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]

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]

Assessment of craniofacial hyperhidrosis and flushing by sphenopalatine blockade – a randomized trial.

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Assessment of craniofacial hyperhidrosis and flushing by sphenopalatine blockade – a randomized trial.

Rhinology. 2019 Sep 02;:

Authors: Lehrer E, Nogues A, Jaume F, Mullol J, Alobid I

Abstract
BACKGROUND: Craniofacial hyperhidrosis (CFH) and flushing express nervous system autonomic dysfunction. Available reference treatments lack good compliance. The study objective was to investigate variations of CFH/flushing after two methods of sphenopalatine ganglion (SPG) blockade.
METHODOLOGY: CFH patients (n=25) were randomized in a ratio of 1:3 in two groups; 1) endoscopic application of topical lidocaine over SPG (TL; n=7); 2) endoscopic injection of lidocaine in the SPG (IL; n=18). CFH, flushing, rhinorrhoea, nasal obstruction, and smell detection were scored by Visual Analogue Scale (VAS). Nasal endoscopy, acoustic rhinometry, mucociliary transport test, smell/taste test, Schirmer test, Short Form-12, Chronic Skin Diseases Questionnaire, and Skin Satisfaction Questionnaire were also performed at visit 0, 1, 3 and 6 months.
RESULTS: At baseline, groups reported similar CFH VAS (TL: 89.3 plus or minus 17.5mm; IL: 85.7 plus or minus 22.1mm) or flushing VAS (TL: 52.7 plus or minus 30mm; IL: 59 plus or minus 33.8mm). After 6 months, the least squares mean of CFH VAS in IL was -38.1 (-47.3 to -28.9) compared to TL 1.9 (-12.2 to 15.9). However, flushing VAS did not improve. Any rhinological measure nor quality of life test showed significant changes. One patient presented controlled epistaxis intraoperatively during IL.
CONCLUSIONS: This preliminary study shows the sphenopalatine blockade injection as a safe procedure. Patients with CFH or flushing had significant improvement after lidocaine injection which lasted 6 months. Due to the small sample and the lack of objective measures more studies are needed.

PMID: 31475696 [PubMed – as supplied by publisher]

Erratum: Zur E. Topical Treatment of Primary Focal Hyperhidrosis, Part 2. IJPC 2019; 23(2):94-104.

Erratum: Zur E. Topical Treatment of Primary Focal Hyperhidrosis, Part 2. IJPC 2019; 23(2):94-104.

Int J Pharm Compd. 2019 Jul-Aug;23(4):351

Authors: IJPC Staff

Abstract
The METHOD OF PREPARATION in the formulation titled Compounded Oxybutynin Chloride 10% Topical Gel on page 102 in the article titled Topical Treatment of Primary Focal Hyperhidrosis, Part 2. IJPC. 2019; 23(2): 94-104 was published incorrectly. Please replace that information with the data provided herein.

PMID: 31315087 [PubMed – in process]

Safety and efficacy of topical formulations containing 0.5, 1 and 2% glycopyrronium bromide in patients with primary axillary hyperhidrosis: a randomised, double-blind, placebo-controlled study.

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Safety and efficacy of topical formulations containing 0.5, 1 and 2% glycopyrronium bromide in patients with primary axillary hyperhidrosis: a randomised, double-blind, placebo-controlled study.

Br J Dermatol. 2019 Jun 19;:

Authors: Masur C, Soeberdt M, Kilic A, Knie U, Abels C

Abstract
primary hyperhidrosis (HH), a dysregulation of the parasympathetic nerve system, is characterized by focal symmetrical sweating of axillae, palms or the plantar region.1 Hyperhidrosis is a chronic condition with severe impact on patients’ quality of life, however, more than 50% of hyperhidrosis patients receive no treatment.1,2 Overall prevalence was reported to be 16% in German adults, with axillary hyperhidrosis being the most common form of HH.2 The objective of this study was to assess safety and tolerability, efficacy and pharmacokinetics, of escalating concentrations of glycopyrronium bromide (GPB), a competitive antagonist of muscarinic acetylcholine receptor mAChR, in subjects with axillary hyperhidrosis. This article is protected by copyright. All rights reserved.

PMID: 31218668 [PubMed – as supplied by publisher]

A 44-Week Open-Label Study Evaluating Safety and Efficacy of Topical Glycopyrronium Tosylate in Patients with Primary Axillary Hyperhidrosis.

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A 44-Week Open-Label Study Evaluating Safety and Efficacy of Topical Glycopyrronium Tosylate in Patients with Primary Axillary Hyperhidrosis.

