Category: Hyperhidrosis

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Transdermal theranostics

Skin offers an easily accessible site for drug administration as well as for health signal monitoring, with non‐noninvasiveness or minimal‐invasiveness, convenience, and good patient compliance. Transdermal theranostics promises for personalized, home‐based, long‐term management of chronic diseases.

Abstract
Skin offers an easily accessible site for drug administration as well as for health signal monitoring, with non‐invasiveness or minimal‐invasiveness, convenience, and good patient compliance. Transdermal theranostics promises for personalized, home‐based, and long‐term management of chronic diseases, and is expected to change the landscape of healthcare profoundly. In this article, we review the recent advances in transdermal drug delivery, diagnosis based on sweat and skin interstitial fluid, and wearable devices. The advantages, limitations, and commercialization of these emerging techniques are comparatively discussed.

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

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

Clin Auton Res. 2020 May 25;:

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

Abstract
Unfortunately, the 3rd coauthor name has been published incorrectly in the original publication.

PMID: 32451754 [PubMed – as supplied by publisher]

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A skin disease and needs assessment analysis of the displaced Rohingya population in the Kutupalong refugee camp, Bangladesh

Abstract
The physical, psychological and financial burden of skin disease in low to middle income countries, where access to skincare is limited, is poorly understood. A group that we know very little about in this regard are refugees. There are limited data on the range of skin diseases and skincare needs of this group. To better understand the skincare needs of the displaced Rohingya population, residing in the Kutupalong refugee camp, Bangladesh we collected data on demographics, living conditions and range of dermatoses. Of the 380 patients seen, fungal skin infections, predominantly dermatophytes, were by far the most common skin disease seen (n=219), followed by dermatitis (n=81). Skin disease can be the presenting feature in many systemic conditions and may cause significant secondary complications itself. Developing a better understanding of the skincare needs of the refugee population is essential for future healthcare planning for this vulnerable group.
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Gastrointestinal involvement of primary skin diseases

Abstract
Less is known about gastrointestinal (GI) involvement of primary skin diseases due to the difference in embryology, histology, microbiology and physiology between integument and alimentary tract. Esophagus, following the oropharyngeal mucosa, is the most common GI segment affected by primary skin diseases, especially by eosinophilic esophagitis, lichen planus, and autoimmune bullous dermatoses like pemphigus vulgaris, mucosal membrane pemphigoid and epidermolysis bullosa acquisita. Eosinophilic esophagitis is an emerging chronic atopic disease with esophageal dysfunction as the typical presentation, and esophageal narrowing, rings and stricture as late complications. Esophageal lichen planus mainly involves the proximal to mid‐esophagus in elderly‐aged women with long‐term oral mucosal lesions. In acute attack of pemphigus vulgaris esophageal involvement is not uncommon but often neglected and may cause sloughing esophagitis (esophagitis dissecans superficialis) with acute GI bleeding in rare cases. GI manifestation of hereditary bradykininergic angioedema with colicky acute abdomen mostly affects small intestine, usually in the absence of pruritus or urticaria, and is more severe and long‐lasting than the acquired histaminergic form.
Strong evidence supports association between inflammatory bowel disease, especially Crohn disease, and hidradenitis suppurativa/acne inversa. Patients with vitiligo need surveillance of autoimmune liver disease, autoimmune atrophic gastritis or celiac disease when corresponding symptoms become suspect.
Melanoma is the most common primary tumor metastatic to the GI tract, with small intestine predominantly targeted. Gastrointestinal involvement is not uncommon in disseminated mycosis fungoides. Extramammary Paget’s disease is an intraepidermal adenocarcinoma of controversial origin and a high association between the ano‐genital occurrence and colorectal adenocarcinoma has been reported.
As GI tract is the largest organ system with multidimensional functions, dermatologists in daily practice should be aware of the gastrointestinal morbidities related to primary skin diseases for an early diagnosis and treatment.
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A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis.

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A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis.

Pediatrics. 2020 May 22;:

Authors: Rosenblatt T, Ort K, Shaw R, Levy RJ, Chen C, Niemi A, Hoang K

Abstract
A previously healthy 15-year-old boy presented with 3 months of progressive psychosis, insomnia, back and groin pain, and hyperhidrosis. On examination, the patient was disheveled, agitated, and soaked with sweat, with systolic blood pressure in the 160s and heart rate in the 130s. Aside from occasional auditory and visual hallucinations, his neurologic examination was normal. The patient was admitted for an extensive workup, including MRI of the brain and spine and lumbar puncture, which were normal. Through collaboration with various pediatric specialists, including psychiatry and neurology, a rare diagnosis was ultimately unveiled.

PMID: 32444380 [PubMed – as supplied by publisher]

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The clinical significance of fungi in atopic dermatitis

Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases and is caused by multiple factors including genetic factors, skin barrier defects, host immune responses, allergen sensitivity, environmental effects, and infections. Commonly, bacterial and viral infections are present in the eczematous lesions of AD patients and clearly aggravate the symptoms. However, studies of fungal infections in AD are limited in spite of the fact that there are reports showing that Malassezia, Candida, and some dermatophytes can affect the symptoms of AD. Moreover, certain fungal infections are sometimes overlooked and need to be considered particularly in AD patients with treatment failure as clinical features of those fungal infections could mimic eczematous lesions in AD. Here, we review the epidemiology, pathogenesis, clinical manifestations, and overlooked features of fungal infections associated with the symptoms of AD including the diagnosis and effectiveness of fungal treatments in AD patients.
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Psychodermatology in clinical practice: An examination of physician attitudes, beliefs and interventions towards psychocutaneous disease

Abstract

Background
Fifteen days post‐conception, the embryonic ectoderm simultaneously gives rise to the central nervous system and the epidermis of the integumentary system. The connections between the two organ systems manifests in both the psychiatric and dermatologic setting.

Objectives
To examine the current awareness of psychiatric comorbidity in dermatologic practice and its management in a sample of dermatologists across the United States.

Methods
A survey was conducted that explored physician perspective on psychiatric comorbidity, clinical practice, and management i.e., use of survey screening measures, employment of psychological interventions and coordination with mental health services. SPSS v25 was used for descriptive statistical analysis and to calculate Pearson’s correlation coefficients between familiarity with dermatologic/psychiatric comorbidity and its management.

Results
98% of respondents believed a relationship between mental and dermatological health. 61.7% of respondents reported seeing patients with known psychological problems more than once a week. The administration of a psychiatric questionnaires was noted in 23% of practices and only 6.38% administer the questionnaire at every appointment.

Conclusion
Management of comorbid disease is best done through the collaboration of dermatology and psychiatry. Implications for streamlining practice includes the routine administration of quality of life surveys, utilization of brief psychotherapeutic strategies and regular interdisciplinary referrals.
This article is protected by copyright. All rights reserved.

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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.