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Safety and efficacy of oxybutynin in patients with hyperhidrosis: systematic review and meta-analysis of randomized controlled trials

Arch Dermatol Res. 2023 Mar 4. doi: 10.1007/s00403-023-02587-5. Online ahead of print.

ABSTRACT

BACKGROUND: Sweating is a physiologic mechanism of human thermoregulation. Hyperhidrosis is defined as a somatic disorder where the sweating is exaggerated in an exact area because the sweat glands are hyperfunctioning. It negatively affects the quality of life of the patients. We aim to investigate patient satisfaction and the effectiveness of oxybutynin in treating hyperhidrosis.

METHODS: We prospectively registered the protocol of this systematic review and meta-analysis on PROSPERO (CRD 42022342667). This systematic review and meta-analysis were reported according to the PRISMA statement guidelines. We searched three electronic databases (PubMed, Scopus, Web of Science) from inception until June 2, 2022, using MeSH terms. We include studies comparing patients with hyperhidrosis who received oxybutynin or a placebo. We assessed the risk of bias using the Cochrane risk of bias assessment tool (ROB2) for randomized controlled trials. The risk ratio was calculated for categorical variables, and the mean difference was calculated for continuous variables using the random effect model with 95% confidence intervals (CI).

RESULTS: Six studies were included in the meta-analysis, with a total of 293 patients. In all studies, patients were assigned to receive either Oxybutynin or Placebo. Oxybutynin represented an HDSS improvement (RR = 1.68 95% CI [1.21, 2.33], p = 0.002). It also can improve the quality of life. There is no difference between oxybutynin and placebo regarding dry mouth (RR = 1.68 95% CI [1.21, 2.33], p = 0.002).

CONCLUSION: Our study suggests that using oxybutynin as a treatment for hyperhidrosis is significant and needs to be highlighted for clinicians. However, more clinical trials are needed to grasp the optimum benefit.

PMID:36869926 | DOI:10.1007/s00403-023-02587-5

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Pharmacovigilance-based drug repurposing: searching for putative drugs with hypohidrosis or anhidrosis adverse events for use against hyperhidrosis

Eur J Med Res. 2023 Feb 24;28(1):95. doi: 10.1186/s40001-023-01048-z.

ABSTRACT

BACKGROUND: Drug repurposing refers to the application of existing drugs to new therapeutic indications. As phenotypic indicators of human drug response, drug side effects may provide direct signals and unique opportunities for drug repurposing.

OBJECTIVES: We aimed to identify drugs frequently associated with hypohidrosis or anhidrosis adverse reactions (that is, the opposite condition of hyperhidrosis) from the pharmacovigilance database, which could be potential candidates as anti-hyperhidrosis treatment agents.

METHODS: In this observational, retrospective, pharmacovigilance study, adverse event reports of hypohidrosis or anhidrosis in the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) were assessed between January 2004 and December 2021 using reporting odds ratio (ROR) estimates and categorized by the World Health Organization Anatomical Therapeutic Chemical (ATC) classification code. The onset time of drug-associated hypohidrosis or anhidrosis was also examined.

RESULTS: There were 540 reports of 192 drugs with suspected drug-associated hypohidrosis or anhidrosis in the FAERS database, of which 39 drugs were found to have statistically significant signals. Nervous system drugs were most frequently reported (187 cases, 55.82%), followed by alimentary tract and metabolism drugs (35 cases, 10.45%), genitourinary system and sex hormones (28 cases, 8.36%), and dermatologicals (22 cases, 6.57%). The top 3 drug subclasses were antiepileptics, drugs for urinary frequency and incontinence, and antidepressants. Taking disproportionality signals, pharmacological characteristics of drugs and appropriate onset time into consideration, the main putative drugs for hyperhidrosis were glycopyrronium, solifenacin, oxybutynin, and botulinum toxin type A. Other drugs, such as topiramate, zonisamide, agalsidase beta, finasteride, metformin, lamotrigine, citalopram, ciprofloxacin, bupropion, duloxetine, aripiprazole, prednisolone, and risperidone need more investigation.

CONCLUSIONS: Several candidate agents among hypohidrosis or anhidrosis-related drugs were identified that may be redirected for diminishing sweat production. There are affirmative data for some candidate drugs, and the remaining proposed candidate drugs without already known sweat reduction mechanisms of action should be further explored.

PMID:36829251 | DOI:10.1186/s40001-023-01048-z

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Efficacy and Safety of Botulinum Toxin B in Focal Hyperhidrosis: A Narrative Review

Toxins (Basel). 2023 Feb 11;15(2):147. doi: 10.3390/toxins15020147.

ABSTRACT

Botulinum toxin type B (BoNT-B), known as Myobloc® in the United States and as Neurobloc® in Europe, is a new therapeutically available serotype among the botulinum toxin family. During the last years several data have been reported in literature investigating its efficacy and safety, as well as defining the dosing and application regiments of BoNT-B in the treatment of hyperhidrosis. Moreover, recent studies have been examining its safety profile, which may be different from those known about BoNT-A. The aim of this review is to provide information about what is currently known about BoNT-B in regards to the treatment of focal hyperhidrosis.

