Category: Generalized

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Surprising Resolution of Life-Long Severe Generalized Hyperhidrosis Post-angioplasty and Stenting

Cureus. 2024 Jan 17;16(1):e52451. doi: 10.7759/cureus.52451. eCollection 2024 Jan.

ABSTRACT

Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond thermoregulation needs. HH can be primary with no known etiology or secondary, as a symptom of underlying medical disease or a side effect of certain medications. Furthermore, HH can be focal, affecting one or a few body parts, or generalized, affecting the entire body. We present the case of a 49-year-old male with a history of primary generalized HH as well as coronary artery disease whose HH symptoms surprisingly resolved following coronary angioplasty and stenting. This unprecedented outcome of the procedure points to a potential association between HH and coronary artery disease, proposing potential management of HH through cardiovascular workup. In light of this result, we suggest that patients exhibiting generalized primary HH undergo a thorough comprehensive cardiovascular workup.

PMID:38371051 | PMC:PMC10871155 | DOI:10.7759/cureus.52451

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Diltiazem for clozapine-induced generalized hyperhidrosis

Ment Health Clin. 2023 Aug 7;13(4):193-195. doi: 10.9740/mhc.2023.08.193. eCollection 2023 Aug.

ABSTRACT

BACKGROUND: Clozapine can be associated with significant side effects and tolerability issues. Hyperhidrosis occurs less commonly and is unanticipated by clinicians because of clozapine’s significant anticholinergic activity.

CASE REPORT: A 34-year-old female developed clozapine-induced nocturnal, generalized hyperhidrosis following initial titration to 400 mg/day. Dose reduction did not decrease the side effect. Treatment with an anticholinergic medication could not be initiated because of constipation. Treatment with a beta blocker resulted in worsening of asthma. Treatment with a calcium channel blocker, diltiazem CD 180 mg/day, resulted in a significant reduction in hyperhidrosis.

CONCLUSION: This case supports the use of calcium channel blockers to reduce clozapine-induced hyperhidrosis and offers an alternative to anticholinergic medications that may negatively impact clozapine tolerability.

PMID:37860588 | PMC:PMC10583255 | DOI:10.9740/mhc.2023.08.193

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Cannabinoids in hyperhidrosis

J Dermatolog Treat. 2022 Oct 6:1-6. doi: 10.1080/09546634.2022.2127308. Online ahead of print.

ABSTRACT

Hyperhidrosis can significantly curtail patient quality of life, from debilitating physical symptoms to social stigmatization and reduced life opportunities. Current treatments often prove unsatisfactory, especially in sufferers of generalized hyperhidrosis. In this open trial, we present the case of a refractory generalized hyperhidrosis treated with cannabinoids. We found a remarkable reduction in the volume of sweat and an improvement to the patient’s quality of life using this novel low-cost and low-impact approach.

PMID:36200741 | DOI:10.1080/09546634.2022.2127308

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Treatment of Hyperhidrosis: An Update

Am J Clin Dermatol. 2022 Jul 1. doi: 10.1007/s40257-022-00707-x. Online ahead of print.

ABSTRACT

Hyperhidrosis is a dermatosis presenting as pathologically excessive focal or generalized sweating. The stigmatizing nature of hyperhidrosis may cause patients to feel embarrassment and apprehension about their symptoms and experience a significant decrease in well-being. Severe cases of hyperhidrosis can also increase the risk of developing psychiatric and somatic comorbidities. Conventional non-surgical treatments of hyperhidrosis include aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium. In recent years, new topical anticholinergic medications and devices have emerged that may improve the patients’ symptoms and even prevent the development of comorbidities. The treatment of hyperhidrosis can be a complex matter and may require the combination of several therapies. The purpose of this paper was to firstly review the literature on existing non-surgical treatment options for hyperhidrosis, and secondly provide a stepwise approach to investigating and treating patients with hyperhidrosis.

PMID:35773437 | DOI:10.1007/s40257-022-00707-x

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The temporal association of hyperhidrosis and its co-morbidities – a nationwide hospital-based cohort study

J Eur Acad Dermatol Venereol. 2022 Jun 23. doi: 10.1111/jdv.18351. Online ahead of print.

ABSTRACT

BACKGROUND: Research on hyperhidrosis comorbidities has documented the co-occurrence of diseases but has not provided information about temporal disease associations.

OBJECTIVE: To investigate the temporal disease trajectories of individuals with hospital diagnosed hyperhidrosis.

METHODS: This is a hospital-based nationwide cohort study including all patients with a hospital contact in Denmark between 1994 and 2018. International Classification of Diseases version-10 diagnoses assigned to inpatients, outpatients and emergency department patients were collected from the Danish National Patient Register. The main outcome was the temporal disease associations occurring in individuals with hyperhidrosis, which was assessed by identifying morbidities significantly associated with hyperhidrosis and then examining whether there was a significant order of these diagnoses using binomial tests.