Am J Clin Dermatol. 2019 May 20;:

Authors: Glaser DA, Hebert AA, Nast A, Werschler WP, Green L, Mamelok RD, Quiring J, Drew J, Pariser DM

Abstract
BACKGROUND: Glycopyrronium tosylate is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged ≥ 9 years (Qbrexza™ [glycopyrronium] cloth, 2.4%).
OBJECTIVE: This 44-week open-label extension study assessed glycopyrronium tosylate safety and descriptive efficacy in patients completing one of two, phase III, double-blind, vehicle-controlled, 4-week trials (NCT02530281; NCT02530294).
METHODS: Patients aged ≥ 9 years with primary axillary hyperhidrosis were randomized 2:1 (glycopyrronium tosylate: vehicle, once daily) in the double-blind trials. Completers could receive open-label glycopyrronium tosylate for up to an additional 44 weeks. Treatment-emergent adverse events and local skin reactions were assessed. Descriptive efficacy assessments were gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale responder rate (≥ 2 grade improvement), and Dermatology Life Quality Index/children’s Dermatology Life Quality Index.
RESULTS: Of 651 patients completing the double-blind trials, 564 (86.6%) entered the open-label extension; 550 were analyzed. Most patients experiencing treatment-emergent adverse events had mild or moderate events (> 90%). Discontinuation because of treatment-emergent adverse events remained low and relatively stable, with a cumulative rate of 8.0% (44/550) over 44 weeks. Common treatment-emergent adverse events (> 5%) were dry mouth (16.9%), vision blurred (6.7%), application-site pain (6.4%), nasopharyngitis (5.8%), and mydriasis (5.3%). Most patients (67.5%) had no local skin reactions; those occurring were predominantly mild/moderate. Glycopyrronium tosylate efficacy was maintained throughout the trial; at week 44, the Hyperhidrosis Disease Severity Scale responder rate was 63.2%, and improvements from baseline (double blind) in sweat production were - 71.3% and 8.7 ± 6.2/6.2 ± 4.9 for Dermatology Life Quality Index/children’s Dermatology Life Quality Index.
CONCLUSIONS: Daily long-term application of glycopyrronium tosylate for up to 48 weeks (double blind plus open label) was generally well tolerated and efficacy was maintained. No new safety signals emerged.
TRIAL REGISTRY: Clinicaltrials.gov NCT02553798.

PMID: 31111409 [PubMed – as supplied by publisher]

Topical Treatment of Primary Focal Hyperhidrosis, Part 2.

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Topical Treatment of Primary Focal Hyperhidrosis, Part 2.

Int J Pharm Compd. 2019 Mar-Apr;23(2):94-104

Authors: Zur E

Abstract
This represents part 2 of a 2-part article on the topic of primary focal hyperhidrosis. Part 1, which was published in the International Journal of Pharmaceutical Compounding’s January/February 2019 issue, provided a comprehensive review of the active pharmaceutical ingredients aluminum salts and methenamine in the treatment of primary focal hyperhidrosis. Part 2 provides a comprehensive review of the active pharmaceutical ingredients glycopyrronium salts and oxybutynin chloride in the treatment of primary focal hyperhidrosis.

PMID: 31085774 [PubMed – in process]

Glycopyrronium Tosylate (Qbrexza) for Hyperhidrosis

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Glycopyrronium Tosylate (Qbrexza) for Hyperhidrosis

Skin Therapy Lett. 2019 Mar;24(2):1-3

Authors: Nwannunu CE, Limmer AL, Coleman K, Shah R, Patel RR, Mui UN, Tyring SK

Abstract
Hyperhidrosis is a condition characterized by excessive sweat production beyond which is physiologically necessary for thermal regulation. Affecting over 4.8% of the United States population, studies have shown that severe primary hyperhidrosis interferes with daily activities and can be considered intolerable, negatively impacting a patient’s quality of life. Glycopyrronium tosylate is a topical anticholinergic agent that reduces sweat production by blocking the activation of acetylcholine receptors in peripheral sweat glands. In clinical trials, topical glycopyrronium tosylate, a pre-moistened cloth containing 2.4% glycopyrronium solution, was shown to be an effective, safe and non-invasive treatment for patients suffering from primary hyperhidrosis. This review examines the clinical trials of topical glycopyrronium tosylate and its role in primary hyperhidrosis. Glycopyrronium tosylate was recently US FDA-approved (as of June 2018) to manage patients with primary axillary hyperhidrosis.

PMID: 30970203 [PubMed – as supplied by publisher]

The Treatment of Primary Focal Hyperhidrosis

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The Treatment of Primary Focal Hyperhidrosis

Skin Therapy Lett. 2018 Jan;24(1):7

Authors: Wechter T, Feldman SR, Taylor SL

Abstract
Primary focal hyperhidrosis is a relatively common disease that has a significant impact on afflicted patient’s quality of life. The pathogenesis of the disease is thought to stem from increased cholinergic activity on eccrine sweat glands. Topical aluminum chloride based antiperspirants are good first-line agents for all affected body sites. Anticholinergic agents are emerging as effective topical alternatives. Iontophoresis passes an electrical current through the skin and is an excellent treatment option for palmoplantar disease. Botulinum toxin type A injections remain a mainstay second-line treatment. Local procedural advances including microwave thermolysis, laser therapy and focused ultrasound are emerging as safe and effective alternatives for refractory disease. Oral anticholinergics are generally well tolerated and can also be used for intractable disease. Last-line interventions include local surgical options and sympathectomy, though some patients may prefer permanent treatment. Further investigation of novel treatments as well as ways to optimize existing therapeutic options are needed.

PMID: 30817880 [PubMed – as supplied by publisher]