Category: Treatment

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A comparative evaluation of aluminum chloride hexahydrate gel iontophoresis versus tap water iontophoresis in people with primary palmar hyperhidrosis: A randomized clinical trial

Indian J Dermatol Venereol Leprol. 2023 Jun 30:1-7. doi: 10.25259/IJDVL_975_2022. Online ahead of print.

ABSTRACT

Background Primary palmar hyperhidrosis causes a lot of problems for patients and negatively affects their quality of life. Currently, iontophoresis with tap water and aluminum chloride hexahydrate is used for primary palmar hyperhidrosis. Yet, little evidence exists about iontophoresis with aluminum chloride hexahydrate in the form of gel. This study investigated the effect of aluminum chloride hexahydrate gel iontophoresis compared to tap water iontophoresis on primary palmar hyperhidrosis. Methods In this randomized controlled trial study, 32 patients with primary palmar hyperhidrosis were divided randomly into two groups (n = 16). Participants received 7 sessions of iontophoresis with aluminum chloride hexahydrate gel or tap water every other day on the dominant hand. The sweating rate was measured by gravimetry and iodine-starch tests before and after the last treatment session. Results Following the iontophoresis, the rate of sweating in both hands in the two groups was significantly reduced (P < 0.001). However, the sweating rate in the treated hand and the non-treated hand showed no significant difference. There was no significant difference observed in sweating rate reduction between both groups over time, but the larger effect size values observed in the aluminum chloride hexahydrate gel iontophoresis group may suggest the superiority of this gel over tap water in reducing the rate of sweating. Limitation Further investigations with longer follow-up are needed to confirm the hypothesis regarding the effectiveness of aluminum chloride hexahydrate gel iontophoresis over other types of iontophoresis. In addition, contraindications of iontophoresis such as pregnancy, pacemakers, and epilepsy should be considered. Conclusion The present study provides preliminary evidence suggesting that aluminum chloride hexahydrate gel iontophoresis is an effective alternative treatment to decrease sweating rate in extended areas with fewer side effects in patients with primary palmar hyperhidrosis.

PMID:37436009 | DOI:10.25259/IJDVL_975_2022

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Low-Dose OnabotulinumtoxinA using Seven-Point Pattern Intradermal Injections in Patients with Moderate-to-intolerable Primary Axillary Hyperhidrosis: A Single-Blinded, Side-by-Side Randomized Trial

J Clin Aesthet Dermatol. 2023 Jun;16(6):37-43.

ABSTRACT

BACKGROUND: The axilla is the most common site for primary hyperhidrosis (HH) affecting quality of life. No consensus on the optimal doses of botulinum toxin (BTX) has been established.

OBJECTIVE: This study aimed to scrutinize the effectiveness of 25- and 50-U onabotulinumtoxinA in patients with moderate-to-intolerable primary axillary HH as well as pain scores after BTX injection.

METHODS: A single-blinded, side-by-side randomized trial was conducted between January and June 2022. Participants were randomly treated with 25-unit (U) onabotulinumtoxinA in one axilla and 50-U onabotulinumtoxinA in the other. The Minor starch-iodine test and gravimetric testing, the Hyperhidrosis Disease Severity Scale (HDSS), Hyperhidrosis Quality of Life Index (HidroQoL), global self-assessment scale (GSAS), and satisfaction scores were collected and analyzed.

RESULTS: A total of 12 participants were included in the final analysis; six (50.0%) were female. The median age was 30.3 (interquartile range: 28.7-32.3) years. No statistically significant differences were noted in the sweat rate production, hyperhidrotic area, HDSS, HidroQoL, GSAS, and satisfaction scores between 25- and 50-U BTX at any follow-up visit. No significant difference was noted in pain scores between the two groups (p=0.810).

CONCLUSION: Low-dose onabotulinumtoxinA is associated with similar efficacy and safety outcomes in primary axillary HH treatment as is conventional-dose onabotulinumtoxinA. No difference was noted in injection site pain between the two groups.

PMID:37361360 | PMC:PMC10286880

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Shapiro syndrome: a cause of episodic hyperhidrosis, hypothermia and altered mental status

QJM. 2023 Jun 20:hcad145. doi: 10.1093/qjmed/hcad145. Online ahead of print.

ABSTRACT

INTRODUCTION: Shapiro syndrome is characterized by recurrent episodes of hypothermia and hyperhidrosis, with agenesis of the corpus callosum. This is a rare condition with only approximately 60 cases described worldwide. We describe a case of Shapiro syndrome.

