Category: Treatment

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Case Reports of Transdermal Fentanyl Patch Administration Difficulties in Cancer Patients with Excess Sweating

J Pain Palliat Care Pharmacother. 2022 Nov 15:1-6. doi: 10.1080/15360288.2022.2141413. Online ahead of print.

ABSTRACT

(Case 1) A 45-year-old male was diagnosed with prostate cancer. Treatment was administered using bicalutamide and leuprorelin acetate, while a transdermal fentanyl (TDF) was applied for pain relief. However, TDF continued to peel off owing to excessive sweating, even when reinforced by a protective layer. As such, TDF was discontinued and pain control was initiated using other medicines. Sweating occurred irregularly because of hot flashes, approximately four to five times per day. (Case 2) A 37-year-old male was diagnosed with a malignant thymoma and sacral metastasis. For analgesic control, etodolac tablets, carbamazepine tablets, and TDF were administered. Subsequently, the dose of the TDF was gradually increased, but the analgesic effect was low; thus, fentanyl blood concentration was measured. The measurements showed that even higher TDF doses did not increase fentanyl blood levels. During this period, full body sweating began to occur to a large extent due to unknown causes, and it was thought that the absorption of fentanyl decreased. When using a TDF, it is necessary to monitor patients for any sweating during treatment, while also considering changes in medication in some cases. This should promote the maintenance and improvement of the quality of life of the affected patients.

PMID:36378038 | DOI:10.1080/15360288.2022.2141413

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Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics

Dermatol Ther (Heidelb). 2022 Nov 3. doi: 10.1007/s13555-022-00838-3. Online ahead of print.

ABSTRACT

BACKGROUND: Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate.

OBJECTIVE: This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options.

METHODS: We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH.

RESULTS: The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate.

CONCLUSION: Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.

PMID:36329359 | DOI:10.1007/s13555-022-00838-3

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Computed Tomography-Guided Percutaneous T4 Thoracic Sympathetic Radiofrequency Thermocoagulation for Primary Palmar Hyperhidrosis: A Retrospective Observational Trial

Cardiovasc Intervent Radiol. 2022 Oct 31. doi: 10.1007/s00270-022-03305-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy, safety, and patient satisfaction of computed tomography (CT)-guided percutaneous T4 thoracic sympathetic radiofrequency thermocoagulation (RFT) for the treatment of primary palmar hyperhidrosis (PPHH).

MATERIALS AND METHODS: A total of 158 patients who underwent bilateral thoracic sympathetic RFT at the T4 level were analysed. Hyperhidrosis Severity Scale (HDSS), Dermatologic Quality of Life Index (DLQI), patient satisfaction, and adverse events were evaluated within 12 months after RFT.

RESULTS: The mean age of the patients was 25.27 years, and 95 (60.1%) were females. The technical success, defined as planned needle placement and completion of RFT, was 99.4%. After the procedure, 243 hands (77.4%) were completely dry; and 58 hands (18.4%) were partially dry. From before RFT to 12 months after RFT, the proportion of hands with the HDSS grades 3 and 4 from 100% decreased to 31.9%; and that with the DLQI scores D and E from 100% decreased to 4.0% (P < .001). The clinical success rate was 76.6%, and the patient satisfaction rate was 80.8% at 12 months after RFT. During the procedures, there was unilateral local bleeding in two patients (0.6%) and bradycardia in five patients (3.2%); after the procedures, unilateral pneumothorax occurred in 15 patients (4.7%) and closed thoracic drainage was performed in two patients (0.6%); thoracic neuralgia occurred in 24 patients (15.2%). The incidence of compensatory hyperhidrosis (CH) 12 months after RFT was 15.2%.

CONCLUSIONS: CT-guided percutaneous T4 thoracic sympathetic RFT is safe, effective, and minimally invasive for the treatment of PPHH.

LEVEL OF EVIDENCE: Level 2 observational study with dramatic effect.

