Category: Hyperhidrosis

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Psychotropic drugs in dermatology: A dermatologist’s approach and choice of medications

Abstract
Psychiatric symptoms in dermatology practice are increasingly being recognized. The use of psychiatric medications by dermatologist is dealt with caution and uncertainty in several psychodermatological conditions. Several skin conditions are associated with anxiety, depression, and obsessive‐compulsive symptoms. Some conditions such as delusion of parasitosis require antipsychotic medication treatment. Keeping in mind the importance of psychotropic medications and its use in dermatology, following brief review will familiarize dermatologists about the ease of understanding and prescribing psychotropic medications to help their patients with psychiatric symptoms and increase the compliance in treatment.
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Ventricular arrhythmia suppression with ivabradine in a patient with catecholaminergic polymorphic ventricular tachycardia refractory to nadolol, flecainide, and sympathectomy

Abstract
Conventional treatment strategies for catecholaminergic polymorphic ventricular tachycardia (CPVT) include avoidance of strenuous exercise and competitive sports, drugs such as ß‐blockers and flecainide and, cervical sympathectomy. An implantable cardioverter‐defibrillator (ICD) has been utilized if the response to these strategies is inadequate; however, ICD use in CPVT patients, in addition to usual complications, is associated with an increased risk of life‐threatening electrical storm. Ivabradine is a selective inhibitor of hyperpolarization‐activated cyclic nucleotide‐gated potassium channel 4 generated funny current (If), which has been shown to be efficacious in suppression of inappropriate sinus tachycardia, junctional tachycardia, atrial tachycardia, and ventricular ectopy in humans. We report an 18‐year‐old male with a severe CPVT phenotype refractory to flecainide, nadolol, and sympathectomy who exhibited suppression of ventricular arrhythmias after initiation of ivabradine. These findings are of importance as ivabradine could be an important add‐on therapy in CPVT patients who are drug refractory or are unable to continue conventional therapies at the recommended doses.
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Successful treatment of Pachyonychia congenita with Rosuvastatin

Abstract
Pachyonychia congenita (PC) is a rare genetic disorder affecting nails, skin, oral mucosae, larynx, hair and teeth. Patients with PC present with nail thickening and painful plantar keratoderma. Additional features include hyperhidrosis, oral leukokeratosis, follicular keratosis, palmar keratoderma, cutaneous cysts, hoarseness or laryngeal involvement, coarse or twisted hair and abnormalities of the teeth 1. Current treatment focuses on symptom relief 2. Several experimental therapies (including siRNA, mTOR‐inhibition) have been developed but did not reach clinical use 3, 4. We herein report on the effective therapy of a 9‐year‐old female with PC due to a heterozygous KRT6A mutation. After failed efficacy of common available therapies, our patient was successfully treated with Rosuvastatin.
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Ischemic ulcers of the toes secondary to Raynaud’s phenomenon in a child successfully treated with botulinum toxin

Abstract
Raynaud’s phenomenon (RP) is an episodic vasospastic response to cold or emotional stress causing color changes and pain. These attacks can lead to digital ischemia, ulcers, and gangrene. Severe and refractory RP in children is a therapeutic challenge for clinicians because there are no standardized treatment protocols for these patients. We present a case of RP involving the toes of a child successfully treated with botulinum toxin A.
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Transcutaneous Vagus Nerve Stimulation in Patients With Severe Traumatic Brain Injury: A Feasibility Trial

Objectives
Preclinical studies have shown that surgically implanted vagus nerve stimulation (VNS) promotes recovery of consciousness and cognitive function following experimental traumatic brain injury (TBI). The aim of this study is to report the feasibility and safety of a noninvasive transcutaneous vagus nerve stimulation (tVNS) in patients with persistent impairment of consciousness following severe TBI.

Materials and Methods
The feasibility of tVNS was evaluated in five patients presenting with diffuse axonal injury and reduced dominant EEG activity one month following severe TBI. tVNS was applied to the left cymba conchae of the external ear using a skin electrode four hours daily for eight weeks. Possible effects of tVNS on physiological parameters and general side effects were recorded. In addition, we report the rate of recovery using coma recovery scale revised (CRS‐R).

Results
The tVNS regime of four hours daily for eight weeks was feasible and well tolerated with little side effects and no clinically relevant effects on physiological parameters. Three patients showed improvements (>3 points) in the CRS‐R following eight weeks tVNS.

Conclusion
We demonstrated that tVNS is a feasible and safe VNS strategy for patients following severe TBI. Controlled studies are needed to clarify whether tVNS has a potential to promote recovery of consciousness following severe TBI.

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A Phase 2a Trial Investigating the Safety and Tolerability of the Novel Cortical Enhancer IRL752 in Parkinson’s Disease Dementia

Abstract

Background
IRL752 is a novel small‐molecule compound that acts to regioselectively enhance norepinephrine, dopamine, and acetylcholine neurotransmission in the cerebral cortex.

Objective
The primary objective of the trial was to investigate the safety and tolerability of IRL752 in patients with Parkinson’s disease and dementia.

Methods
Patients with Parkinson’s disease and dementia were randomized to IRL752 or placebo treatment (3:1 ratio) for 28 days. The study drug was given as an adjunct treatment to the patients’ regular stable antiparkinsonian medication. Dosing was individually titrated for 14 days after which the dose was kept stable for an additional 14 days.