RESULTS: Overall, 7,191,519 patients were included. Of these, 8,758 (0.12%) patients had localized hyperhidrosis (5,674 female sex [64.8%]; median age at first diagnosis 26.9 [interquartile range 21.3-36.1]) and 1,102 (0.015%) generalized hyperhidrosis (606 female sex [59.9%]; median age at first diagnosis 40.9 [interquartile range 26.4-60.7]). The disease trajectories comprised pain complaints, stress, epilepsy, respiratory and psychiatric diseases. The most diagnosed morbidities for localized hyperhidrosis were abdominal pain (relative risk [RR]=121.75; 95% Confidence Interval [CI] 121.14-122.35; p<0.001), soft tissue disorders (RR=151.19; 95% CI 149.58-152.80; p<0.001) and dorsalgia (RR=160.15; 95% CI 158.92-161.38); p<0.001). The most diagnosed morbidities for generalized hyperhidrosis were dorsalgia (RR=306.59; 95% CI 302.17-311.02; p<0.001), angina pectoris (RR=411.69; 95% CI 402.23-421.16; p<0.001) and depression (RR=207.92; 95% CI 202.21-213.62; p<0.001). All these morbidities were diagnosed before hyperhidrosis.

CONCLUSIONS: This paper ascertains which hospital-diagnosed morbidities precede hospital-diagnosed hyperhidrosis. As hyperhidrosis mainly is treated in the primary health care sector, the trajectories suggests that these morbidities may lead to a worse disease course of hyperhidrosis that necessitates treatment in hospitals. Treating these morbidities may improve the disease course of hyperhidrosis.

PMID:35735049 | DOI:10.1111/jdv.18351

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Hyperhidrosis in Parkinson’s disease: a 3-year prospective cohort study

J Eur Acad Dermatol Venereol. 2022 Mar 13. doi: 10.1111/jdv.18072. Online ahead of print.

ABSTRACT

BACKGROUND: Although hyperhidrosis is a common symptom in patients with Parkinson’s disease (PD), no study has yet examined it longitudinally.

OBJECTIVES: We conducted a 3-year prospective cohort study to investigate the development, evolution, and correlates of hyperhidrosis in patients with PD.

METHODS: A total of 224 patients with early-stage PD were enrolled at baseline and followed up annually for three consecutive years. Hyperhidrosis was assessed using hyperhidrosis question (item 30) of the Non-Motor Symptoms Scale (NMSS). The generalized estimating equations model was applied to investigate the correlates of both presence and severity of hyperhidrosis.

RESULTS: The frequency of hyperhidrosis in PD had an overall increasing tendency from 24.1% at baseline to 34.4% after 3 years, although hyperhidrosis was not always persistent in all patients over the 3-year study period. The presence of hyperhidrosis was found to be associated with dyskinesia (OR 2.27 [1.02-5.04], p = 0.045), the sexual function domain subscore of the NMSS (OR 1.04 [1.01-1.07], p = 0.016), the Hamilton Anxiety Rating Scale (HARS) score (OR 1.08 [1.03-1.13], p = 0.001) and the Unified Parkinson’s Disease Rating Scale part III score (OR 1.02 [1.00-1.04], p = 0.036). Only the HARS score was associated with the severity of hyperhidrosis (B 0.08 [0.03-0.12], p = 0.001).

CONCLUSIONS: Hyperhidrosis is common in PD, and its frequency increases along with disease duration. Hyperhidrosis in PD is not only associated with motor severity and motor complication such as dyskinesia, but may be also with non-motor symptoms such as sexual dysfunction and anxiety.

PMID:35279891 | DOI:10.1111/jdv.18072

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Unexpected improvement of hyperhidrosis with cannabidiol

Einstein (Sao Paulo). 2022 Feb 14;20:eRC5795. doi: 10.31744/einstein_journal/2022RC5795. eCollection 2022.

ABSTRACT

Hyperhidrosis is characterized by excessive sweating and it affects almost 5% of the population. The affected age group is wide, and it can affect from children to elderlies. There are two types of hyperhidrosis: generalized and focal. Treatment depends on the symptoms presented. In more severe cases, radiofrequency sympatholysis and bilateral thoracic sympathectomy are the options. However, recurrence is possible or the postoperative appearance of conditions called compensatory hyperhidrosis or reflex hyperhidrosis. We describe two cases of patients treated with Cannabidiol who had significant and unexpected improvement of hyperhidrosis. The first patient received Cannabidiol specific for public presentations at work, and the second patient had a diagnosis of autism spectrum disorder. The hyperhidrosis improved in both patients immediately after using Cannabidiol.

