Treatment – Page 29 – Hyperhidrosis Research . org

January 24, 2019

Topical Treatment of Primary Focal Hyperhidrosis, Part 1.

Topical Treatment of Primary Focal Hyperhidrosis, Part 1.

Int J Pharm Compd. 2019 Jan-Feb;23(1):23-31

Authors: Zur E

Abstract
Primary focal hyperhidrosis is idiopathic, localized, uncontrollable, excessive, and unpredictable sweating beyond what is necessary to regulate body temperature. Primary hyperhidrosis is thought to affect approximately 2% to 3% of the population, and its effect on a patient’s quality of life is very significant. Primary focal hyperhidrosis can be managed using various therapeutic options, including drugs (topical and systemic), nonsurgical interventions (e.g., iontophoresis, botulinum toxin injections), and surgery. This article, which is presented in 2 parts, is a comprehensive review of the topical, evidence-based treatments of primary focal hyperhidrosis, and it covers the following active pharmaceutical ingredients: aluminum salts, methenamine, glycopyrronium salts, oxybutynin chloride; the latter 2 ingredients will be discussed in part 2 of this article. This article discusses the evidence-based data that exists from clinical trials that support the use of topical medications to treat the pathology from efficacy and from a safety point of view. This review also discusses compounding considerations for professionally and safely compounding various topical preparations. In addition, a range of relevant formulas are attached to the article and can be used by compounding pharmacists.

PMID: 30668532 [PubMed – in process]

January 18, 2019

A Retrospective Analysis of the use of Tap Water Iontophoresis for Focal Hyperhidrosis at a District General Hospital: The Patients’ Perspective.

A Retrospective Analysis of the use of Tap Water Iontophoresis for Focal Hyperhidrosis at a District General Hospital: The Patients’ Perspective.

J Dermatolog Treat. 2019 Jan 16;:1-9

Authors: Gollins CE, Carpenter A, Steen C, Bulinski H, Mahendran R

Abstract
Tap water iontophoresis as a treatment for focal hyperhidrosis, is given as an initial series of treatments in hospital followed by home maintenance treatments. Our study assessed quality of life and perception of hyperhidrosis with the use of iontophoresis. All patients treated with iontophoresis at our hospital from 2012 – 2017 were retrospectively assessed (n = 82, mean age 34 years; 60% female). 50 of the 82 patients (mean age 34 years; 60% female) had a pre-treatment DLQI (mean 12.6). Twenty three of these patients (mean age 33 years; 60% female) had a paired pre- and post-treatment DLQI recorded. The average DLQI pre-treatment was 14.1 and post-treatment was 2.2. Therefore, the average reduction (improvement) was 11.9 (p < 0.05). 38 of the 82 patients (46%) completed a telephone interview (mean age 35 years; 65% female). Of this cohort, 24 had an improvement in HDSS following treatment, and the remaining 14 patients had no change. 9 patients (24%) bought their own iontophoresis machine. In these patients, there was a higher average improvement in HDSS (1.8), compared to the total interviewed cohort (1.0). In conclusion tap water iontophoresis can result in a significant improvement in perceived severity of hyperhidrosis and quality of life.

PMID: 30646797 [PubMed – as supplied by publisher]

December 28, 2018

Examining hyperhidrosis: an update on new treatments.

Examining hyperhidrosis: an update on new treatments.

Am J Manag Care. 2018 Dec;24(23 Suppl):S496-S501

Authors: Jacob CI

Abstract
Primary hyperhidrosis is a debilitating condition that causes significant distress and financial burden for affected patients, triggering them to seek medical care for their excessive sweating. Once a diagnosis of primary hyperhidrosis has been established, treatment is initiated to help control sweat production and increase quality of life. While there are no current guidelines in the United States for the treatment of primary hyperhidrosis, there are International Hyperhidrosis Society guidelines that clinicians can use. Currently, a step-therapy approach with the least invasive treatments prioritized first is recommended; the patient’s reported disability should also be taken into consideration when selecting a first-line treatment. This update will discuss new treatment modalities, surgical procedures, associated comorbidities, and the impact on managed care of hyperhidrosis, so clinicians can tailor therapy, improve outcomes, and increase patient satisfaction.

PMID: 30589249 [PubMed – in process]

December 12, 2018

Short-Term Clinical Outcomes and Safety Associated With Percutaneous Radiofrequency Treatment for Excessive Sweating.

