A collection of the latest publications on hyperhidrosis
Development of inflammatory nodules and scarring mimicking hidradenitis suppurativa after treatment of axillary hyperhidrosis using a microwave-based energy device.
JAAD Case Rep. 2020 Oct;6(10):999-1000
Authors: Aleisa A, Feingold DS
PMID: 32995428 [PubMed]
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Efficacy and Tolerability of 20% Aluminum Sesquichlorohydrate vs 20% Aluminum Chloride for the Treatment of Axillary Hyperhidrosis: A Randomized Controlled Trial.
Dermatol Ther. 2020 Sep 29;:e14354
Authors: Thianboonsong T, Kanokrungsee S, Paichitrojjana A, Udompataikul M, Kamanamool N, Rojhirunsakool S
Abstract
This study evaluated the efficacy and tolerability of topical aluminum sesquichlorohydrate (AS) when compared to aluminum chloride (AC) as a treatment for primary axillary hyperhidrosis. Twenty subjects were included in this randomized, controlled, split-side 8-week study. All participants applied 20% AS and 20% AC lotions in their axillae (one treatment per axilla) every night for 2 weeks; next, the application was reduced to three times a week for 4 weeks. The assessment was performed using the sweating intensity visual scale (SIVS), hyperhidrosis disease severity score (HDSS), patient satisfaction score, and the appearance of adverse effects on weeks 0, 1, 2, 4, 6, and 8. Both AS as well as AC application showed positive results, significantly differing from the baseline, as assessed using SIVS, HDSS, and patient satisfaction score at every follow-up visit; however, no significant difference was observed between the AS and AC groups at any follow-up visit. The mean time of response was 1.14 weeks for both treatments. A side effect was observed in one subject (5%), who reported itching on the AC axilla. The therapeutic effects persisted even after reducing the frequency of application and lasted for at least two weeks after cessation of use. In conclusion, topical 20% AS demonstrated similar efficacy to topical 20% AC in the treatment of primary axillary hyperhidrosis, with a high safety profile. This article is protected by copyright. All rights reserved.
PMID: 32990370 [PubMed – as supplied by publisher]
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Thoracoscopic sympathicotomy in children for the treatment of palmar and axillary primary focal hyperhidrosis: Caution advocated.
J Pediatr Surg. 2020 Sep 05;:
Authors: Vasconcelos-Castro S, Borges-Dias M, Soares-Oliveira M
PMID: 32981661 [PubMed – as supplied by publisher]
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Oxybutynin in primary hyperhidrosis: a long-term real-life study.
Dermatol Ther. 2020 Sep 27;:e14344
Authors: Almeida ART, Ferrari F, Restrepo MVS, Rocha VB
Abstract
Hyperhidrosis is a condition of excessive sweating beyond physiological parameters that can seriously impair quality of life. This study aims to evaluate the oral oxybutynin effectiveness in hyperhidrosis, besides its tolerance and safety. In a real-life long-term study, thirty patients with primary hyperhidrosis and Hyperhidrosis Disease Severity Scale (HDSS) with score of at least two were submitted to a questionnaire to assess demographic data, HDSS and side effects of oxybutynin. Most patients were women (n = 23, 76.7%), median age was 40y (range 12-70, SD 17.5) and 17(56.7%) had family history of hyperhidrosis. The most common hyperhidrosis form was axillary (n = 15, 50.0%), followed by palmoplantar (n = 8, 26.7%), cranio-facial (n = 11, 36.7%) and trunk (n = 5, 16.7%). Median duration of treatment was 2.4y (range 1-6y, SD 1.3). Thus, all patients used oxybutynin for at least one year, 30% for two years, 20% three years, 17% four years and 3% six years. There was a significant improvement in HDSS score of patients (P < 0.001). This real life study suggests that oxybutynin is effective and safe for treatment of hyperhidrosis, both in children and adults, with mild and tolerable side effects, with significant improvement in HDSS. This article is protected by copyright. All rights reserved.
PMID: 32981151 [PubMed – as supplied by publisher]
Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy.
Med J Malaysia. 2020 Sep;75(5):555-560
Authors: Ho YL, Fauzi M, Sothee K, Basheer A
Abstract
INTRODUCTION: Hyperhidrosis is a disorder of excessive and uncontrollable sweating beyond the body’s physiological needs. It can be categorised into primary or secondary hyperhidrosis based on its aetiology. Detailed history review including onset of symptoms, laterality of disease and family history are crucial which may suggest primary hyperhidrosis. Secondary causes such as neurological diseases, endocrine disorders, haematological malignancies, neuroendocrine tumours and drugs should be adequately examined and investigated prior to deciding on further management. The diagnosis of primary hyperhidrosis should only be made only after excluding secondary causes. Hyperhidrosis is a troublesome disorder that often results in social, professional, and psychological distress in sufferers. It remains, however, a treatment dilemma among some healthcare providers in this region.