METHODS/RESULTS: A 50-year-old Indian man with diabetes and hypertension presented with a 3-month history of frequent episodic profuse hyperhidrosis, accompanied by postural giddiness and confusion. He had episodes of isolated hyperhidrosis 20 years ago which had spontaneously resolved. These episodes re-emerged 3 years prior to presentation, with increasing frequency over the last 3 months. Previous extensive investigations, including a positron emission tomography (PET) scan were normal and he was treated for anxiety. During his inpatient stay, he was observed to have recurrent episodes of hypothermia (lowest temperature recorded 31.3 degrees Celsius), labile blood pressure (systolic ranging from 71mmHg to 175mmHg) and pulse rate (38/min to 214/min). Apart from slow responses to routine questioning, the rest of his neurological examination was normal. Extensive investigations looking for malignancy, autoimmune diseases and infections were unremarkable. CSF studies were negative for inflammation or infection. Magnetic resonance imaging of the brain demonstrated agenesis of the corpus callosum and schizencephaly. Based on his symptoms of hyperhidrosis, hypothermia and imaging findings, a diagnosis of Shapiro syndrome was made. He was treated with clonidine and levetiracetam with good response.

CONCLUSION: Shapiro syndrome is characterized by a triad of episodic hyperhidrosis, hypothermia and agenesis of the corpus callosum. Recognition of this rare condition is important to direct effective treatment.

PMID:37338563 | DOI:10.1093/qjmed/hcad145

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Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

Front Surg. 2023 May 31;10:1126596. doi: 10.3389/fsurg.2023.1126596. eCollection 2023.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand’s exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient’s daily activities and quality of life.

OBJECTIVE: The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH.

METHODS: A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation.

RESULTS: Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05).

CONCLUSION: Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.

PMID:37325414 | PMC:PMC10264635 | DOI:10.3389/fsurg.2023.1126596

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Attempted treatment of primary axillary hyperhidrosis with one session of either Neodymium YAG laser or Intense Pulsed Light: A within patient randomized trial of treated versus untreated contralateral axilla

Lasers Surg Med. 2023 Jun 14. doi: 10.1002/lsm.23697. Online ahead of print.

ABSTRACT

BACKGROUND: Primary axillary hyperhidrosis (PAH) affects 1-5% of the world’s population who has an unmet need for improved treatments. The heating of sweat glands with specific microwave therapy has shown promising results, yet, treatment with widely available devices such as long-pulsed Neodymium Yttrium Aluminum Garnet (Nd:YAG) lasers, diode lasers or Intense Pulsed Light (IPL) may serve as pragmatic alternatives.

OBJECTIVES: To compare sweat secretion of treated versus untreated contralateral control axilla 1-3 months after one session of Nd:YAG laser or IPL in patients with PAH.

METHODS: A within-person randomized controlled trial. Patients were randomized to receive either one session of Nd:YAG laser or IPL in one axilla with the contra-lateral serving as control. Sweat production was assessed by gravimetry, trans-epidermal water loss, hyperhidrosis disease severity scale and dynamic optical coherence tomography. Mixed-effects models were used to handle the within-person design, containing both fixed effect factors (side, group, and subgroup), and random effects (patients), while also adjusting for the level at baseline.

RESULTS: A total of 20 patients were enrolled. At follow-up 1-3 months after treatment, sweat secretion was not affected in the treated axilla when compared to the control axillae (0.01 [95%CI: -0.04 to 0.05]; p = 0.68). In the Nd:YAG subgroup (10 patients), least squares means for sweat secretion was 0.18 mg/5 min in the treated versus 0.15 mg/5 min in the control axilla, respectively, corresponding to a statistically insignificant mean difference of 0.02 mg/5 min (95% CI: -0.06 to 0.11; p = 0.54). In the IPL subgroup (10 patients), sweat secretion was 0.06 mg/5 min in the treated axilla versus 0.07 mg/5 min in the control axilla with a statistically insignificant difference of -0.01 points (95% CI: -0.03 to 0.02; p = 0.46). Likewise, none of the secondary outcomes were significantly affected by treatment. However, both treatments appeared safe and well tolerated with no adverse effects reported at follow-up.

CONCLUSIONS: One treatment with external 1064 nm Nd:YAG laser or 640 nm IPL at commercially available settings, failed to demonstrate clinical benefit in treating PAH, with narrow confidence intervals implying that this was not due to a type-2 error.

PMID:37313834 | DOI:10.1002/lsm.23697

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Comparison of the efficacy of ETS with different segments for palmar, axillary and plantar hyperhidrosis

BMC Surg. 2023 Apr 11;23(1):82. doi: 10.1186/s12893-023-01976-x.

ABSTRACT

BACKGROUND: To compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis.

METHODS: We retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups.

RESULTS: There were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group.

CONCLUSION: Patients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

PMID:37041509 | DOI:10.1186/s12893-023-01976-x

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A novel lotion formulation of 20% oxybutynin hydrochloride for the treatment of primary palmar hyperhidrosis: A randomized, placebo-controlled, double-blind, phase III study in Japan

J Am Acad Dermatol. 2023 Mar 27:S0190-9622(23)00511-X. doi: 10.1016/j.jaad.2023.03.025. Online ahead of print.

ABSTRACT

BACKGROUND: No previous controlled studies have been specifically designed or adequately powered to show the efficacy of topical oxybutynin for palmar hyperhidrosis by using quantitative measures.

OBJECTIVE: To evaluate efficacy of 20% oxybutynin hydrochloride lotion (20% OL) in reducing palmar sweat volume in patients with primary palmar hyperhidrosis (PPHH).

