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Diltiazem for clozapine-induced generalized hyperhidrosis

Ment Health Clin. 2023 Aug 7;13(4):193-195. doi: 10.9740/mhc.2023.08.193. eCollection 2023 Aug.

ABSTRACT

BACKGROUND: Clozapine can be associated with significant side effects and tolerability issues. Hyperhidrosis occurs less commonly and is unanticipated by clinicians because of clozapine’s significant anticholinergic activity.

CASE REPORT: A 34-year-old female developed clozapine-induced nocturnal, generalized hyperhidrosis following initial titration to 400 mg/day. Dose reduction did not decrease the side effect. Treatment with an anticholinergic medication could not be initiated because of constipation. Treatment with a beta blocker resulted in worsening of asthma. Treatment with a calcium channel blocker, diltiazem CD 180 mg/day, resulted in a significant reduction in hyperhidrosis.

CONCLUSION: This case supports the use of calcium channel blockers to reduce clozapine-induced hyperhidrosis and offers an alternative to anticholinergic medications that may negatively impact clozapine tolerability.

PMID:37860588 | PMC:PMC10583255 | DOI:10.9740/mhc.2023.08.193

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Oxybutynin for Primary Palmer Hyperhidrosis Attenuates Migraine Attacks and Burdens

Cureus. 2023 Sep 7;15(9):e44826. doi: 10.7759/cureus.44826. eCollection 2023 Sep.

ABSTRACT

Migraine is a neurological disorder with recurrent headaches accompanied by burdens in social life. Primary palmar hyperhidrosis is a chronic condition with excessive sweating of the palms that can significantly impair quality of life. Primary hyperhidrosis can cause anxiety, and stress, including anxiety, is the most common inducer of migraine headaches. Recently, oxybutynin has been used for primary palmar hyperhidrosis. We herein describe a 26-year-old female migraine patient with primary palmar hyperhidrosis whose migraine attacks and burdens were attenuated after the prescription of an oxybutynin lotion formula. The patient’s monthly headache days (MHD) and monthly acute medication intake days (AMD) at the first visit were 10 and 9. Headache Impact Score 6 (HIT-6) at the initial visit was 63. After the prescription of Japanese herbal kampo medicine Goreisan (TJ-17), Goshuyuto (TJ-31), and 200 mg of valproic acid, MHD, AMD, and HIT-6 decreased gradually. However, these parameters could not improve sufficiently at nine months: MHD 4, AMD 4, and HIT-6 52. We first prescribed a lotion formulation of 20% oxybutynin hydrochloride at nine months. After this, migraine was further attenuated, and stress related to primary palmar hyperhidrosis was reduced; at 12 months, the patient had achieved MHD 2, AMD 2, and HIT-6 48. She will continue receiving primary palmar hyperhidrosis treatment while tapering off migraine prophylaxis. While the exact mechanisms connecting migraine and primary hyperhidrosis remain uncertain, this case raises important questions about the potential interplay between stress, sweating, and migraine triggers.

PMID:37818504 | PMC:PMC10561519 | DOI:10.7759/cureus.44826

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Efficacy of 5% sofpironium bromide gel in Duchenne muscular dystrophy with palmoplantar hyperhidrosis: A retrospective case study

J Dermatol. 2023 Oct 5. doi: 10.1111/1346-8138.16990. Online ahead of print.

ABSTRACT

Duchenne muscular dystrophy (DMD) is a severe, progressive, muscle-wasting disease. Notably, several extramuscular manifestations and complications of advanced DMD, including skin disorders, are known. However, hyperhidrosis and its treatment have not been well-described in association with advanced DMD, therefore we aimed to confirm the efficacy of 5% sofpironium bromide gel in treating secondary hyperhidrosis in patients with advanced DMD. We retrospectively reviewed patients with advanced DMD who underwent treatment with 5% sofpironium bromide gel. All patients were evaluated using the hyperhidrosis disease severity scale (HDSS) score and by measuring the gravimetric weight of palmar and/or plantar sweat. Three patients with advanced DMD were treated and the patients were aged 28, 31, and 32 years, respectively. Their HDSS scores showed a decreasing tendency within 5 weeks after treatment. In addition, all patients had a decreased gravimetric weight of palmar and/or plantar sweat, and the mean decrease rate of palmar sweat at 7 weeks after treatment was 53.7%. One patient had skin dryness on both soles, but no serious adverse events were observed. Treatment using 5% sofpironium bromide gel showed beneficial efficacy against palmoplantar hyperhidrosis in patients with advanced DMD. These findings warrant further investigation in future studies.

