Category: Hyperhidrosis

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Tolerance of Oral Oxybutynin in The Treatment Of Hyperhidrosis.

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Tolerance of Oral Oxybutynin in The Treatment Of Hyperhidrosis.

Dermatol Ther. 2020 Aug 14;:

Authors: Del Boz Gonzalez J, Barón DR, Millán-Cayetano JF, de Troya Martin M

Abstract
BACKGROUND: Oral oxybutynin (OOx) is an effective and safe treatment for the treatment of hyperhidrosis (HH). However, in some patients a loss of efficacy during prolonged treatment has been observed. Analysis of these cases could enable us to identify patients susceptible to OOx tolerance. An alternative treatment might then be considered.
OBJECTIVES: To assess tolerance to OOx in the treatment of HH. Secondarily, to assess epidemiological data and the duration of efficacy, together with the probable causes of any loss in this respect.
METHODS: Retrospective study of patients who started treatment with OOx for HH during the period 2007-2017 and who either abandoned this treatment due to loss of efficacy or needed higher daily doses to maintain the initial efficacy. Epidemiological data were collected, the duration of the efficacy of OOx was recorded and the possible causes of loss of efficacy were considered.
RESULTS: The development of tolerance was suspected in 18 patients (8.5%) of the 211 who had previously responded to OOx. Thirteen patients abandoned OOx due to its lack of efficacy and five had to increase the dose in order to maintain efficacy. In seven patients, tolerance to the drug appeared in the first year of treatment, while in the remaining eleven, the tolerance appeared later.
CONCLUSIONS: Most patients achieved and maintained good control of HH with long-term OOx. However, in some cases the efficacy of the drug decreases. The study analysis did not produce findings enabling us to predict a loss of treatment efficacy. This article is protected by copyright. All rights reserved.

PMID: 32794595 [PubMed – as supplied by publisher]

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Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

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Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

J Am Acad Dermatol. 2020 Aug 08;:

Authors: Galadari H, Galadari I, Smit R, Prygova I, Redaelli A

Abstract
BACKGROUND: Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis.
OBJECTIVE: To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis.
METHODS: Embase, MEDLINE and the Cochrane Library were searched for relevant observational studies (OSs), randomized controlled trials (RCTs) and non-RCTs. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted.
RESULTS: Of 191 unique articles identified, 23 were considered relevant (3 OSs, 10 non-RCTs and 10 RCTs). These articles provided data on axillary (13), palmar (7) and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey’s syndrome (1) and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed following aboBoNT-A treatment.
LIMITATIONS: Variability in the injection technique when comparing data across studies.
CONCLUSION: This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

PMID: 32781184 [PubMed – as supplied by publisher]

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Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

J Am Assoc Nurse Pract. 2020 Aug 07;:

Authors: Thompson S, Johnson D, Lindgren T, Compton L, Chen JL

Abstract
BACKGROUND: Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.
LOCAL PROBLEM: Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider’s overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.
METHODS: This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.
INTERVENTIONS: Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a “Lunch and Learn” educational session at a Federally Qualified Health Care Center located in the Northern California.
RESULTS: The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.
CONCLUSIONS: Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.

PMID: 32773537 [PubMed – as supplied by publisher]

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Hyperhidrosis and Aesthetics.

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Hyperhidrosis and Aesthetics.

Handb Exp Pharmacol. 2020 Jul 30;:

Authors: Wang JV, Saedi N, Zachary CB

Abstract
When one considers the avalanche of new indications and uses for botulinum toxins, it is truly surprising that this has all happened in such a short time. And the safety and dependability of these products are profound, when used appropriately. There is still much to be discovered about the potential of this agent when you contemplate the profound non-cosmetic benefits reported by clinicians and scientists from around the world. The mechanism of action has been studied in depth, and yet the benefits appreciated by people with chronic migraine or major depressive disorder, for instance, are unlikely to be explained by our current mechanistic understanding. Given that these toxins control acetylcholine at the motor end plates, and given that acetylcholine is central to practically every cell in the body, it will not be surprising to find that botulinum toxin researchers will be enjoying many decades of fruitful studies. The advent of the non-surgical aesthetic physician has helped push the clinical utilization of botulinum toxins well beyond its original adoption by oculoplastic surgeons in their patients with blepharospasm. We can expect that the next edition of this book to have a dozen or more new indications which will surprise us all.

