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November 11, 2018

Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years.

Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years.

Pediatr Dermatol. 2015 Sep-Oct;32(5):663-7

Authors: Wolosker N, Teivelis MP, Krutman M, de Paula RP, Schvartsman C, Kauffman P, de Campos JR, Puech-Leão P

Abstract
Oxybutynin for treating hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

PMID: 25490865 [PubMed – indexed for MEDLINE]

November 11, 2018

Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut.

Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut.

Int J Surg. 2014 Dec;12(12):1478-83

Authors: Panhofer P, Ringhofer C, Gleiss A, Jakesz R, Prager M, Bischof G, Neumayer C

Abstract
INTRODUCTION: Limited procedures at the T4 ganglion show low rates of compensatory sweating (CS). The aim of the study was to compare endoscopic sympathetic block (ESB) via clip application with endothoracic sympathicotomy (ETS) via diathermy with special regard on patients’ quality of life (Qol).
PATIENTS AND METHODS: Treatment success, side effects and patient satisfaction were evaluated in a prospectively gathered database of a tertiary-care referral hospital. Two disease-specific Qol questionnaires were used (Keller, Milanez de Campos).
RESULTS: 406 operations were performed in 205 patients (ESB4 N = 114, ETS4 N = 91) with a median follow-up of 12 months. Both procedures improved Qol significantly (P < 0.001) and the degree of improvement was equal in both groups. Palmar and axillary HH were ameliorated after both procedures (P < 0.001). Accordingly, plantar HH decreased after ESB4 (P = 0.002), while remaining unaltered after ETS4. Nineteen patients (9.3%) reported CS and 10 patients (4.9%) judged it as "disturbing". Nine of the latter belonged to the ETS4 group compared to one ESB patient (P = 0.015). Patients developed higher rates of plantar CS after ETS4 compared to ESB4 (P = 0.006). Five patients (2.4%) from both cohorts reported persistence of axillary HH. Recurrence of axillary symptoms was found in 5 ESB4 patients. Satisfaction rates did not differ significantly.
CONCLUSION: Patients’ Qol and satisfaction rates are similar in both treatment groups for upper limb HH. Outcome and recurrence rates speak in the favor of ETS4, severity of CS and potential reversibility argue for ESB4.

PMID: 25463770 [PubMed – indexed for MEDLINE]

November 11, 2018

3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects.

3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects.

J Laparoendosc Adv Surg Tech A. 2014 Nov;24(11):782-5

Authors: Karamustafaoglu YA, Kuzucuoglu M, Yanik F, Sagiroglu G, Yoruk Y

Abstract
OBJECTIVE: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients.
SUBJECTS AND METHODS: This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007-2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2-T3 for palmar-only hyperhidrosis (n=34), T2-T4 for palmar and axillary hyperhidrosis (n=39), and T3-T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2±23.3 months. Questionnaires assessed patients’ degree of sweating, postoperative CS, overall satisfaction, and complications.
RESULTS: Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence.
CONCLUSIONS: CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.

PMID: 25376004 [PubMed – indexed for MEDLINE]

November 11, 2018

Iontophoresis for palmar and plantar hyperhidrosis.

Iontophoresis for palmar and plantar hyperhidrosis.

Dermatol Clin. 2014 Oct;32(4):491-4

Authors: Pariser DM, Ballard A

Abstract
Iontophoresis is a safe, efficacious, and cost-effective primary treatment of palmar and plantar hyperhidrosis. Decades of clinical experience and research show significant reduction in palmoplantar excessive sweating with minimal side effects. To get the best results from iontophoresis, health care professionals need to provide education on the mechanism of action and benefits, evidence of its use, and creation of a future patient-specific plan of care for continued treatments at home or in the physician’s office. Iontophoresis may be combined with other hyperhidrosis treatments, such as topical antiperspirants and botulinum toxin injections.

