Posts

Posted on

Reconstituted and frozen botulinum toxin A is as effective and safe as fresh for treating axillary hyperhidrosis: A retrospective study

PLoS One. 2023 Dec 4;18(12):e0295393. doi: 10.1371/journal.pone.0295393. eCollection 2023.

ABSTRACT

The use of reconstituted and frozen left-over botulinum toxin A, for treatment of patients with axillary hyperhidrosis seems to be common practice in healthcare. Thus, the objective of this study was to investigate the efficacy and safety of frozen and thawed versus fresh reconstituted abobotulinum toxin (Dysport®) and onabotulinum toxin (Botox®) in the treatment of axillary hyperhidrosis. A retrospective study was conducted analysing efficacy and data from pre- and 24 weeks post-treatment questionnaires together with medical records of individuals with moderate to severe axillary hyperhidrosis. The patients had received fresh prepared botulinum toxin A in their right axilla while frozen and thawed botulinum toxin A had been administered in their left axilla. Treatment was conducted at our Hyperhidrosis Clinic, Umeå University Hospital, Sweden 2019-2021. Pre- and post-treatment questionnaires from 106 patients were analysed. The patients were 18 to 55 years old, with a mean age of 30.7 ± 9.9 years. No significant differences in patient-reported variables, Hyperhidrosis Disease Severity Scale and VAS 10-point scale, were found between the different preparations (frozen compared to fresh) for abobotulinum toxin and onabotulinum toxin, before treatment and at 6 months follow-up. Multivariable regression analysis resulted in no significant difference regarding side-effects between the preparations or brands of botulinum toxin. The findings of this study support our clinical experience that both abobotulinum toxin and onabotulinum toxin, reconstituted, frozen and thawed, seem to be as effective and safe as fresh prepared botulinum toxin when treating axillary hyperhidrosis. Our findings indicate that left-over preparations of abo- and onabotulinum toxins, stored and frozen for up to 6 months, is a cost-and time-effective way of handling botulinum toxin for treatment of axillary hyperhidrosis.

PMID:38048338 | DOI:10.1371/journal.pone.0295393

Posted on

Involvement of aquaporin 5 and Na-K-2Cl co-transporter 1 in the pathogenesis of primary focal hyperhidrosis: evidence from the primary sweat gland cell culture

Am J Physiol Cell Physiol. 2023 Dec 4. doi: 10.1152/ajpcell.00274.2023. Online ahead of print.

ABSTRACT

People with primary focal hyperhidrosis (PFH) usually have an overactive sympathetic nervous system, which can activate the sweat glands through the chemical messenger of acetylcholine. The role of aquaporin 5 (AQP5) and Na-K-2Cl co-transporter 1 (NKCC1) in PFH is still unknown. The relative mRNA and protein levels of AQP5 and NKCC1 in the sweat gland tissues of three subtypes of PFH patients (primary palmar hyperhidrosis, PPH; primary axillary hyperhidrosis, PAH; primary craniofacial hyperhidrosis, PCH) were detected with Real-Time PCR (qPCR) and Western blot. Primary sweat gland cells from healthy controls (NPFH-SG) were incubated with different concentrations of acetylcholine, and the relative mRNA and protein expression of AQP5 and NKCC1 were also detected. NPFH-SG cells were also transfected with si-AQP5 or shNKCC1, and acetylcholine stimulation-induced calcium transients were assayed with Fluo-3 AM calcium assay. Up-regulated AQP5 and NKCC1 expression were observed in sweat gland tissues, and AQP5 demonstrated a positive Pearson correlation with NKCC1 in PPH patients (r=0.66, p<0.001), PAH patients (r=0.71, p<0.001), and PCH patients (r=0.62, p<0.001). Up-regulated AQP5 and NKCC1 expression were also detected in primary sweat gland cells derived from three subtypes of PFH patients when compared with primary sweat gland cells derived from healthy control. Acetylcholine stimulation could induce the up-regulated AQP5 and NKCC1 expression in NPFH-SG cells, and AQP5 or NKCC1 inhibitions attenuated the calcium transients induced by acetylcholine stimulation in NPFH-SG cells. The dependence of ACh-stimulated calcium transients on AQP5 and NKCC1 expression may be involved in the development of PFH.