Short-Term Clinical Outcomes and Safety Associated With Percutaneous Radiofrequency Treatment for Excessive Sweating.

Aesthet Surg J. 2018 Dec 09;:

Authors: Cohen SR, Goodacre AK, Leong TS, Southwell L, Nomachi T

Abstract
Background: Primary excessive sweating of the axilla affects approximately 3.12% of the US population and has a negative impact on individuals’ lives.
Objectives: We report the safety and effectiveness up to 90 days after treating excessive sweating with percutaneous radiofrequency when using a standardized protocol.
Methods: Twenty adult subjects (13 females, 7 males) aged 18-49 years with excessive sweating were enrolled in a single-center, single-treatment unblinded prospective study conducted at the FACES+ Aesthetic Facility. Forty axilla were treated using the ThermiGen ThermiRF device. The Dermatology Quality of Life Index (DLQI), the Hyperhidrosis Disease Severity Scale (HDSS), and the Odor Scale (OS) were used for qualitative assessment.
Results: Primary and secondary exploratory evaluations were favorable at 90 days, indicating a significant improvement in quality of life and a significant reduction in both sweating and odor. The DLQI demonstrated an average improvement of 10.8 points at day 30, 10.7 at day 60, and 11.1 at day 90 (P = 0.0001). At day 90, 100% of individuals had ≥50% improvement in their excessive sweating based on the HDSS. At the conclusion of the study, 15 subjects had a ≥1-point drop in their OS, whereas 5 subjects had no change (P = 0.0002). There were no serious adverse events reported during this study. All adverse events were classified as mild and moderate and resolved within 2 months.
Conclusions: The addition of the ThermiRF temperature-controlled radiofrequency device to the algorithm of hyperhidrosis treatments reduces sweating and odor with minimal downtime.
Level of Evidence 4:

PMID: 30535166 [PubMed – as supplied by publisher]

November 20, 2018

Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials.

Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials.

Pediatr Dermatol. 2018 Nov 19;:

Authors: Hebert AA, Glaser DA, Green L, Werschler WP, Forsha DW, Drew J, Gopalan R, Pariser DM

Abstract
OBJECTIVES: Hyperhidrosis in pediatric patients has been understudied. Post hoc analyses of two phase 3 randomized, vehicle-controlled, 4-week trials (ATMOS-1 [NCT02530281] and ATMOS-2 [NCT02530294]) were performed to assess efficacy and safety of topical anticholinergic glycopyrronium tosylate (GT) in pediatric patients.
METHODS: Patients had primary axillary hyperhidrosis ≥ 6 months, average Axillary Sweating Daily Diary (ASDD/ASDD-Children [ASDD-C]) Item 2 (sweating severity) score ≥ 4, sweat production ≥ 50 mg/5 min (each axilla), and Hyperhidrosis Disease Severity Scale (HDSS) ≥ 3. Coprimary end points were ≥ 4-point improvement on ASDD/ASDD-C Item 2 (a validated patient-reported outcome) and change in gravimetrically measured sweat production at Week 4. Efficacy and safety data are shown through Week 4 for the pediatric (≥ 9 to ≤ 16 years) vs older (> 16 years) subgroups.
RESULTS: Six hundred and ninety-seven patients were randomized in ATMOS-1/ATMOS-2 (GT, N = 463; vehicle, N = 234); 44 were ≥ 9 to ≤ 16 years (GT, n = 25; vehicle, n = 19). Baseline disease characteristics were generally similar across subgroups. GT-treated pediatric vs older patients had comparable improvements in ASDD/ASDD-C Item 2 (sweating severity) responder rate, HDSS responder rate (≥ 2-grade improvement]), sweat production, and quality of life (mean change from Baseline in Dermatology Life Quality Index [DLQI]/children’s DLQI), with greater improvement vs vehicle. Treatment-emergent adverse events were similar between subgroups, and most were mild, transient, and infrequently led to discontinuation.
CONCLUSIONS: Topical, once-daily GT improved disease severity (ASDD/ASDD-C, HDSS), sweat production, and quality of life (DLQI), with similar findings in children, adults, and the pooled population. GT was well tolerated, and treatment-emergent adverse events were qualitatively similar between subgroups and consistent with other anticholinergics.

PMID: 30451318 [PubMed – as supplied by publisher]

November 11, 2018

Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Patient-Reported Outcomes from the ATMOS-1 and ATMOS-2 Phase III Randomized Controlled Trials.

Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Patient-Reported Outcomes from the ATMOS-1 and ATMOS-2 Phase III Randomized Controlled Trials.

Am J Clin Dermatol. 2018 Oct 30;:

Authors: Pariser DM, Hebert AA, Drew J, Quiring J, Gopalan R, Glaser DA

Abstract
BACKGROUND: Glycopyrronium tosylate (GT) is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged ≥ 9 years. GT was evaluated for primary axillary hyperhidrosis in replicate, randomized, double-blind, vehicle-controlled, phase III trials. GT reduced sweating severity and production versus vehicle and was generally well tolerated.
OBJECTIVE: Our objective was to evaluate patient-reported outcomes (PROs) from these trials.
METHODS: Patients aged ≥ 9 years with primary axillary hyperhidrosis ≥ 6 months, gravimetrically measured sweat production ≥ 50 mg/5 min in each axilla, Axillary Sweating Daily Diary (ASDD) Item 2 severity score ≥ 4, and Hyperhidrosis Disease Severity Scale (HDSS) score ≥ 3 were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. The 4-item ASDD, 6 Weekly Impact (WI) items, Patient Global Impression of Change (PGIC), HDSS, and Dermatology Life Quality Index (DLQI) were utilized.
RESULTS: In the pooled population, 463 patients were randomized to GT and 234 to vehicle; 426 (92.0%) and 225 (96.2%) completed the trials. At baseline, most patients considered their axillary sweating to be at least moderate in severity, impact, and bothersomeness (ASDD items 2, 3, and 4, respectively). Improvement was substantially greater for GT than for vehicle at every study week, and, at week 4, ASDD scores improved from baseline by 62.6 versus 34.0% (severity), 65.5 versus 40.3% (impact), and 65.4 versus 39.0% (bothersomeness). Improvements favoring GT versus vehicle also occurred for WI items, PGIC, HDSS, and DLQI.
CONCLUSIONS: PRO results demonstrated that GT reduced the disease burden of primary axillary hyperhidrosis.
TRIAL REGISTRATION: Clinicaltrials.gov; ATMOS-1 (NCT02530281), ATMOS-2 (NCT02530294).

PMID: 30378087 [PubMed – as supplied by publisher]

November 11, 2018

Changes in Palm Temperature as Predictor of Long-term Cure of Sympathicotomy for Palmar hyperhidrosis?

Changes in Palm Temperature as Predictor of Long-term Cure of Sympathicotomy for Palmar hyperhidrosis?

J Neurol Surg A Cent Eur Neurosurg. 2018 Oct 31;:

Authors: Liu G, Kang G, Huang J, Xie S, Hu H

Abstract
OBJECTIVES: To investigate the long-term relationship between intraoperative temperature changes of the palm, treatment effects and compensatory hyperhidrosis (CH).
METHODS: We retrospectively analyzed the data of 41 patients with palmar hyperhidrosis who underwent bilateral endoscopic sympathicotomy 3 to 6 years ago. Before and after the operation, changes in ipsilateral palm temperature were monitored and recorded to evaluate the curative effect of the sympathicotomy.
RESULTS: All operations were performed successfully. Concerning cure, there was no statistically significant difference between patients with different maximum temperature (Tmax) values (p = 0.455). There was a very weak correlation between postoperative palm temperature (34.309 ± 1.377°C) (p = 0.049; correlation coefficient - 0.218). The T3 + T4 sympathicotomies had a higher Tmax (p = 0.000). The incidence and degree of CH had no relationship with Tmax in the left (p = 0.266 and p = 0.168, respectively) or the right hand (p = 0.640 and p = 0.824, respectively).
CONCLUSIONS: Temperature change has a relationship with surgery, but it cannot directly predict the long-term curative effect of a sympathicotomy or the occurrence of CH. Additional studies are required.

PMID: 30381813 [PubMed – as supplied by publisher]

November 11, 2018

[Hyperhidrosis-aetiopathogenesis, diagnosis, clinical symptoms and treatment].

[Hyperhidrosis-aetiopathogenesis, diagnosis, clinical symptoms and treatment].