PMID:36316494 | DOI:10.1007/s00270-022-03305-w

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Mydriasis and anisocoria in a pediatric hyperhidrosis patient with interesting findings in the family cat

Pediatr Dermatol. 2022 Oct 19. doi: 10.1111/pde.15157. Online ahead of print.

ABSTRACT

Here, we report a case of unilateral ocular mydriasis in a pediatric patient with longstanding hyperhidrosis, as well as similar findings in her cat. The patient had been undergoing treatment of her hyperhidrosis with topical glycopyrrolate. This case highlights the potential side effect profile of topical antimuscarinics and the importance of counseling patients on proper precautions.

PMID:36263444 | DOI:10.1111/pde.15157

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Impact of microwave thermolysis energy levels on patient-reported outcomes for axillary hyperhidrosis and osmidrosis

Lasers Surg Med. 2022 Oct 13. doi: 10.1002/lsm.23610. Online ahead of print.

ABSTRACT

OBJECTIVE: Microwave thermolysis (MWT) is an emerging treatment for axillary hyperhidrosis reducing both sweat and odor. No prior studies have investigated and compared the different available energy settings of the MWT device. This study evaluated patient-reported outcome measures (PROMs) for axillary hyperhidrosis and osmidrosis following MWT treatment with two different energy levels.

METHODS: Twenty adults with axillary hyperhidrosis and osmidrosis reported sweat on Hyperhidrosis Disease Severity scale (HDSS: 1-4) and odor on Odor scale (OS: 1-10), respectively, supplemented by overall Dermatology Life Quality Index (DLQI: 0-30). This was a prospective, randomized, patient-blinded and intraindividually controlled study with 3 months follow-up (FU). Randomization comprised MWT treatment of one axilla with a standard medium energy setting (energy level 3) and the contralateral axilla with a standard high energy setting (energy level 5).

RESULTS: At baseline, patients reported substantial sweat and odor, negatively affecting their quality of life. At 3 months FU, PROMs showed improved quality of life with significantly reduced odor and sweat. Overall DLQI was reduced from a median of 10 to 4, with a median 6.5-point reduction (p = 0.0002). HDSS was reduced from a median of 4 to 2 on both sides, with a median reduction of 1 for medium energy level and 2 points for high energy level (p = 0.014). OS was reduced from a median of 8 to 3 for both energy levels, with a median reduction of 3.5 and 4.5 points for the medium and high energy level, respectively (p = 0.017). Local skin reactions were mild and transient, but slightly more pronounced following treatment with the high energy level.

CONCLUSION: MWT effectively improved patients’ quality of life, axillary sweat, and odor 3 months after on baseline treatment. Treatment with the high energy level presented a subtle but significant increase of efficacy based on PROMs for both sweat and odor. Patients were willing to accept a higher amount of temporary local skin reactions from a higher energy setting when experiencing greater odor and sweat reduction.

PMID:36229952 | DOI:10.1002/lsm.23610

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Microneedling Delivery of Botulinum Toxin Versus Intradermal Injection in the Treatment of Facial Hyperhidrosis

J Clin Aesthet Dermatol. 2022 Sep;15(9):40-44.

ABSTRACT

BACKGROUND: The current treatments of Facial hyperhidrosis (FH) are often limited and are associated with many adverse effects.

OBJECTIVE: The objective was to study the efficacy and safety of botulinum toxin-A delivery by microneedling versus its intradermal injection in the treatment of FH. Forty-two patients with FH were subjected to microneedling (Mn) followed by topical application of BTX-A on one side of the face and intra-dermal injection of BTX-A on the other side. Two sessions were performed at two week intervals. The assessment tools were Hyperhidrosis Disease Severity Scale (HDSS), the Dermatology Life Quality Index (DLQI), and patient satisfaction.