PMID: 25152342 [PubMed – indexed for MEDLINE]

November 11, 2018

Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis.

Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis.

Dermatol Clin. 2014 Oct;32(4):505-15

Authors: Weinberg T, Solish N, Murray C

Abstract
Palmar and plantar hyperhidrosis is relatively common and can have severe psychological and medical consequences for those afflicted. A multitude of treatments exist but are often inadequate especially for those with significant disease. In these cases botulinum neurotoxin provides a reliable method for reducing the symptoms and improving quality of life. Although actual administration is relatively straightforward, pain management is a crucial component that requires a mastery of several techniques. Patients have a high degree of satisfaction with botulinum neurotoxin treatment and are motivated to come back for repeat treatments, usually every 6 months.

PMID: 25152344 [PubMed – indexed for MEDLINE]

November 11, 2018

A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis.

A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis.

Drug Des Devel Ther. 2014;8:931-5

Authors: Iannitti T, Palmieri B, Aspiro A, Di Cerbo A

Abstract
BACKGROUND: Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required.
AIM: We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis.
MATERIALS AND METHODS: Twenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied).
RESULTS: Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups.
CONCLUSION: Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.

PMID: 25075176 [PubMed – indexed for MEDLINE]

November 11, 2018

The clinical study of the optimalization of surgical treatment and the traditional Chinese medicine intervention on palmar hyperhidrosis.

The clinical study of the optimalization of surgical treatment and the traditional Chinese medicine intervention on palmar hyperhidrosis.

Cell Biochem Biophys. 2014 Nov;70(2):1401-5

Authors: Yang Y, Yan Z, Fu X, Dong L, Xu L, Wang J, Cheng G

Abstract
To analyze the efficacy of different surgical methods in treating palmar hyperhidrosis and the compensatory hyperhidrosis after surgery and to observe the efficacy of “Energy-boosting and Yin-nourishing anti-perspirant formula” on postsurgical hyperhidrosis patients. Two-hundred patients were randomly assigned to groups A (Chinese and Western medicine, T4 transection plus “Energy-boosting and Yin-nourishing anti-perspirant formula”) and B (Western medicine, T4 transection). The surgical efficiency, recurrence rate, compensatory hyperhidrosis, and the long-term life quality were compared. Another 100 cases (group C, T2 transection) were analyzed as a control group. After surgery, the palmar hyperhidrosis and armpit sweating were relieved in all the three group patients and in 34 % of patients combined with plantar hyperhidrosis, the symptoms were relieved. Transient palmar hyperhidrosis was found in three cases at day 2 to day 5 postoperatively. One case of Horner’s syndrome and one case recurrence were found in group C patients. The compensatory sweating of various degrees occurred in all the three groups. There were 25, 24, and 43 cases in groups A, B, and C, respectively. There is a significant difference between groups C, A, and B. The compensatory sweating in 13 cases of group A and four cases of group B had different degrees of improvement in the follow-up 6 months after surgery. There is a significant difference. Thoracoscopic bilateral T4 sympathetic chain and the Kuntz resection are the optimized surgical treatments for the palmar hyperhidrosis. “Energy-boosting and Yin-nourishing anti-perspirant formula” is effective in treating the postoperative compensatory sweating.

PMID: 24908265 [PubMed – indexed for MEDLINE]

November 11, 2018

Quality of Life in Patients with Focal Hyperhidrosis before and after Treatment with Botulinum Toxin A.

Quality of Life in Patients with Focal Hyperhidrosis before and after Treatment with Botulinum Toxin A.