METHODS: The medical records and clinical outcomes of 35 patients who underwent endoscopic thoracic sympathectomy for primary hyperhidrosis from 2008 to 2018 in Department of Cardiothoracic Surgery were reviewed.
RESULTS: The mean age of the patients was 27±10.1years, with male and female distribution of 18 and 17, respectively. Fifty-one percent of patients complained of palmar hyperhidrosis, while 35% of them had concurrent palmaraxillary and 14% had palmar-plantar-axillary hyperhidrosis. Our data showed that 77% (n=27) of patients were not investigated for secondary causes of hyperhidrosis, and they were not counselled on the non-surgical therapies. All patients underwent single-staged bilateral endoscopic thoracic sympathectomy. There was resolution of symptoms in all 35 (100%) patients with palmar hyperhidrosis, 13(76%) patients with axillary hyperhidrosis and only 2 (50%) patients with plantar hyperhidrosis. Postoperatively 34.3% (n=12) of patients reported compensatory hyperhidrosis. There were no other complications such as pneumothorax, chylothorax, haemothorax and Horner’s Syndrome.
CONCLUSION: Clinical evaluation of hyperhidrosis in local context has not been well described, which may inadvertently result in the delay of appropriate management, causing significant social and emotional embarrassment and impair the quality of life of the subjects. Detailed clinical assessment and appropriate timely treatment, be it surgical or non-surgical therapies, are crucial in managing this uncommon yet distressing disease.
PMID: 32918426 [PubMed – as supplied by publisher]
Treatment Patterns, Depression, and Anxiety Among US Patients Diagnosed with Hyperhidrosis: A Retrospective Cohort Study.
Dermatol Ther (Heidelb). 2020 Sep 11;:
Authors: Klein SZ, Hull M, Gillard KK, Peterson-Brandt J
Abstract
INTRODUCTION: Hyperhidrosis is associated with social and emotional stress due to limitations on health-related quality of life. This study examined real-world treatment patterns and concomitant depression and/or anxiety in patients with hyperhidrosis.
METHODS: Commercial health plan members in the US with ≥ 2 hyperhidrosis diagnosis codes and/or antiperspirant prescription claims were identified from January 2010 through November 2017. A control cohort (CC) of patients without hyperhidrosis was matched to the hyperhidrosis cohort on demographic characteristics. Depression and/or anxiety were identified by ≥ 1 relevant diagnosis code or pharmacy claim. A multivariable logistic regression model estimated odds of treatment in the hyperhidrosis cohort, and depression/anxiety in the hyperhidrosis cohort and CC, adjusting for patient characteristics.
RESULTS: A total of 44,484 patients with hyperhidrosis were identified, of whom 58.5% were female, with a mean (± standard deviation) age of 36.5 ± 16.5 years (83.5% ≥ 18 years). A small majority of patients (51.6%, 0.69/person-year) received treatment with prescription antiperspirants. Post-index oral systemic therapies, medical procedures, and surgical options were uncommon. At 12 months post-index, 48.4% of the sample had not filled a prescription for extra- or prescription-strength antiperspirants. Compared with the CC (n = 137,451), a higher percentage of patients with hyperhidrosis had depression or anxiety reported during follow-up (41.1 vs. 28.2%, p < 0.001); this corresponded to higher adjusted odds of depression/anxiety in patients with hyperhidrosis [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.72-1.80, p < 0.001]. Baseline depression and/or anxiety were associated with lower odds of receiving hyperhidrosis treatment (OR 0.77, 95% CI 0.73-0.80), as was increasing age and male gender. Patients with hyperhidrosis also had more frequent incident depression/anxiety during follow-up (18.2 vs. 10.6%, p < 0.001).
CONCLUSION: In this real-world analysis, hyperhidrosis was associated with increased odds of depression and/or anxiety. However, relatively low percentages of patients received prescription topical or oral treatments or underwent surgery, suggesting that tolerability, efficacy, and provider awareness may be limiting factors in the effective treatment of hyperhidrosis.
PMID: 32915394 [PubMed – as supplied by publisher]
A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating.
Wideochir Inne Tech Maloinwazyjne. 2020 Sep;15(3):488-495
Authors: Xie H, Lu T, Zhu Y, Zhu D, Wei T, Yuan G, Yang Y, Liu X
Abstract
Introduction: Thoracoscopic sympathectomy (TS) has been proven to be a safe and effective treatment for primary palmar hyperhidrosis (PH). However, the complications include compensatory hyperhidrosis (CH), and over-dry hands may occur in some patients after TS.
Aim: To compare the therapeutic effect of T3 and T4 TS on primary PH and primary PH with axillary and plantar sweating.
Material and methods: We retrospectively analyzed 100 patients with PH who had undergone T3 (group A, n = 49) or T4 (group B, n = 51) TS in our department, with at least 1 year of postoperative follow-up.
