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November 11, 2018

Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel.

Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel.

J Eur Acad Dermatol Venereol. 2013 Sep;27(9):1120-6

Authors: van der Snoek EM, Ekkelenkamp MB, Suykerbuyk JC

Abstract
BACKGROUND: Pitted keratolysis (PK) is a common plantar skin manifestation in army personnel, farmers and athletes. Due to pain while walking and marching, the condition can cause reduced operational deployability (in case of army personnel).
OBJECTIVE: We used a questionnaire to investigate currently used treatment options of PK and perceptions on perceived efficacy of these treatments among Royal Netherlands Armed Forces primary health care physicians.
METHODS: A cross-sectional anonymous postal questionnaire survey was conducted among all Royal Netherlands Armed Forces primary health care physicians. In addition to question about prescription behaviour on the treatment of PK by topical and oral therapies and given non-pharmacological treatment, several questions assessed perceived efficacy of these therapies.
RESULTS: Of the 164 eligible primary health care physicians, 51 (31.1%) completed the questionnaire. Half of physicians had seen less than five patients with PK in the preceding year. Two-thirds of physicians reported problems with operational deployability in less than 10% of army personnel with PK. PK was treated mostly with topical and non-pharmacological treatments. Oral therapy was seldom prescribed. For hyperhidrosis, aluminium chloride hexahydrate was used in most cases.
CONCLUSION: PK and related reduced operational deployability were less often reported than expected in this study. Dutch physicians prefer combined topical antibiotic therapy with non-pharmacological treatments and perceive the efficacy of topical antibiotic therapy superior to non-pharmacological treatments. Preventive measures, topical antibiotic therapy and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with PK.

PMID: 22882561 [PubMed – indexed for MEDLINE]

November 11, 2018

[Clinical importance of CT-assisted sympathicolysis in primary, focal plantar and palmar hyperhidrosis].

[Clinical importance of CT-assisted sympathicolysis in primary, focal plantar and palmar hyperhidrosis].

Rofo. 2012 Jul;184(7):624-8

Authors: Scheer F, Wins A, Kamusella P, Wiggermann P, Wissgott C, Andresen R

Abstract
PURPOSE: The objective of this study was to evaluate the benefit of thoracic and lumbar computed tomographic-assisted sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis.
MATERIALS AND METHODS: Thoracic and/or lumbar CTSy was conducted on 101 patients (average age 37.5 ± 15.5 years) with primary, focal hyperhidrosis of the hands and/or feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients were divided into groups with palmar, palmoplantar and plantar hyperhidrosis. The patients evaluated the severity of their symptoms prior to the intervention and 2 days, 6 months and 12 months after the intervention using a Dermatology Quality of Life Index (DLQI) and side effects.
RESULTS: The performed interventions led to a statistically significant decrease in the preinterventional severity of symptoms after the intervention (2 days), and 6 and 12 months after CTSy in the palmar, palmoplantar and plantar (p < 0.01) group. The technical success rate of CTSy was 100 %. No major complications occurred. Patients reported compensatory perspiration over the course of treatment, neuralgia and paraesthesia as side effects. The differentiated assessment of the strength of perspiration of the hands and feet showed statistically significant differences between the foot and hand region, whereby the decrease in sweat secretion of the feet was more significant and more lasting (p < 0.02).
CONCLUSION: After conservative measures have been exhausted, CT-assisted sympathicolysis represents a therapeutic option with minimal side effects for patients with primary, focal hyperhidrosis.

PMID: 22661390 [PubMed – indexed for MEDLINE]

November 11, 2018

Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system.

Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system.

