas: the face, palms, armpits and abdomino-lumbar area. Objective evaluation of sweating was performed using gravimetry.
Results: The prevalence of hyperhidrosis in gravimetric measures was 1.12%. In subjective evaluation hyperhidrosis (HDSS 3 or 4) was present in 11.17% of cases. There was no significant difference in subjective evaluation of hyperhidrosis between men and women (15% vs. 9.24%; p = 0.32). In gravimetry men showed a higher perspiration rate on the face (5.85 vs. 3.38; p < 0.05) and in the armpits (17.27 vs. 9.12; p < 0.05). Individuals with body mass index ≥ 25 kg/m2 reported hyperhidrosis more often (28% vs. 8.44%; p < 0.05); however, in gravimetric evaluation, beside the facial area, no significant differences in above-mentioned groups were observed.
Conclusions: There is a discrepancy between subjective and objective methods of evaluating sweating.

PMID: 33240009 [PubMed]

October 20, 2020

Can we predict the compensatory hyperhidrosis following a thoracic sympathectomy?

Can we predict the compensatory hyperhidrosis following a thoracic sympathectomy?

Indian J Thorac Cardiovasc Surg. 2019 Apr;35(2):190-195

Authors: Kara M, Kose S, Cayirci CE, Koksal A

Abstract
Background: Primary hyperhidrosis is a functionally and socially disabling condition resulting in social embarrassment and low quality of life. Thoracic sympathectomy is a definitive choice of treatment with favorable results. However, patients may face another embarrassing condition following surgery as compensatory hyperhidrosis which has no definitive treatment. The predictors of compensatory hyperhidrosis are controversial and remain unclear.
Patients and methods: A total of 74 patients underwent a videothoracoscopic sympathectomy for primary hyperhidrosis. We statistically analyzed our patients with correlations and uni-multivariate logistic regression models to outline the possible predictors of compensatory hyperhidrosis.
Results: A total of 45 (60.8%) patients had compensatory hyperhidrosis. The correlations showed that patients, with age greater than 21 years (P = 0.018), with body mass index (BMI) greater than 22 kg / m2 (P = 0.045), with isolated facial hyperhidrosis (P = 0.044), and with smoking status (P = 0.015), had significantly greater rates of compensatory hyperhidrosis. Similarly, the significant univariate predictors of compensatory hyperhidrosis were age > 21 (P = 0.020), BMI > 22 kg / m2 (P = 0.048), and the presence of smoking status (P = 0.015). Multivariate analysis revealed only smoking as a predictor within the threshold of significance (P = 0.078).
Conclusion: The clinical predictors of compensatory hyperhidrosis following a thoracic sympathectomy appear as older age, greater body mass index, and smoking.

PMID: 33061004 [PubMed]

September 30, 2020

Oxybutynin in primary hyperhidrosis: a long-term real-life study.

Oxybutynin in primary hyperhidrosis: a long-term real-life study.

Dermatol Ther. 2020 Sep 27;:e14344

Authors: Almeida ART, Ferrari F, Restrepo MVS, Rocha VB

Abstract
Hyperhidrosis is a condition of excessive sweating beyond physiological parameters that can seriously impair quality of life. This study aims to evaluate the oral oxybutynin effectiveness in hyperhidrosis, besides its tolerance and safety. In a real-life long-term study, thirty patients with primary hyperhidrosis and Hyperhidrosis Disease Severity Scale (HDSS) with score of at least two were submitted to a questionnaire to assess demographic data, HDSS and side effects of oxybutynin. Most patients were women (n = 23, 76.7%), median age was 40y (range 12-70, SD 17.5) and 17(56.7%) had family history of hyperhidrosis. The most common hyperhidrosis form was axillary (n = 15, 50.0%), followed by palmoplantar (n = 8, 26.7%), cranio-facial (n = 11, 36.7%) and trunk (n = 5, 16.7%). Median duration of treatment was 2.4y (range 1-6y, SD 1.3). Thus, all patients used oxybutynin for at least one year, 30% for two years, 20% three years, 17% four years and 3% six years. There was a significant improvement in HDSS score of patients (P < 0.001). This real life study suggests that oxybutynin is effective and safe for treatment of hyperhidrosis, both in children and adults, with mild and tolerable side effects, with significant improvement in HDSS. This article is protected by copyright. All rights reserved.

PMID: 32981151 [PubMed – as supplied by publisher]

May 17, 2020

Topographic Computer Analysis for Acne Scar Treatment on Face accompanying Biopsy Study after Dermal Injection of Hydrotoxin Mixture

Abstract

Background
Acne during youth can leave permanent facial scarring. The depressed acne scars can be treated by injection of stabilized hyaluronic acid (S‐HA) into the dermis. Due to the large number of acne scars, manual injection methods are technically difficult, and bear high risk of lump formation in the dermis. Therefore, the author designed a specific injection method to solve the two abovementioned problems.

Materials/Methods
102 Patients who suffered from acne scars were treated with a mixture of S‐HA (Restylane Vital®) and abobotulinumtoxinA (Dysport®). Using an automatic injector, microdroplets of the mixture (0.001cc of S‐HA and 0.125 U abobotulinumtoxinA) were delivered into 1000 intradermal sites on whole face except eyelids. This instrument radically reduced injection amounts per site (0.001cc), lessened manual operator efforts, and ensured consistent injection depth (from 0.8mm to 1.2mm depending on individual dermal thickness) into the facial dermis. The changes in each depression site of acne scars were evaluated by topographical computer analysis (point‐roughness), based on the 40 magnification microscopic photos generated. Depth measurements of each small acne scar point were taken one by one at the exact same point before and after the treatments. Global Aesthetic Improvement Scale (GAIS) was measured for improvement of acne scars at 1 and 6 months post‐treatment. Additionally, serial histologic examinations of the biopsy specimens evaluated neocollagenesis, neoelastinogenesis, and longevity state of the S‐HA.