METHODS: In a randomized controlled trial, Japanese patients with PPHH aged 12 years and older received either 20% OL (n = 144) or placebo (n = 140) on both palms once daily for 4 weeks. Palmar sweat volume was measured by the ventilated capsule method. For the primary outcome, response was defined as a reduction of sweat volume of at least 50% from baseline.

RESULTS: At week 4, the responder rate for sweat volume was significantly higher in the 20% OL arm than in the placebo arm (52.8% vs 24.3%, respectively; treatment difference, 28.5% [95% CI, 17.7 to 39.3%]; P < .001). No serious adverse events (AEs) occurred, and no AEs led to treatment discontinuation.

LIMITATIONS: The treatment period was only 4 weeks.

CONCLUSIONS: In patients with PPHH, 20% OL is superior to placebo in reducing palmar sweat volume.

PMID:36990320 | DOI:10.1016/j.jaad.2023.03.025

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A single session of high-energy microwave axillary hyperhidrosis and osmidrosis therapy: Key pretherapeutic assessment and outcome analysis

Lasers Surg Med. 2023 Mar 23. doi: 10.1002/lsm.23656. Online ahead of print.

ABSTRACT

BACKGROUND: Microwave therapy is used to treat axillary hyperhidrosis and osmidrosis. Even while a “danger zone” has been identified and reports of potential complications from nerve injury have been made, there has been little real-world discussion regarding whether there is any pretreatment evaluation key factor that may lower the risk. Furthermore, the efficacy of a single treatment and the safety of high-energy therapies have not been well investigated.

OBJECTIVE: The aim of this study is to demonstrate the key aspects of pre-therapeutic assessment, efficacy, and suitability of a single treatment, as well as the safety of high-energy treatments.

METHODS: Fifteen patients with axillary hyperhidrosis (AH) and axillary osmidrosis (AO) between ages of 20 and 50 had pretherapeutic ultrasonography and clinical assessments performed followed by a single-pass microwave treatment using the miraDry system at energy level 5. The severity of AH and AO was evaluated using the Hyperhidrosis Disease Severity Scale and Odor-10 scale, respectively, at baseline, 1 month, 3 months, and 1 year after treatment. Adverse reactions were recorded at each point of evaluation.

RESULTS: Out of 30 treatment areas, 14 have a danger zone. Female gender, a small mid-upper arm circumference, and a low body mass index (BMI) are all associated risk factors. The average Hyperhidrosis Disease Severity Scale score decreased from 3.1 ± 0.7 to 1.3 ± 0.5 (p < 0.001), while the odor-10 score declined from 7.1 ± 1.6 to 3.0 ± 1.6 (p < 0.001), indicating a significant improvement in AH and AO. Most of the unfavorable treatment effects disappeared within the first month.

LIMITATIONS: This study has no objective quantitative measurement of axillary odor severity and sweat assessment.

CONCLUSION: Female patients, those with a smaller mid-upper arm circumference, and those with a low BMI should be treated with extra caution, and the tumescent anesthetic dose may be increased based on safety. A high-energy microwave treatment procedure performed in a single session is a safe and effective therapeutic option with good recovery.

PMID:36950892 | DOI:10.1002/lsm.23656

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Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis

Front Surg. 2023 Feb 24;10:1144299. doi: 10.3389/fsurg.2023.1144299. eCollection 2023.

ABSTRACT

BACKGROUND: Endoscopic thoracoscopic sympathectomy (ETS) is the preferred method for treating primary palmar hyperhidrosis (PPH) that bears the risk of compensatory hyperhidrosis (CH) following surgery. The current study aims to evaluate the effectiveness and safety of an innovative surgical procedure of ETS.

METHODS: A survey of the clinical data of 109 patients with PPH who underwent ETS in our department from May 2018 to August 2021 was retrospectively conducted. The patients were organized into two groups. Group A underwent R4 sympathicotomy combined with R3 ramicotomy. Group B underwent R3 sympathicotomy. Patients were followed up to evaluate the safety, effectiveness and the incidence of postoperative CH of the modified surgical approach.

RESULTS: A total of 102 patients completed follow-up, and seven of the total enrolled patients were lost to follow-up, with a loss rate of 6% (7/109). Among these, Group A constitutes 54 cases, group B constitutes 48 cases, and the mean follow-up was 14 months (interquartile range 12-23 months). There was no statistically difference in surgical safety, postoperative efficacy, and postoperative quality of life (QoL) score between group A and group B (p > 0.05). The score of the psychological assessment was higher (p = 0.004) in group A (14.15 ± 2.06) compared to group B (13.30 ± 1.86). The incidence of CH in group A was lower than in group B (p = 0.019).

CONCLUSION: R4 sympathicotomy combined with R3 ramicotomy is safe and effective for PPH treatment, along with a reduced incidence of postoperative CH rate and improved postoperative psychological satisfaction.

PMID:36911618 | PMC:PMC9998541 | DOI:10.3389/fsurg.2023.1144299