PMID:38047298 | DOI:10.1152/ajpcell.00274.2023

Posted on

What do Hyperhidrosis Quality of Life Index (HidroQoL ©) scores mean? Transferring science into practice by the establishing of a score banding system

Br J Dermatol. 2023 Nov 28:ljad444. doi: 10.1093/bjd/ljad444. Online ahead of print.

ABSTRACT

BACKGROUND: The Hyperhidrosis Quality of Life Index (HidroQoL ©) is a measure of quality of life (QoL) impacts in hyperhidrosis.

OBJECTIVES: We aimed to establish score banding systems for the HidroQoL total score for specific contexts representing different severity/impact categories by using the Dermatology Life Quality Index (DLQI) and the Hyperhidrosis Disease Severity Scale (HDSS) as anchors, including data from 357 patients from a phase III clinical trial.

METHODS: We used the HDSS, the established DLQI score bands, and two single items (i.e. 5 and 7) of the DLQI as anchors for the creation of banding systems for the HidroQoL. These anchors were chosen via consensus among an expert group according to relevance to patient experience. Due to the distribution of the HDSS and the single DLQI item 7, Receiver Operating Characteristic (ROC) curves were computed, in order to create an optimal cut-off value of the HidroQoL total score. For the DLQI banding system and the single DLQI item 5, we created a banding system for the HidroQoL based on the distribution of their different categories.

RESULTS: A score of 30 and greater is proposed as cut-off for sweating that “always interferes in daily activities”, based on the HDSS as anchor. In terms of overall skin QoL effects, score bands of 0 – 6, 7 – 18, 19 – 25, 26 – 32, and 33 – 36 represent “no effect”, “small effect”, “moderate effect”, “very large effect” and “extremely large effect” on the patient’s life, respectively.

CONCLUSIONS: In this study, we propose different banding systems for four different contexts: skin-specific QoL (DLQI banding), hyperhidrosis severity (HDSS), working and studying (single DLQI item 7), and social and leisure activities (single DLQI item 5). These banding systems and cut-off values can be used in clinical research and practice to place the patients in different severity categories.

CLINICALTRIALS.GOV IDENTIFIER: NCT03658616.

PMID:38015827 | DOI:10.1093/bjd/ljad444

Posted on

A multicenter retrospective study of lumbar sympathectomy for plantar hyperhidrosis: satisfaction and postoperative complications

Clin Exp Dermatol. 2023 Nov 15:llad373. doi: 10.1093/ced/llad373. Online ahead of print.

ABSTRACT

Primary plantar hyperhidrosis has a severe impact on quality of life and conservative treatments are only effective in the short-term. Thoracic sympathectomy has proven its effectiveness in the treatment of palmar hyperhidrosis, but lumbar sympathectomy for plantar hyperhidrosis remains poorly described. The objective of this study is to report the satisfaction of treated patients as well as the postoperative complications. This was a multicenter retrospective observational study of sixteen patients with primary plantar hyperhidrosis, treated with mechanical lumbar sympathectomy from December 2012 to October 2022. Patients’ characteristics were collected from medical records. Quality of life, postoperative satisfaction and complications were evaluated using a standardized questionnaire. Lumbar sympathectomy was performed on 16 patients, fourteen were women and two were men with a total of thirty-one procedures. 87.5% of patients were satisfied and would recommend the surgery to other patients. Compensatory hyperhidrosis occured in 75% of patients, recurrence of hyperhidrosis in 31.3% and sexual dysfunction in 18.8%. Lumbar sympathectomy provides satisfying results for plantar hyperhidrosis with acceptable postoperative complications, regardless of gender. Compensatory hyperhidrosis was the most frequent complication but had no impact on patient satisfaction. Data on the risk of sexual dysfunction are reassuring, with only one case of transient ejaculation disorder.

PMID:37966306 | DOI:10.1093/ced/llad373

Posted on

Management of primary plantar hyperhidrosis with botulinum toxin type A: A retrospective case series of 129 patients

Australas J Dermatol. 2023 Nov 14. doi: 10.1111/ajd.14188. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: To date, scientific data on the efficacy of botulinum toxin type A (BoNT-A) for primary plantar hyperhidrosis (PPH) are mainly derived from case reports and small case series. Herein, we sought to assess the efficacy and safety of BoNT-A for PPH on a large series of patients.

