Category: Hyperhidrosis

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Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions.

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Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions.

Clin Cosmet Investig Dermatol. 2019;12:733-744

Authors: Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D

Abstract
Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.

PMID: 31632121 [PubMed]

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[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience].

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[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience].

Cir Pediatr. 2019 Oct 01;32(4):177-180

Authors: Esteva Miró C, Núñez García B, Brun Lozano N, Pérez Gaspar M, Álvarez García N, Betancourth Alvarenga JE, Santiago Martínez S, Jiménez Gómez J

Abstract
INTRODUCTION: Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis. The aim of our study is to evaluate the results of surgery in paediatric patients.
MATERIAL AND METHODS: Retrospective study of patients with primary palmar or palmo-axillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years.
RESULTS: We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications. 1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction.
CONCLUSIONS: Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment.

PMID: 31626401 [PubMed – in process]

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T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis.

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T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis.

Medicine (Baltimore). 2019 Oct;98(42):e17272

Authors: Chen S, Zhang P, Chai T, Shen Z, Kang M, Lin J

Abstract
BACKGROUND: Palmar hyperhidrosis (PH) is a common sympathetic disorder that reduces patient’ quality of life. Video-assisted thoracoscopic sympathectomy (VTS) is a popular and effective treatment for PH. However, there is substantial controversy about the treatment of PH with VTS at the T3 or T4 level. We will compare the quality metrics of VTS at T3 versus T4 to determine the optimal level for VTS.
METHODS: We will search PubMed, Scopus, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and the Google Scholar databases for relevant clinical trials published in any language before March 31, 2019. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, sex of patient, and ethnicity of patient will be performed.
RESULTS: The results of this study will be published in a peer-reviewed journal.
CONCLUSIONS: The results of this study will provide reliable evidence for the development of optimal treatment strategies for patients with PH. Owing to the characteristics of disease and intervention methods, randomized controlled trials may not be sufficient. We will include high-quality nonrandomized controlled trials, but this may lead to high heterogeneity and may affect the reliability of the results.
PROSPERO REGISTRATION NUMBER: CRD42018116607.

PMID: 31626085 [PubMed – in process]

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Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database.

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Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database.

Int J Environ Res Public Health. 2019 Oct 15;16(20):

Authors: Park JM, Moon DH, Lee HS, Park JY, Lee JW, Lee S

Abstract
Sympathetic overactivity is associated with hyperhidrosis and cardiovascular diseases. Endoscopic thoracic sympathectomy (ETS) is a treatment for hyperhidrosis. We aimed to compare the risk for cardiovascular events between individuals with and without hyperhidrosis and investigate the effects of ETS on cardiovascular outcomes. We conducted a nationwide population-based cohort study using data acquired from the Korean Health Insurance Review and Assessment Service. Subjects newly diagnosed with hyperhidrosis in 2010 were identified and divided into two groups according to whether or not they underwent ETS. Propensity scores were calculated using a logistic regression model to match hyperhidrosis patients with control subjects. Combined cardiovascular events were defined as stroke and ischemic heart diseases. Subjects were followed up until the first cardiovascular event or 31 December 2017. The risk for cardiovascular events with hyperhidrosis and ETS was analyzed using Cox proportional hazards regression analysis. The risk for stroke was significantly higher in the hyperhidrosis group than in the control group (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.08-1.51); nonetheless, no significant difference in the risk for ischemic heart diseases was observed between the hyperhidrosis group and the control group (HR, 1.17; 95% CI, 0.99-1.31). Hyperhidrosis patients who did not undergo ETS were at significantly higher risk for cardiovascular events than the control group (HR, 1.28; 95% CI, 1.13-1.45). However, no significant difference in the risk for cardiovascular events was observed between hyperhidrosis patients who underwent ETS and the control group. Hyperhidrosis increases the risk for cardiovascular events. ETS could reduce this risk and needs to be considered for high-risk patients with cardiovascular diseases.

PMID: 31619017 [PubMed – in process]

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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

Mol Pharm. 2019 Oct 15;:

Authors: Shim DH, Nguyen TT, Park PG, Kim MJ, Park BW, Jeong HR, Kim DS, Joo HW, Choi SO, Park JH, Lee JM

Abstract
Hyperhidrosis is a disorder that produces excess amount of sweat. The botulinum neurotoxin A (BoNT/A) has been used to treat hyperhidrosis through multiple intradermal injections at the site of condition. However, due to its toxicity, it is important to precisely deliver the proper dose of toxin to the target site. In addition, the use of conventional hyperdermic needle for multiple injections in the palm makes the approach undesirable and painful. Here, we designed a BoNT/A-coated microneedle (BoNT-MN) array and tested its efficacy as a substitute pain-free method to treat hyperhidrosis. BoNT-MNs were prepared by coating BoNT/A formulation on poly-lactic acid microneedles and were found to successfully penetrate in vitro thick skin. The coating formulations were then tested for its stability at 4°C, 25°C, and 37°C for 24 h. BoNT-MNs were found to be much more stable than its liquid state. Additionally, we carried out in vivo experiments by treating the right paw of mice with BoNT-MNs and found that the treatment induced a significant reduction of sweating response in the mouse’s foot pads. Thus, BoNT/A treatment with microneedles is beneficial and may be used as a more efficient and less painful approach to treat hyperhidrosis.

PMID: 31613636 [PubMed – as supplied by publisher]

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

Dermatol Surg. 2019 Oct 04;:

Authors: Awaida CJ, Rayess YA, Jabbour SF, Abouzeid SM, Nasr MW

PMID: 31592920 [PubMed – as supplied by publisher]

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Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use.

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use.

Clin Drug Investig. 2019 Sep 30;:

Authors: Lamb YN

Abstract
Glycopyrronium tosylate (Qbrexza™) is available as single-use, pre-moistened cloths and has been approved in the USA for the topical treatment of primary axillary hyperhidrosis in adults and children ≥ 9 years of age. Glycopyrronium tosylate is effective in reducing patient-reported severity of disease and gravimetrically measured sweat production in this patient population; improvements have been shown to be maintained throughout long-term treatment (up to 48 weeks). Glycopyrronium tosylate is generally well tolerated, with most adverse events being mild to moderate in severity. Glycopyrronium tosylate thus provides a self-administered, non-invasive alternative to topical antiperspirant therapy and clinic-based treatments in adults with primary axillary hyperhidrosis, and is the only alternative to topical antiperspirants specifically approved in children and adolescents ≥ 9 years of age.

PMID: 31571127 [PubMed – as supplied by publisher]

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Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

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Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

Clin Auton Res. 2019 Sep 24;:

Authors: Hasimoto FN, Cataneo DC, Hasimoto EN, Ximenes AMG, Cataneo AJM

Abstract
PURPOSE: To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH).
METHODS: Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment.
RESULTS: Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF.
CONCLUSIONS: RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.

PMID: 31552511 [PubMed – as supplied by publisher]

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Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.

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Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.

Gen Thorac Cardiovasc Surg. 2019 Sep 21;:

Authors: Dogru MV, Sezen CB, Girgin O, Cansever L, Kocaturk CI, Metin M, Dincer SI

Abstract
BACKGROUND: The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications.
METHODS: 165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life.
RESULTS: Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy.
CONCLUSION: Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.

PMID: 31542862 [PubMed – as supplied by publisher]