Results
A total of 32 patients were randomized to treatment, and 29 patients completed the 4‐week treatment. Adverse events were generally mild and transient and were mostly reported during the dose titration phase. There were 2 serious adverse events, and none of them were related to the experimental treatment. The average dose achieved in the stable dose phase was 600 mg daily, yielding a 2‐hour postdose plasma concentration of about 4 μM on day 28. Exploratory assessment of secondary outcomes indicated efficacy for symptoms and signs known to be poorly responsive to levodopa.

Conclusions
IRL752 appears to be safe and well tolerated for a 4‐week treatment in patients with Parkinson’s disease and dementia. © 2020 International Parkinson and Movement Disorder Society

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Successful treatment of Pityriasis Versicolor by photodynamic therapy mediated by methylene blue

Abstract

Background
Although systemic therapies are recommended for severe or recalcitrant cases of pityriasis versicolor (PV), they are not free of important side effects and drug interactions. Photodynamic therapy (PDT) utilizes the action of singlet oxygen and free radicals produced by a light‐activated photosensitizer to kill viruses, bacteria, or fungi. In this study, the effect of a PDT mediated by methylene blue (MB) in PV was evaluated.

Methods
Five women with PV disseminated on the back and diagnosed by fresh microscopic analysis were treated with a solution of MB (2%) applied to the PV lesions for 3 minutes. Next, a red LED lamp (λ = 630±5 nm, 37 J/cm2), placed 100 mm from the skin for 10 minutes, was applied on the dyed PV lesions. Six sessions of MB/PDT were implemented with a 2‐week interval in between. Wood’s lamp examination was used to monitor fungal infection at each time point.

Results
Complete cure was observed in the five women at the 4 weeks post‐treatment follow‐up. Fluoresce images from PV lesions by Wood’s lamp allowed to evaluate whether the lesions were healed or not at each time point. No patient showed relapse at the 6‐month follow‐up. The patients did not have any adverse effect, and good cosmetic outcome was observed.

Conclusions
Six sessions of MB/PDT spaced at 14‐day intervals are sufficient for the treatment for PV in healthy patients.

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Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis.

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Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis.

Gen Thorac Cardiovasc Surg. 2020 May 10;:

Authors: Wei Y, Xu ZD, Li H

Abstract
OBJECTIVE: Palmar hyperhidrosis affects 0.6-10% of the general population, having an important impact in patients’ quality of life. The definitive treatment for palmar hyperhidrosis is thoracic sympathectomy. The purpose of this study is to evaluate the quality of life after thoracic sympathectomy for palmar hyperhidrosis.
METHODS: The interest studies were searched in six comprehensive databases. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane system evaluation manual. Meta-analysis was performed with RevMan version 5.3. The outcome of interest was quality of life. The subgroup analysis and sensitive analysis were performed.
RESULTS: Nine trials, including 895 patients, with accessible data comparing preoperative quality of life score with postoperative quality-of-life score were used for data analysis. Compared with preoperative quality-of-life score, application of thoracic sympathectomy improved the postoperative quality of life of palmar hyperhidrosis patients (MD = 57.81, 95% CI 53.33-62.30). Subgroup analysis of the different thoracic sympathectomy segment showed that there was no significant difference in the results obtained when operated with single segment or multiple segments (single segment: MD = 61.16, 95% CI [56.10, 66.22], multiple segments: MD = 52.14, 95% CI [48.39, 55.88]).
CONCLUSION: The meta-analysis provided evidence of the improved quality of life after thoracic sympathectomy for palmar hyperhidrosis.

PMID: 32390086 [PubMed – as supplied by publisher]

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The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis.

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The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis.

Clin Auton Res. 2020 Apr 27;:

Authors: Hirakawa N, Higashimoto I, Takamaori A, Tsukamoto E, Uemura Y

Abstract
PURPOSE: When performing endoscopic thoracic sympathectomy (ETS) in palmar hyperhidrosis patients, a device can be used to measure sweat volume pre- and postoperatively in order to assess indications and treatment effects. In this study, we measured changes in the dynamics of sweating in hyperhidrosis patients pre- and postoperatively and compared the values with those in healthy subjects without hyperhidrosis.
METHODS: The patient group comprised 25 persons with palmar hyperhidrosis who were scheduled for ETS. The dynamics of sweating was measured at 1 day prior to surgery and at 2 days postoperatively, in 18 patients at > 1 year postoperatively in another palmar hyperhidrosis group, and in 20 healthy subjects without hyperhidrosis. A device for measuring local sweat volume was applied at the thenar eminence of both palms. Indicators established were basal sweat rate (BSR; mg/min/cm2), peak sweat rate (PSR; mg/min/cm2) during mental stress (sympathetic sweating response), sweat volume (SV), and sweat time (ST; s).
RESULTS: After surgery, all of the indicators were significantly reduced in hyperhidrosis patients and there was very little response to mental stress. The subgroup of these patients assessed at > 1 year after ETS showed a trend of increased BSR similar to that of healthy subjects. These changes did not correlate with the extent of the removal surgery. Preoperatively, hyperhidrosis patients had significantly greater BSR, PSR, and SV and longer ST than healthy subjects.
CONCLUSION: All of the sweating parameters were increased in palmar hyperhidrosis patients prior to surgery. Immediately after ETS, all these parameters were significantly reduced. At > 1 year after ETS, the BSR had increased to a level similar to that of the healthy volunteers, although PSR did not respond to mental stress.

PMID: 32342237 [PubMed – as supplied by publisher]