RESULTS: A score of one of HDSS was achieved in 85.7 percent of patients on the intradermally injected side versus 83.3 percent on the microneedling side (P=0.76%). Most of the patients on the injection side responded with the first session while the microneedling side responded with the second one (P<0.001). The DLQI was highly significant on both sides post-treatment (P<0.001). The side effects were mild in the form of pain on the intradermally injected sides, and mild transient erythema on the microneedling side. The microneedling side showed higher patient satisfaction compared to the intradermally injected side.

CONCLUSION: Both techniques were safe and effective in controlling the FH. Microneedling delivery of BTX-A was less painful and had higher patient satisfaction.

PMID:36213604 | PMC:PMC9529074

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Case Report: Paroxysmal hyperhidrosis as an initial symptom in a patient with anti-LGI1 encephalitis

Front Immunol. 2022 Sep 23;13:986853. doi: 10.3389/fimmu.2022.986853. eCollection 2022.

ABSTRACT

Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is the second most common cause of autoimmune encephalitis and is characterized by cognitive impairment, psychiatric disorders, and faciobrachial dystonic seizures. In recent decades, literature reports have expanded the phenotypic spectrum associated with the LGI1 autoantibody. The present report describes the case of a 58-year-old man who presented with repetitive unilateral hyperhidrosis of the body and arm as an initial symptom and gradually developed psychiatric symptoms, involuntary movements of the face and arms, and progressive cognitive decline. Anti-LGI1 antibodies were positive in both the serum and cerebrospinal fluid at approximately 2 months after symptom onset, and the patient was, therefore, diagnosed with anti-LGI1 encephalitis. His symptoms, namely hyperhidrosis and involuntary movements, were not relieved by antiepileptic drug treatment, but responded favorably to high-dose steroid therapy and intravenous immunoglobulin. We interpreted the repetitive unilateral hyperhidrosis as possible epilepsy. Based on this case, unilateral hyperhidrosis of the body and arm as a rare neurological presentation can be added to the phenotypic spectrum of anti-LGI1 encephalitis, and early recognition of this manifestation might support timely diagnosis and treatment.

PMID:36211373 | PMC:PMC9537696 | DOI:10.3389/fimmu.2022.986853

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Percutaneous radiofrequency sympatholysis in the treatment of primary palmar hyperhidrosis: A retrospective case-controlled study of rib-based anatomical targeting

J Vasc Interv Radiol. 2022 Sep 28:S1051-0443(22)01216-7. doi: 10.1016/j.jvir.2022.09.020. Online ahead of print.

ABSTRACT

PURPOSE: To compare the efficacy, adverse reactions, quality of life and patient satisfaction of percutaneous radiofrequency (RF) thoracic sympatholysis at different rib-based anatomical targets for primary palmar hyperhidrosis (PPHH).

MATERIALS AND METHODS: Patients with PPHH were divided according to the target, namely, the upper edge (group U) and the lateral border (group L) of the fourth rib; there were 30 patients (mean age 24.9 years; 31, 51.7% female) and 60 cases in each group. The Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI) were assessed.

RESULTS: From before RF to 12 months after RF, the proportion of patients with HDSS grades III and IV (100% to 26.7%) and the DLQI (19.78±5.08 to 4.98±4.18) decreased significantly (P <.001). At 3, 6 and 12 months after RF, the HDSS grades were better in group L than in group U (P = .005, .002 and .004). At 6 and 12 months after RF, the DLQI in group L was lower than that in group U (P= .012 and .016), and at 1, 6 and 12 months after RF, patient satisfaction was higher than that in group U (P= .025, .014 and .009). Adverse events were mild; 8 patients (13.3%) demonstrated compensatory hyperhidrosis at 12-months after RF, and there was no difference between the two groups (P=.448); neuralgia and pneumothorax also did not differ (P= .522, and .643).

CONCLUSION: RF sympatholysis targeting the lateral border of the fourth rib had higher efficacy, better quality of life, and higher patient satisfaction.