Results
78 patients showed improvements of depressed acne scars in physical examinations, medical photos, and dermascopic photos.
Using topographic computer analysis, the average point‐roughness decreased 27.48 % (at 1‐month) from 29.042±6.85 (baseline) to 21.05±6.30 µm (P

May 17, 2020

Long‐term results of the treatment of primary hyperhidrosis with oxybutynin: follow‐up of 1,658 cases

Abstract

Background
Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then.

Objectives
To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients.

Methods
We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used.

Results
Pre‐treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups.

Conclusions
This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

April 19, 2020

Long-term results of the treatment of primary hyperhidrosis with oxybutynin: follow-up of 1,658 cases.

Long-term results of the treatment of primary hyperhidrosis with oxybutynin: follow-up of 1,658 cases.

Int J Dermatol. 2020 Apr 16;:

Authors: Wolosker N, Kauffman P, de Campos JRM, Faustino CB, da Silva MFA, Teivelis MP, Puech-Leão P

Abstract
BACKGROUND: Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then.
OBJECTIVES: To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients.
METHODS: We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used.
RESULTS: Pre-treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups.
CONCLUSIONS: This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

PMID: 32301117 [PubMed – as supplied by publisher]

February 20, 2020

Personality traits associated with blepharospasm: A comparison with healthy subjects, patients with facial hemispasm and patients with hyperhidrosis.

Personality traits associated with blepharospasm: A comparison with healthy subjects, patients with facial hemispasm and patients with hyperhidrosis.

J Clin Neurosci. 2020 Feb 15;:

Authors: Santangelo G, D’Iorio A, Peluso S, Mautone G, Vitale C, Manganelli F, Ruggiero L, Esposito M

Abstract
The aim of this study is to explore the existence of specific personality traits related to patients with blepharospasm (BSP), treated with injections of botulinum neurotoxin (BTX). Sixteen patients with BSP, 22 with facial hemispasm (HFS), 20 with essential hyperhidrosis (EH) and 20 healthy controls (HCs) completed the Temperament and Character Inventory-Revised to explore personality traits based on Cloninger’s Psychobiological Model. The results revealed that the four groups differed on the Harm Avoidance (HA) scale and fear of uncertainty subscale, as well as on Persistence (PS). On HA, BSP group did not differ from HCs, but had higher scores than HFS and EH groups. On PS scales, BSP and HFS patients did not differ between them but showed higher score than HCs and EH patients. Our findings suggested that a high level of Harm Avoidance and Persistence seem to be associated with BSP, when compared with any disorders treated with BTX. An evaluation of the personality traits might help the clinicians to early identify BSP patients at greater risk of developing psychopathological disturbances.

PMID: 32067829 [PubMed – as supplied by publisher]

September 14, 2019

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

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]

February 23, 2019

[Impact of Selective Quality of Life Analysis in Patients with Local Hyperhidrosis after Sympathicus Clipping].

[Impact of Selective Quality of Life Analysis in Patients with Local Hyperhidrosis after Sympathicus Clipping].

Zentralbl Chir. 2019 Feb 22;:

Authors: Schreiner W, Mykoliuk I, Dudek W, Sirbu H

Abstract
INTRODUCTION: Hyperhidrosis (HH) is associated with physical and psychological restrictions. The treatment includes both conservative and surgical methods and aims to permanently improve the quality of life (QoL) of those affected. Endoscopic sympathetic blockade (ESB) is an established surgical therapeutic method and is considered effective when conservative treatment options fail. The aim of our study was to comprehensively analyse the QoL alteration and patient satisfaction after ESB and to identify the corresponding influencing factors.
METHODS: From July 2008 to April 2016, 105 patients were operated for treatment-refractory HH. In all cases, an ESB was performed according to the HH form and the STS expert consensus (STS: Society of Thoracic Surgeons). QoL and hyperhidrosis status were selectively analysed pre- and postoperatively and evaluated using detailed questionnaires (a self-developed questionnaire, SF36, DLQI, Hyperhidrosis LQ (HidroQoL)). Statistical processing was performed with SPSS Statistics version 21.0.0.2 for Windows (Armonk, NY: IBM Corp.). Descriptive statistical analysis and nonparametric tests were used.
RESULTS: 105 patients who underwent bilateral ESB between July 2008 and April 2016 were evaluated: 73 women (69.5%) and 31 men (29.5%) with median age of 26 years (range: 16 - 64 years). Of the 105 patients who underwent bilateral ESB, 12 patients had focal Hyperhidrosis palmar and axillar (12.4%), 20 had Hyperhidrosis palmo-plantar (19.0%), 47 had Hyperhidrosis palmoplantar and axillar (44.8%), 11 had Hyperhidrosis axillar (10.5%), and 14 had Hyperhidrosis facial (13.3%). HydroQoL scores showed improvement in all forms of HH. All patient groups demonstrated improvement in DLQI, while the LQ analysis of SF36 showed an improvement in social functioning and mental well-being in all forms of HH other than HA. 86.7% of patients (n = 91) were satisfied with their postoperative outcome. Compensatory sweating (CS) was observed in 76.2% of cases (n = 80), without a clear LQ impact. No significant correlation between CS and the hyperhidrosis form was found.
CONCLUSIONS: ESB is associated with a long-time improvement in social functioning, psychological well-being, and high patient satisfaction. The onset of CS has no clear correlation to QoL and patient satisfaction.

PMID: 30795027 [PubMed – as supplied by publisher]