PMID:35170710 | DOI:10.31744/einstein_journal/2022RC5795

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Hyperhidrosis Comorbidities and Treatments: A Register-based Study among 511 Subjects

Acta Derm Venereol. 2022 Jan 28. doi: 10.2340/actadv.v101.1061. Online ahead of print.

ABSTRACT

Hyperhidrosis is a dermatological condition that causes psychosocial impairment and has a negative impact on patients’ quality of life. The epidemiology of hyperhidrosis is currently poorly understood. The aim of this study was to analyse comorbidities and treatments in 511 subjects with hyperhidrosis selected from the patient records of Oulu University Hospital. The mean age of patients with local hyperhidrosis was 27.9 years and the majority were female (62.7%). The most common anatomical site of symptoms in the youngest age group was the palms, whereas the axillae were a more common site in advanced age. Depression was a common comorbidity in both local (11.6%) and generalized hyperhidrosis (28.6%). Anxiety affected 12.7% of patients with generalized hyperhidrosis. In 36.8% of the patients with local hyperhidrosis there was a delay in diagnosis of more than 10 years. The most commonly used treatments included topical antiperspirants, iontophoresis and botulin toxin injections.

PMID:35088873 | DOI:10.2340/actadv.v101.1061

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Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

Related Articles

Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: results of a clinical, multicenter, prospective study.

Dermatol Ther. 2020 Jul 21;:e14039

Authors: Campanati A, Gregoriou S, Consales V, Rizzetto G, Bobyr I, Diotallevi F, Martina E, Kontochristopoulos G, Platsidaki E, Offidani A

Abstract
Oxybutynin chloride and Botulinum Toxin type A (BTX-A) have demonstrated to be effective treatments for primary palmar hyperhidrosis, however both of them are not completely free from local and/or generalized side effects. Primary aim of this study is to compare efficacy and safety of a therapeutic approach based on in sequence administration of oral oxybutynin chloride following BTX-A injections versus oral oxybutynin chloride in monotherapy in patients with primary palmar hyperhidrosis. Secondary aim of the study is to evaluate if the sequencing approach can allow the control of hyperhidrosis with lower dose of oral oxybutynin, thus reducing the related side effects. Patients with primary focal palmar hyperhidrosis receiving sequencing treatment with BTX-A injections followed by oral oxybutynin chloride administration and patients in monotherapy with oral oxybutynin chloride were compared for short and long term efficacy and safety of treatments. Effectiveness was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS), and the Dermatology Quality of Life Index (DLQI) score; safety was assessed through collection of the adverse events (AEs) reported by patients both at baseline, at 24 weeks and 52 weeks after starting the treatments in both groups. Patients receiving sequencing treatment showed significant greater improvement than patients receiving oxybutynin chloride alone at T24 (HDSS p=0.0076 and DLQI p=0.0139) and T52 (HDSS p=0.0387 and DLQI p=0.0087). The dose of oxybutynin chloride useful to control hyperhidrosis was lower, and retention rate to the treatment was higher in patients receiving sequencing treatment (p=0.001), than patients receiving monotherapy with oxybutynin chloride alone (p=0.04). A sequencing therapeutic approach to palmar hyperhidrosis provides good clinical results, increasing both efficacy and safety compared with the use of oral oxybutynin chloride alone, and allows clinicians to keep lower dosage of oxybutynin chloride reducing generalized side effects and increasing the retention rate to the treatment. This article is protected by copyright. All rights reserved.

PMID: 32691938 [PubMed – as supplied by publisher]

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Novel pharmacological treatments for generalized anxiety disorder: Pediatric considerations

Abstract

Background
Pediatric anxiety disorders such as generalized anxiety disorder (GAD) are common, impairing, and often undertreated. Moreover, many youth do not respond to standard, evidence‐based psychosocial or psychopharmacologic treatment. An increased understanding of the gamma‐aminobutyric acid (GABA) and glutamate neurotransmitter systems has created opportunities for novel intervention development for pediatric GAD.

Methods
This narrative review examines potential candidates for pediatric GAD: eszopiclone, riluzole, eglumegad (LY354740), pimavanserin, agomelatine.

Results
The pharmacology, preclinical data, clinical trial findings and known side effects of eszopiclone, riluzole, eglumegad (LY354740), pimavanserin, agomelatine, are reviewed, particularly with regard to their potential therapeutic relevance to pediatric GAD.

Conclusion
Notwithstanding numerous challenges, some of these agents represent potential candidate drugs for pediatric GAD. Further treatment development studies of agomelatine, eszopiclone, pimavanserin and riluzole for pediatric GAD also have the prospect of informing the understanding of GABAergic and glutamatergic function across development.