PMID: 32728993 [PubMed – as supplied by publisher]

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A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia.

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A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia.

F1000Res. 2018;7:670

Authors: Musa AF, Gandhi VP, Dillon J, Nordin RB

Abstract
Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1 st January 2011 until 31 st December 2016. Pertinent information was extracted and keyed into a study proforma. Results:  150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis  with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.

PMID: 32724556 [PubMed]

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Diagnosis and Management of Primary Hyperhidrosis: Practical Guidance and Current Therapy Update.

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Diagnosis and Management of Primary Hyperhidrosis: Practical Guidance and Current Therapy Update.

J Drugs Dermatol. 2020 Jul 01;19(7):704-710

Authors: Gorelick J, Friedman A

Abstract
Hyperhidrosis is a chronic medical condition characterized by excessive sweating beyond that which is necessary for thermoregulatory homeostasis. It is estimated to occur in 4.8% of the U.S. population (~15.3 million people) but is both underreported and underdiagnosed. With the busy practitioner and dermatology resident in mind, we provide here a disease state primer for hyperhidrosis, a top-line review of the breadth of literature underscoring the overall burden of the disease, a practical guide to differential diagnosis, and an update on current treatment approaches, including for the most common form of the condition, primary axillary hyperhidrosis. In addition, a case study is presented to provide a real-life perspective from the clinic on the importance of early and effective management strategies for those suffering with hyperhidrosis. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5162.

PMID: 32726555 [PubMed – in process]

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Randomized Controlled Trial Comparing the Efficacy and Safety of Two Injection Techniques of IncobotulinumtoxinA for Axillary Hyperhidrosis.

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Randomized Controlled Trial Comparing the Efficacy and Safety of Two Injection Techniques of IncobotulinumtoxinA for Axillary Hyperhidrosis.

J Drugs Dermatol. 2020 Jul 01;19(7):765-770

Authors: Trindade de Almeida AR, Noriega LF, Bechelli L, Suárez MV

Abstract
Background: Botulinum toxin A (BoNT-A) is an effective treatment for axillary hyperhidrosis (AH) typically applied by multiple injection punctures. Objective: To compare the efficacy and safety of two BoNT-A injection techniques for AH. Methods: Randomized, evaluator-blinded trial, in which each axilla of the same patient received 50 U of incobotulinumtoxin A (IncoA; Xeomin), one injected intradermally using multiple punctures, the other subcutaneously by radial approach. Follow-up visits occurred after 30, 120, 180, and 270 days. Outcomes included procedure duration and pain, gravimetry and starch-iodine tests and safety. Results: Twenty-four patients with severe hyperhidrosis were included; 67% were female and mean age was 34.7 years. Radial injection was faster applied than multiple punctures (P<0.001) but showed higher pain scores (P=0.001). Pre- and post-treatment gravimetric measures showed that IncoA led to a significant sweat reduction, by both techniques, with 95% of responders (≥50% reduction from baseline) after 30 days of treatment. Similarly, Minor’s test showed an excellent response (90-100% reduction) by most patients regardless of the technique used, after 30 days and sustained for at least 270 days. At most time points, there were no significant differences between the two techniques; however, multiple punctures showed a higher reduction of gravimetric measures at days 30 and 180, and of Minor’s test at day 270. Treatment was well tolerated. Conclusions: IncoA is an effective and safe treatment for AH irrespective to the technique used for injection. Our study suggests that multiple punctures injection may confer better outcomes at some time points. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.4989.

PMID: 32726556 [PubMed – in process]