PMID:37795807 | DOI:10.1111/1346-8138.16990

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Infrared thermography in the diagnosis of palmar hyperhidrosis: A diagnostic study

Med J Armed Forces India. 2023 Sep-Oct;79(5):560-564. doi: 10.1016/j.mjafi.2021.07.007. Epub 2021 Sep 23.

ABSTRACT

BACKGROUND: Primary hyperhidrosis is a common condition affecting 1-3% of the general population. Excessive sweating leads to reduced surface temperature due to evaporation that can be captured using a thermal camera. We performed this study to find the utility of thermography in the diagnosis of palmar hyperhidrosis.

METHODS: This was a cross-sectional diagnostic study conducted in a tertiary care dermatology center during the study period Apr 20-Mar 21. Adult patients with palmar hyperhidrosis diagnosed by expert dermatologists were recruited. The severity was assessed using the hyperhidrosis disease severity scale (HDSS). The measurements were done using a FLIR™ thermal camera. A pilot study, including 30 patients and 30 controls were performed. The results of the pilot study were used for the calculation of sample size.

RESULT: The study included 55 patients and 110 controls. The mean age of the patients and controls was 22.4 (±3) years and 21.7 (±2.5) years, respectively. The mean temperature difference in the patient and control group was found to be 19.6 (±3.3)0 F and 5.8 (±2.9)0 F, respectively (p < 0.001). A receiver operating characteristics curve (ROC) to assess the discriminatory ability of mean temperature difference in diagnosis of hyperhidrosis found the area under the curve (AUC) to be 0.995 and a temperature difference of 11.5 °F provides sensitivity and specificity of 98.2% and 97.3% for the diagnosis of hyperhidrosis.

CONCLUSIONS: Thermal imaging is a simple, noninvasive, and objective tool for the diagnosis of hyperhidrosis. It has potential utility in monitoring the effect of the treatment.

PMID:37719898 | PMC:PMC10499645 | DOI:10.1016/j.mjafi.2021.07.007

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Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children: A Narrative Review

Actas Dermosifiliogr. 2023 Sep 13:S0001-7310(23)00733-0. doi: 10.1016/j.ad.2023.09.006. Online ahead of print.

ABSTRACT

Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

PMID:37714301 | DOI:10.1016/j.ad.2023.09.006

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Uniportal thoracoscopic sympathicotomy for hyperhidrosis

Multimed Man Cardiothorac Surg. 2023 Aug 24;2023. doi: 10.1510/mmcts.2023.053.

ABSTRACT

Video-assisted thoracoscopic sympathicotomy is the most widely used technique in the modern era for the treatment of primary hyperhidrosis. Primary hyperhidrosis is characterized by excessive sweating and significantly affects the quality of life in those who suffer from it. This video tutorial details a uniportal, drainless sympathicotomy performed by the cardiothoracic surgical team at St George Hospital, Sydney, Australia.

PMID:37615693 | DOI:10.1510/mmcts.2023.053

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Long-term evaluation of the safety and efficacy of a novel 20% oxybutynin hydrochloride lotion for primary palmar hyperhidrosis: An open-label extension study

J Dermatol. 2023 Aug 21. doi: 10.1111/1346-8138.16922. Online ahead of print.

ABSTRACT

The long-term safety and efficacy of 52-week application of oxybutynin hydrochloride 20% lotion (20% OL) for the treatment of primary palmar hyperhidrosis (PPHH) in Japanese patients aged ≥12 years were evaluated in an open-label extension (OLE) of a 4-week, randomized, double-blind (DB) study. The OLE included 114 patients who completed the DB study and wished to continue treatment and 12 new patients. In the safety analysis population (125 patients), the incidence of adverse events (AEs) and adverse drug reactions (ADRs) was 79.2% and 36.0%, respectively. Serious AEs were observed in two patients but were considered unrelated to the investigational drug. The incidence of AEs that led to study discontinuation was 1.6%. The incidence of application site AEs and ADRs was 35.2% and 26.4%, respectively. The severity of most events was mild. The incidence of anticholinergic AEs related to dry mouth was 3.2% for thirst and 0.8% for dry throat. The long-term efficacy of 20% OL was confirmed by a long-lasting reduction in sweat volume and improvement in the Hyperhidrosis Disease Severity Scale and Dermatology Life Quality Index. This study has several limitations: First the results may include some bias because most of the participants were from the prior DB study; second, the results may not be generalizable because only a few participants were in the age group most susceptible to PPHH (i.e., < 15 years old); and third, the study did not obtain safety information from treatment for more than 52 weeks, so this information must be collected in clinical practice in the future. No reduced therapeutic effect was observed in patients with PPHH in this study after 52-week application of 20% OL. Also, few patients experienced serious AEs or AEs that led to study treatment discontinuation.