ISRN Dermatol. 2014;2014:308650

Authors: Kouris A, Armyra K, Christodoulou C, Karimali P, Karypidis D, Kontochristopoulos G

Abstract
The aim of this study is to assess the effectiveness of treatment with BTX-A in quality of life of patients suffering from primary focal hyperhidrosis. Materials and Methods. A total of 119 patients (62 females and 57 males) between 18 and 65 years suffering from moderate to severe focal hyperhidrosis were treated with BTX-A. Thirty-nine patients suffered from axillary hyperhidrosis, 47 patients from palmar hyperhidrosis, 12 patients from plantar hyperhidrosis, and 21 patients from palmar and plantar hyperhidrosis. A baseline and posttreated examination of patients 6 months after BTX-A is included. The Hyperhidrosis Disease Severity Scale (HDSS) was chosen to assess the disease severity and the modified Dermatology Life Quality Index was used (DLQI) to assess the quality of life. Results. Quality of life showed a significant improvement after treatment with BTX-A. The total DLQI score resulted significantly lower than the basal value (P < 0.0001). The seriousness of hyperhidrosis significantly decreased after the treatment (P < 0.0001). In addition, there was notable difference between the posttreatment DLQI scores and pretreatment severity of hyperhidrosis by sex. Conclusions. Treatment with BTX-A led to the reduction of disease severity and improvement of quality of life, while it is a safe, easy to use method with minimal side effects.

PMID: 24891956 [PubMed]

November 11, 2018

Pitted keratolysis, erythromycin, and hyperhidrosis.

Pitted keratolysis, erythromycin, and hyperhidrosis.

Dermatol Ther. 2014 Mar-Apr;27(2):101-4

Authors: Pranteda G, Carlesimo M, Pranteda G, Abruzzese C, Grimaldi M, De Micco S, Muscianese M, Bottoni U

Abstract
Pitted keratolysis (PK) is a plantar skin disorder mainly caused by coryneform bacteria. A common treatment consists of the topical use of erythromycin. Hyperhidrosis is considered a predisposing factor for bacterial proliferation and, consequently, for the onset of PK. The aim of this study was to evaluate the relationship between PK erythromycin and hyperhidrosis. All patients with PK seen in Sant’Andrea Hospital, between January 2009 and December 2011, were collected. PK was clinically and microscopically diagnosed. All patients underwent only topical treatment with erythromycin 3% gel twice daily. At the beginning of the study and after 5 and 10 days of treatment, a clinical evaluation and a gravimetric measurement of plantar sweating were assessed. A total of 97 patients were diagnosed as PK and were included in the study. Gravimetric measurements showed that in 94 of 97 examined patients (96.90%) at the time of the diagnosis, there was a bilateral excessive sweating occurring specifically in the areas affected by PK. After 10 days of antibiotic therapy, hyperhidrosis regressed together with the clinical manifestations. According to these data, we hypothesize that hyperhidrosis is due to an eccrine sweat gland hyperfunction, probably secondary to bacterial infection.

PMID: 24703267 [PubMed – indexed for MEDLINE]

November 11, 2018

Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis.

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Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis.

An Bras Dermatol. 2014 Mar-Apr;89(2):230-5

Authors: Bragança GM, Lima SO, Pinto Neto AF, Marques LM, Melo EV, Reis FP

Abstract
BACKGROUND: Primary hyperhidrosis (PH) can lead to mood changes due to the inconveniences it causes.
OBJECTIVE: This study aimed to examine the existence of anxiety and depression in patients with severe primary hyperhidrosis who sought treatment at a medical office.
METHODS: The questionnaire “Hospital Anxiety and Depression Scale” was used for 197 individuals, in addition to the chi square test and Fisher exact test, p <0.05.
RESULTS: There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with PH, with no link to gender, age or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary (p = 0.02) and craniofacial (p = 0.02) forms. There was an association between patients with depression and anxiety (p = 0.001).
CONCLUSIONS: the involvement of Primary hyperhidrosis was responsible for a higher prevalence of anxiety than that described among the general population and patients with other chronic diseases. Depression had a low prevalence rate, while mild and moderate forms were the most common and frequently associated with anxiety. The degree of anxiety was higher in mild and moderate types than in the severe form.

PMID: 24770497 [PubMed – indexed for MEDLINE]