J Neurol. 2013 Mar;260(3):701-13

Authors: Dressler D

Abstract
Botulinum toxin (BoNT) has gained widespread use for the treatment of overactive muscles, overactive exocrine glands and, most recently, non-muscular pain conditions. Autonomic conditions treated with BoNT include achalasia, gastroparesis, sphincter of Oddi spasms, and unspecific esophageal spasms in gastroenterology and prostate disorders in urology. BoNT’s use for autonomic conditions related to neurology includes various forms of bladder dysfunction (detrusor sphincter dyssynergia, idiopathic detrusor overactivity, neurogenic detrusor overactivity, urinary retention and bladder pain syndrome), pelvic floor disorders (pelvic floor spasms and anal fissures), hyperhidrosis (axillary, palmar, and plantar hyperhidrosis, diffuse sweating, Frey’s syndrome) and hypersalivation (hypersalivation in Parkinsonian syndromes, motor neuron disease, neuroleptic use, and cerebral palsy). Hyperhidrosis, hypersalivation, some forms of bladder dysfunction and pelvic floor disorders can easily be treated by neurologists. Most bladder dysfunctions require cooperation with urology departments.

PMID: 22878428 [PubMed – indexed for MEDLINE]

November 11, 2018

Papillon-lefevre syndrome: a combined approach from the dermatologist and dentist – a clinical presentation.

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Papillon-lefevre syndrome: a combined approach from the dermatologist and dentist – a clinical presentation.

Indian J Dermatol. 2011 Nov;56(6):740-3

Authors: Muppa R, Prameela B, Duddu M, Dandempally A

Abstract
Papillon-Lefevre syndrome (PLS) is a rare disease characterized by skin lesions, which includes palmar-plantar hyperkeratosis and hyperhidrosis with severe periodontal destruction involving both the primary and the permanent dentitions. It is transmitted as an autosomal-recessive condition, and consanguinity of parents is evident in about one-third of the cases. This paper describes a 13-year-old male patient who presented to the department of pedodontics, with rapidly progressing periodontitis. A general physical examination revealed scaling on the hands and feet, which had been medically diagnosed as PLS. The incidence of this rare entity is increasing in the recent times, which is associated with irreparable periodontal destruction at an early age, with not so prominent skin lesions in some cases. In such instances, the dentist has a more important role in diagnosing, treatment planning and preservation of the periodontal tissues and, at the same time, referring for the treatment of the skin lesions. This paper emphasizes the combined effort of the two specialities in order to maintain skin as well as dental conditions in health by early intervention and a synergistic treatment approach.

PMID: 22345785 [PubMed]

November 11, 2018

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

J Vasc Surg. 2012 Jun;55(6):1696-700

Authors: Wolosker N, de Campos JR, Kauffman P, Puech-Leão P

Abstract
INTRODUCTION: Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects.
OBJECTIVE: This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis.
METHODS: This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life.
RESULTS: Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
CONCLUSIONS: Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life.

PMID: 22341836 [PubMed – indexed for MEDLINE]

November 11, 2018

Treatment of hyperhidrosis with botulinum toxin.

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Treatment of hyperhidrosis with botulinum toxin.

Aesthet Surg J. 2012 Feb;32(2):238-44

Authors: Doft MA, Hardy KL, Ascherman JA

Abstract
Botulinum toxin type A is a safe and effective method for treating focal hyperhidrosis, providing longer-lasting results than topical treatments without the necessity of invasive surgical procedures. Although more useful for axillary hyperhidrosis, botulinum toxin injections can also be effective in treating palmar and plantar disease. The effects of botulinum toxin last for six to nine months on average, and treatment is associated with a high satisfaction rate among patients. In this article, the authors discuss their preferred methods for treating axillary, palmar, and plantar hyperhidrosis. This article serves as guide for pretreatment evaluation, injection techniques, and posttreatment care.