Hautarzt. 2018 Oct;69(10):857-869

Authors: Wohlrab J, Kreft B

Abstract
Although primary hyperhidrosis is a common disease, secondary symptomatic hyperhidrosis is rather rare. Primary hyperhidrosis is a complex neuropathic dysregulation with a genetic predisposition and is diagnosed when patients show pathologic sweating patterns and excessive sweating for at least 6 months and fulfill at least four of the following criteria: affected areas are axillae and/or palms and/or soles and/or forehead; symmetry; no night sweating; at least once a week; onset before the age of 25; positive family history; negative impact on daily activities. Frequently used therapies are topical aluminum salts and anticholinergics, iontophoresis in water, and intracutaneous botulinum toxin. Anticholinergics are also used as systemic treatment. Surgical procedures are used as a last result. Furthermore procedures using thermolysis have been developed.

PMID: 30218113 [PubMed – in process]

November 11, 2018

CT-Guided Chemical Thoracic Sympathectomy versus Botulinum Toxin Type A Injection for Palmar Hyperhidrosis.

CT-Guided Chemical Thoracic Sympathectomy versus Botulinum Toxin Type A Injection for Palmar Hyperhidrosis.

Thorac Cardiovasc Surg. 2018 Sep 14;:

Authors: Yang H, Kang J, Zhang S, Peng K, Deng B, Cheng B

Abstract
BACKGROUND: The present study aimed to evaluate and compare the efficacy of botulinum toxin type A (BTX-A) injection versus thoracic sympathectomy for idiopathic palmar hyperhidrosis.
METHODS: Fifty-one patients with idiopathic palmar hyperhidrosis were treated with either BTX-A injection or thoracic sympathectomy between March 2013 and April 2016. The severity of palmar hyperhidrosis was qualitatively measured via the Hyperhidrosis Disease Severity Scale (HDSS). All patients completed a questionnaire that detailed the time taken for the treatment to work, local or systemic adverse effects, and pre- and post-treatment severity of hyperhidrosis. The efficacy and adverse effects of the two treatments were compared and analyzed.
RESULTS: Hyperhidrosis-related quality of life improved quickly and significantly in the BTX-A group (26 patients) and the sympathectomy group (25 patients). Compared with pre-treatment, the HDSS score significantly reduced after treatment in both groups (p < 0.05). All patients in the sympathectomy group had cessation of sweating of the hands after treatment, and this curative effect lasted for 12 months. In contrast, the treatment took more time to work in the BTX-A group, and the curative effect lasted for a much shorter period (3 months). The sympathectomy group had a significantly lesser mean HDSS score than the BTX-A group at 1 week, 3 months, 6 months, 9 months, and 12 months after treatment (p < 0.05). The sympathectomy group experienced more complications than the BTX-A group.
CONCLUSION: For palmar hyperhidrosis, thoracic sympathectomy is more effective and has a longer lasting curative effect than BTX-A injection, but thoracic sympathectomy has more complications.

PMID: 30216949 [PubMed – as supplied by publisher]

November 11, 2018

Sweaty feet in adolescents-Early use of botulinum type A toxin in juvenile plantar hyperhidrosis.

Sweaty feet in adolescents-Early use of botulinum type A toxin in juvenile plantar hyperhidrosis.

Pediatr Dermatol. 2018 Nov;35(6):784-786

Authors: Bernhard MK, Krause M, Syrbe S

Abstract
BACKGROUND/OBJECTIVES: Plantar hyperhidrosis can have severe social effects on children and adolescents. Therapeutic options include antiperspirants and surgical interventions (eg, sympathectomy). Botulinum type A toxin is approved for axillary hyperhidrosis in adults only. The aim of the study was the determination of effect and safety of botulinum type A toxin in plantar hyperhidrosis in juvenile patients.
METHODS: Children and adolescents with idiopathic focal plantar hyperhidrosis were treated with 50-100 U of botulinum type A toxin per sole. Local anesthesia was provided using topical eutectic mixture of local anesthetics cream and ice, in combination with midazolam as an anxiolytic.
RESULTS: Fifteen patients (aged 12-17) were included in the study. Best results were achieved with a dose of 75-100 U of botulinum type A toxin per sole. Two patients did not benefit from the therapy, and 11 (73%) were satisfied with the results. Nine patients (60%) experienced pain at the injection site for a maximum duration of 3 days. One patient reported transient focal weakness for 4 weeks.
CONCLUSION: Botulinum type A toxin seems to be a safe secondary treatment option for plantar hyperhidrosis in adolescents aged 12 and older. A dose of 75-100 U per sole resulted in a good therapeutic effect of variable duration in most patients. There were no severe side effects.

PMID: 30178509 [PubMed – indexed for MEDLINE]