PMID:37605375 | DOI:10.1111/1346-8138.16922

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Topical Oxybutynin 3% Gel Versus Aluminum Chloride 15% Lotion in Treatment of Primary Focal Hyperhidrosis

Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a192.

ABSTRACT

INTRODUCTION: Hyperhidrosis is excessive sweating beyond thermoregulatory needs. It is a potentially disabling condition with challenging management. Aluminum chloride is the established topical treatment; however, response remains unsatisfactory. Oxybutynin is an anticholinergic drug that stands as a therapeutic chance for hyperhidrosis.

OBJECTIVES: comparing the efficacy of topical oxybutynin 3% gel versus aluminum chloride 15% lotion in treatment of primary focal hyperhidrosis.

METHODS: Forty patients with hyperhidrosis were randomly distributed into 2 equal groups treated by either topical oxybutynin 3% gel or topical aluminum chloride 15% lotion once daily night application for 4 weeks (both groups). Evaluation was done at 2 and 4 weeks of treatment and after 1 month of the end of treatment for follow up by Minor iodine starch test, hyperhidrosis disease severity scale (HDSS) and dermatology life quality index (DLQI).

RESULTS: Both treatment modalities were effective with insignificant differences between patients of both groups regarding improvement in Minor iodine starch test and HDSS after 2 weeks of treatment (P = 0.561, 0.33 respectively). Oxybutynin 3% gel yielded significantly better improvement of Minor’s test, HDSS and patient’s quality of life at the end of 4 weeks of treatment with lower recurrence rate than aluminum chloride 15% lotion at 1 month follow up. Minimal adverse effects were noted in both studied groups.

CONCLUSIONS: Oxybutynin 3% gel could be considered as a promising treatment modality for hyperhidrosis with higher efficacy than aluminum chloride 15% lotion and lower recurrence rate.

PMID:37557105 | DOI:10.5826/dpc.1303a192

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Development and Validation of a Nomogram to Predict Recurrence of Primary Hyperhidrosis after CT-guided Percutaneous Radiofrequency Sympathectomy

J Vasc Interv Radiol. 2023 Aug 5:S1051-0443(23)00568-7. doi: 10.1016/j.jvir.2023.07.030. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the recurrence rate of primary hyperhidrosis (PH) after computed tomography (CT)-guided radiofrequency sympathectomy (RFS) and to identify risk factors associated with recurrence.

MATERIALS AND METHODS: A total of 290 patients with PH who received CT-guided RFS were included in this retrospective cohort study. The electronic medical record was queried for patients’ information and surgical parameters. Follow-ups were conducted for recurrence rate, and Hyperhidrosis Disease Severity Scale was used to assess presence or absence of recurrence. Stepwise regression and the least absolute shrinkage and selection operator regression algorithms were used for feature selection.

RESULTS: The recurrence rate 1 year after procedure was 17.6%. Male (hazard ratio [HR]: 2.35, 95% confidence interval [CI]:1.08-5.15), low postoperative palm or foot temperature (HR: 0.77, 95% CI:0.60-0.98), high postoperative heart rate (HR: 1.06, 95% CI:1.02-1.10), low preoperative and postoperative hospital anxiety and depression score difference (HR: 0.59, 95% CI:0.43-0.80), and the absence of compensatory hyperhidrosis immediately after procedure (HR: 0.46, 95% CI:0.22-0.98) were established as independent factors affecting prognosis. A nomogram was built accordingly. The C-indices of the training and testing sets were 0.773 and 0.659, respectively.

CONCLUSION: Follow-up results showed that the recurrence rate of PH treated with CT-guided RFS was low. This study constructed and validated a nomogram to predict the recurrence of PH 1 year after CT-guided RFS, which is convenient for interventionalists to accurately evaluate the prognosis of postoperative patients, identify high-risk patients who need more active treatment.

PMID:37549843 | DOI:10.1016/j.jvir.2023.07.030