METHODS: Medical records of patients who were referred to the outpatient department for hyperhidrosis of a tertiary care hospital and received BoNT-A for PPH from March 2003 until December 2022 were reviewed.

RESULTS: A total of 129 patients [12 males, 117 females; median age 32 years (range, 16-72)] were included in the study, after excluding 24 patients with insufficient documented follow-up data. Most patients [115 (89.1%)] received onabotulinumtoxin-A, nine (7.0%) abobotulinumtoxin-A and five (3.9%) both in subsequent sessions. The mean number of sessions was 2.02 [standard deviation (SD), 2.29] and the mean duration of response 6.16 months (SD, 4.01). The percentage of response, as evaluated by Minor’s test, was 71.67%, 63.44%, 47.78% and 34.13% after 1, 3, 6 and 9 months, respectively. Most patients were satisfied (21.7%) or very satisfied (58.9%) with the treatment. No serious side effects were reported.

CONCLUSIONS: The results of this retrospective study suggest that BoNT-A is an effective and safe treatment option for PPH.

PMID:37964488 | DOI:10.1111/ajd.14188

Posted on

Ultrasound-guided percutaneous puncturing technique: novel radiofrequency ablation technique for thoracic sympathectomy in treatment of palmar hyperhidrosis

Eur J Cardiothorac Surg. 2023 Nov 8:ezad372. doi: 10.1093/ejcts/ezad372. Online ahead of print.

ABSTRACT

Radiofrequency thoracic sympathectomy is routinely conducted under computed tomography or fluoroscopy in treatment of palmar hyperhidrosis. However, it remains a great challenge to perform thoracic paravertebral puncture precisely and safely, that is associated with repeated exposure of radiation and risk of pneumothorax. Alternatively, ultrasound-guided technique can provide high-resolution and real-time needle tracking during percutaneous procedure. Here, we provided our experience of ultrasonic guidance in radiofrequency sympathectomy for treatment of primary palmar hyperhidrosis.

PMID:37947326 | DOI:10.1093/ejcts/ezad372

Posted on

Botulinum toxin A dissolving microneedles for hyperhidrosis treatment: design, formulation and in vivo evaluation

Biomater Sci. 2023 Oct 31. doi: 10.1039/d3bm01301d. Online ahead of print.

ABSTRACT

Multiple periodic injections of botulinum toxin A (BTX-A) are the standard treatment of hyperhidrosis which causes excessive sweating. However, BTX-A injections can create problems, including incorrect and painful injections, the risk of drug entry into the bloodstream, the need for medical expertise, and waste disposal problems. New drug delivery systems can substantially reduce these problems. Transdermal delivery is an effective alternative to conventional BTX-A injections. However, BTX-A’s large molecular size and susceptibility to degradation complicate transdermal delivery. Dissolving microneedle patches (DMNPs) encapsulated with BTX-A (BTX-A/DMNPs) are a promising solution that can penetrate the dermis painlessly and provide localized translocation of BTX-A. In this study, using high-precision 3D laser lithography and subsequent molding, DMNPs were prepared based on a combination of biocompatible polyvinylpyrrolidone and hyaluronic acid polymers to deliver BTX-A with ultra-sharp needle tips of 1.5 ± 0.5 μm. Mechanical, morphological and histological assessments of the prepared DMNPs were performed to optimize their physicochemical properties. Furthermore, the BTX-A release and diffusion kinetics across the skin layers were investigated. A COMSOL simulation was conducted to study the diffusion process. The primary stability analysis reported significant stability for three months. Finally, the functionality of the BTX-A/DMNPs for the suppression of sweat glands was confirmed on the hyperhidrosis mouse footpad, which drastically reduced sweat gland activity. The results demonstrate that these engineered DMNPs can be an effective, painless, inexpensive alternative to hypodermic injections when treating hyperhidrosis.

PMID:37905676 | DOI:10.1039/d3bm01301d