PMID:36182001 | DOI:10.1016/j.jvir.2022.09.020

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Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis

Surg Laparosc Endosc Percutan Tech. 2022 Sep 5. doi: 10.1097/SLE.0000000000001100. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic thoracoscopic sympathectomy (ETS) is the gold standard therapy for primary focal palmar hyperhidrosis (PFPH), resulting in high patient satisfaction rates. The most common side effect of ETS is compensatory hyperhidrosis (CH). Previous studies followed patients’ satisfaction degree of surgery and the incidence of CH during a limited follow-up period of 1 to 3 years. The purpose of this study was to investigate the long-term outcomes and patient satisfaction after ETS.

MATERIALS AND METHODS: After approval of our institutional review board, we conducted a retrospective review of all consecutive patients who underwent ETS for PFPH at our institution between 1998 and 2019. Electronic medical records were reviewed for short-term outcomes. Long-term outcomes were collected through telephone questionnaires. Primary outcome was the resolution of PFPH. Secondary outcomes were CH and long-term patient satisfaction.

RESULTS: During the study period, 256 patients underwent ETS to treat primary focal palmar hyperhidrosis at our institution between the years 1998-2019. One-hundred and fifty (58.6%) patients agreed to participate in the study and were included in the final analysis. The mean age was 23.8 (17 to 58) years, 56% were females. The mean follow-up time was 11±6.1 (1 to 22) years. Ninety-four percent reported resolution of PFPH; however, CH was reported by 90% of participants. CH decreased mean patient satisfaction score from 4.8±0.5 to 3.8±2 (P=0.009). This effect was more pronounced in patients with CH of the head and neck (P=0.009). Patients’ satisfaction decreased over time from a mean of 4.8±0.4 in the first year after surgery to a mean of 3.7±1.4 12 years or more after surgery (P <0.001). Despite this, 79% of patients reported they would recommend ETS to other patients.

CONCLUSIONS: ETS for PFPH is highly effective and results in high patient satisfaction rates even after long-term follow-up. Despite high rates of postoperative CH, nearly 80% of patients would still recommend the procedure to fellow patients, justifying its reputation as the gold standard treatment for PFPH.

PMID:36130719 | DOI:10.1097/SLE.0000000000001100

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A Pilot Study of the Safety and Effectiveness of a Novel Device in Subjects With Axillary Hyperhidrosis

Dermatol Surg. 2022 Sep 20. doi: 10.1097/DSS.0000000000003598. Online ahead of print.

ABSTRACT

BACKGROUND: One-third of U.S. adults are bothered by excessive sweating and 5% suffer from hyperhidrosis, both of which negatively affect quality-of-life (QoL). A single-use disposable patch using the novel targeted alkali thermolysis (TAT) technology is being developed to address this condition.

OBJECTIVE: Assess the efficacy and safety of the TAT patch for the treatment of excessive sweating using a randomized, double-blind, sham-controlled study design.

MATERIALS AND METHODS: Adults with Hyperhidrosis Disease Severity Scale (HDSS) scores of 3 or 4 (n = 16) were treated with an active or sham patch for up to 3 minutes (as established in a previous unpublished feasibility study) and evaluated weekly for 6 weeks post-treatment. The primary effectiveness measure was improved HDSS at Week-4.

RESULTS: The study met its objective. For the primary efficacy measure, 83% of TAT-treated subjects reported HDSS scores of 1 or 2 at Week-4 versus 0% of sham-treated subjects (p = .0032). Furthermore, 67% of TAT-treated subjects had a 2-point improvement in HDSS scores versus 0% of sham-treated subjects (p = .0123). Quality-of-life improvement correlated with HDSS. The TAT patch seemed to be well-tolerated; one transient moderate adverse event that resolved without sequelae was reported.

CONCLUSION: The TAT patch successfully demonstrated efficacy and was well-tolerated.

PMID:36129240 | DOI:10.1097/DSS.0000000000003598