PMID: 22328694 [PubMed – indexed for MEDLINE]

November 11, 2018

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

Surg Endosc. 2012 Apr;26(4):1146-52

Authors: Ramos R, Ureña A, Rivas F, Macia I, Rosado G, Pequeño S, Masuet C, Badia M, Miguel M, Delgado MA, Escobar I, Moya J

Abstract
BACKGROUND: Thoracoscopic bilateral sympathicolysis of the T3 sympathetic ganglia is an effective treatment for palmar hyperhidrosis, though not without potential complications and consequences such as Horner’s syndrome. The objective of our study is to evaluate the repercussion of T3 sympathetic denervation on pupillary tone in patients with primary hyperhidrosis.
METHODS: A prospective descriptive study of 25 patients (50 pupils) ranging in age from 18 to 40 years with an indication of T3 sympathectomy for palmar hyperhidrosis or palmar-plantar hyperhidrosis from 1 December 2009 to 31 December 2010 was carried out. We excluded all patients with previous eye surgery or other ocular pathologies and those with pathologies that contraindicate denervation surgery and ocular study. All patients were evaluated before surgery and at 24 h and 1 month after sympathetic denervation. Pupil/iris (P/I) ratio was measured before and after instillation of sympathicomimetic eye drops containing 1% apraclonidine.
RESULTS: No statistically significant differences were found when we compared the preoperative P/I ratio of the left eyes versus the right eyes (P = 0.917). We found statistically significant differences (P < 0.001) between the preoperative P/I ratio [0.40 mm (standard deviation, SD 0.07 mm)] and the postoperative basal ratio [0.33 (SD 0.05)] at 24 h. The P/I ratio at 24 h increased from 0.33 to 0.36 (SD 0.09), a nonsignificant increase (P = 0.45), after instillation of medicated eye drops. No differences were observed between the preoperative [0.40 (SD 0.07)] and 1-month basal values [0.38 (SD 0.07)], and instillation of apraclonidine no longer induced a hypersensitivity response.
CONCLUSIONS: T3 sympathectomy leads to subclinical pupillary dysfunction with a tendency for miosis, even though this impairment is not generally evident on standard physical examination or reported by patients. This subclinical dysfunction may be caused by injury to an undefined group of presympathetic nerve cell axons in caudocranial direction that communicate with the cervical sympathetic ganglia and whose function is mydriatic pupillary innervation.

PMID: 22044979 [PubMed – indexed for MEDLINE]

November 11, 2018

Hyperhidrosis plantaris – a randomized, half-side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride.

Hyperhidrosis plantaris – a randomized, half-side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride.

J Dtsch Dermatol Ges. 2012 Feb;10(2):115-9

Authors: Streker M, Reuther T, Hagen L, Kerscher M

Abstract
BACKGROUND: Primary focal hyperhidrosis plantaris can cause impairment in social, physical, leisure and occupational activities. Topical treatment with aluminium chloride is the first-line treatment. The aim of this trial was to evaluate efficacy and safety of two different concentrations of aluminium chloride hexa-hydrate (12.5%, 30%) for 6 weeks.
PATIENTS AND METHODS: 20 volunteers with hyperhidrosis plantaris were included. Efficacy was evaluated using a clinical rating scale of the hyperhidrosis level and qualitative assessments including Minor’s (iodine-starch) test and a standardized sniff test. Furthermore a patient questionnaire and measurements of skin surface pH were done to evaluate the subjective assessments and side effects.
RESULTS: The hyperhidrosis level significantly decreased in both concentrations. There were no differences in tolerability regarding the skin surface pH and the patient questionnaires. In addition the hidrotic areas decreased after application of both products and the sniff test improved.
CONCLUSION: Topical application of an antiperspirant containing aluminium chloride reduced sweat production in plantar hyperhidrosis significantly. As both 12.5% and 30% were efficacious and safe, we would recommend 12.5% for outpatient treatment.

PMID: 21848980 [PubMed – indexed for MEDLINE]

November 11, 2018

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.

Mayo Clin Proc. 2011 Aug;86(8):721-9

Authors: Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ

Abstract
OBJECTIVE: To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
PATIENTS AND METHODS: We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.
RESULTS: Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).
CONCLUSION: In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

PMID: 21803954 [PubMed – indexed for MEDLINE]

November 11, 2018

Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

J Eur Acad Dermatol Venereol. 2012 Jan;26(1):1-8

Authors: Hoorens I, Ongenae K

Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).

PMID: 21749468 [PubMed – indexed for MEDLINE]