Results: At discharge, no major complications or deaths occurred in either group. The condition of sweaty hands was fully improved in 44 of 49 patients in group A and all patients in group B, with a significant difference (p = 0.031). After 12 months of follow-up, 18 (36.7%) patients in group A and 4 (7.8%) patients in group B developed CH, 16 (48.5%) patients in group A and 24 (77.4%) patients in group B had improved axillary sweating, with a significant difference (p < 0.05). The satisfaction rate of group B was significantly higher than that of group A (p < 0.01).
Conclusions: Both T3 and T4 TS were safe and effective treatments for PH patients, but the incidence of CH in T4 TS was lower than that in T3 TS. T3 TS may be more suitable for patients with severe PH, while T4 TS had a better therapeutic effect on PH patients with axillary sweating.
PMID: 32904609 [PubMed]
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Adjusting oral glycopyrrolate medication for hyperhidrosis to reflect seasonal temperature variations.
Dermatol Ther. 2020 Aug 29;:e14249
Authors: García-Souto F, Del Boz J, Polo-Padillo J
Abstract
The condition of most patients with hyperhidrosis (HH) is known to worsen with increased temperature. However, most prior studies of oral glycopyrrolate (OGly) for the treatment of HH have assumed a stable treatment protocol, without taking into account seasonal variations in temperature. The main aim of this study is to evaluate the outcomes derived from performing a seasonal adjustment of the dose of OGly for patients with HH. A prospective study of patients who began OGly for HH, and maintained treatment for at least one year, was performed. All patients had experienced treatment failure with oral oxybutynin. All were recommended to vary the dose of medication according to the time of year. Of the thirty-five patients included in the study, twenty (57.14%) varied the dose. Those with palmar and plantar HH had a greater propensity to do so. The patients who varied the dose according to the time of year were significantly more likely to report an “Excellent” response after 12 months of treatment. The frequency of adverse effects was 71.4% with no significant differences among the study groups. However, there was a significantly higher proportion of adverse effects other than oral xerosis in the group that did not vary the dose. This article is protected by copyright. All rights reserved.
PMID: 32860330 [PubMed – as supplied by publisher]
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Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin.
Dermatol Ther. 2020 Aug 21;:
Authors: Del Boz J, García-Souto F, Rivas-Ruiz F, Polo-Padillo J
Abstract
Oral anticholinergics such as oxybutynin (OOx) and glycopyrrolate (OGly) are frequently used in the management of hyperhidrosis. Although OOx is considered currently the anticholinergic drug of first choice, OGly is a safe and effective alternative if OOx fails. The aim of this study was to identify the main variables associated with treatment adherence by patients receiving OGly, for whom previous treatment with OOx had failed. A prospective study was conducted of patients with hyperhidrosis receiving treatment with OGly in the period 2012-19. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. A total of 58 patients (41 women), with a mean age of 35.9 years, were included in the study. The median follow-up period was 32 months. At 3 months, 70.7% of the patients had responded to treatment (excellent response: 75.6%), and adverse effects were reported by 70.7%. At 12 months, 53.4% had responded (excellent response: 74.2%), with adverse effects in 70.9%. The variables associated with poorer adherence were affected areas: palms of the hands, soles of the feet and armpits. The only variable associated with greater adherence was the generalised presence of hyperhidrosis. Our results provide valuable insights into the outcomes achieved when OGly is used to treat hyperhidrosis. This article is protected by copyright. All rights reserved.
PMID: 32827198 [PubMed – as supplied by publisher]
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Tolerance of Oral Oxybutynin in The Treatment Of Hyperhidrosis.
Dermatol Ther. 2020 Aug 14;:
Authors: Del Boz Gonzalez J, Barón DR, Millán-Cayetano JF, de Troya Martin M
Abstract
BACKGROUND: Oral oxybutynin (OOx) is an effective and safe treatment for the treatment of hyperhidrosis (HH). However, in some patients a loss of efficacy during prolonged treatment has been observed. Analysis of these cases could enable us to identify patients susceptible to OOx tolerance. An alternative treatment might then be considered.
OBJECTIVES: To assess tolerance to OOx in the treatment of HH. Secondarily, to assess epidemiological data and the duration of efficacy, together with the probable causes of any loss in this respect.
METHODS: Retrospective study of patients who started treatment with OOx for HH during the period 2007-2017 and who either abandoned this treatment due to loss of efficacy or needed higher daily doses to maintain the initial efficacy. Epidemiological data were collected, the duration of the efficacy of OOx was recorded and the possible causes of loss of efficacy were considered.
RESULTS: The development of tolerance was suspected in 18 patients (8.5%) of the 211 who had previously responded to OOx. Thirteen patients abandoned OOx due to its lack of efficacy and five had to increase the dose in order to maintain efficacy. In seven patients, tolerance to the drug appeared in the first year of treatment, while in the remaining eleven, the tolerance appeared later.
CONCLUSIONS: Most patients achieved and maintained good control of HH with long-term OOx. However, in some cases the efficacy of the drug decreases. The study analysis did not produce findings enabling us to predict a loss of treatment efficacy. This article is protected by copyright. All rights reserved.
PMID: 32794595 [PubMed – as supplied by publisher]