PMID:36828461 | DOI:10.3390/toxins15020147

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Botulinum toxin in the treatment of residual limb hyperhidrosis: A systematic review

Rehabilitacion (Madr). 2023 Feb 13;57(3):100754. doi: 10.1016/j.rh.2022.07.003. Online ahead of print.

ABSTRACT

The aim of the study was to analyze the current evidence regarding the effect of intradermal injections of botulinum toxin on residual limb hyperhidrosis. A comprehensive search of the MEDLINE and Scopus databases from inception until December 2021 was performed according to the PRISMA guidelines. The search terms used were “botulinum toxins”, “botulinum toxins, Type A”, “rimabotulinumtoxinB”, “amputees”, “amputation stumps”, “amputation” and “residual limbs”. The specific controlled vocabulary of each database was also used (e.g., MeSH). One hundred and thirty-one different studies met this search criteria and were reviewed. Two independent reviewers assessed the quality of the manuscripts. Eight studies met the inclusion criteria for this review. The results demonstrated an improvement in residual limb hyperhidrosis in all studies. Botulinum toxin A or B can be regarded as safe and effective for the treatment of residual limb hyperhidrosis, as well as improving prosthesis use and quality of life.

PMID:36791670 | DOI:10.1016/j.rh.2022.07.003

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Use of thoracoscopy for thoracic sympathetic nerve block in primary hyperhidrosis

Sci Rep. 2023 Jan 25;13(1):1402. doi: 10.1038/s41598-023-28727-5.

ABSTRACT

Thoracic sympathetic nerve block (TSNB) has been widely used in the treatment of neuropathic pain. To reduce block failure rates, TSNB is assisted with several modalities including fluoroscopy, computed tomography, and ultrasonography. The present study describes our experience assessing the usefulness of thoracoscopy in TSNB for predicting compensatory hyperhidrosis before sympathectomy in primary hyperhidrosis. From September 2013 to October 2021, TSNB was performed under local anesthesia using a 2-mm thoracoscope in 302 patients with severe primary hyperhidrosis. Among the 302 patients, 294 were included for analysis. The target level of TSNB was T3 in almost all patients. The mean procedure time was 21 min. Following TSNB, the mean temperature of the left and right palms significantly changed from 31.5 to 35.3 °C and from 31.5 to 34.8 °C, respectively. With TSNB, primary hyperhidrosis was relieved in all patients. Pneumothorax occurred in six patients, in which no chest tube insertion was required. One patient developed hemothorax and was discharged the next day after small-bore catheter drainage. Transient ptosis developed in 10 patients and improved within a day in all patients. Our experiences showed that thoracoscopic TSNB is accurate, safe, and feasible to block the thoracic sympathetic nerve in patients with severe primary hyperhidrosis.

PMID:36697462 | DOI:10.1038/s41598-023-28727-5

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Postoperative diaphragmatic hernia following endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: A case report

Front Surg. 2023 Jan 6;9:1059604. doi: 10.3389/fsurg.2022.1059604. eCollection 2022.

ABSTRACT

Postoperative diaphragmatic hernia (DH) following endoscopic thoracic sympathectomy for primary palmar hyperhidrosis is extremely rare. We present a 21-year-old female patient who developed a left DH with herniation of the stomach and gastric perforation on the first postoperative day after undergoing bilateral video-assisted thoracoscopic sympathectomy R4 ablation. She complained of severe dyspnea and chest pain, and an emergency chest x-ray and computed tomography revealed left pleural effusion, collapsed lung, and left DH, which allowed the stomach to herniate into the chest. Emergency thoracoscopic surgery was performed. We repaired the diaphragmatic defect intraoperatively and replaced the stomach with the peritoneal cavity from the thoracic field. The patient was discharged without complications. She did not present with recurrent symptoms at the 3-month follow-up. Postoperative DH should be considered when patients complain of gastrointestinal or respiratory symptoms after sympathectomy, although it is very rare.

PMID:36684120 | PMC:PMC9852327 | DOI:10.3389/fsurg.2022.1059604

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Robotic Sympathectomy for Hyperhidrosis

Cureus. 2023 Jan 17;15(1):e33885. doi: 10.7759/cureus.33885. eCollection 2023 Jan.

ABSTRACT

In hyperhidrosis, the body’s sweat glands overact. Excessive sweating results from this overactivity, and for many hyperhidrosis patients, managing symptoms can be difficult in day-to-day life. Both surgical and non-surgical types of treatment are available for hyperhidrosis. Surgical treatments include microwave sympathectomy (video-assisted thoracic surgery and robotic). Da Vinci Si and Xi robotic systems are used. This review summarizes the outcomes, complications, advantages, and disadvantages of robotic sympathectomy. We conducted a literature search using PubMed, Cochrane, and Scopus. After analyzing nine articles, we found that robotic sympathectomy decreased compensatory hyperhidrosis with similar outcomes to other procedures. Robotic sympathectomy also reduced complications of Horner syndrome and has changed minimally invasive surgery significantly due to the reduction in tremors by a surgeon’s hands to three-dimensional magnified views. It can potentially address the limitations of human video-assisted sympathectomy. However, the higher cost of robotic surgery, longer perioperative time due to the setting up of the machine, and higher training requirements are some of the disadvantages. The advantages of robotic sympathectomy are a reduction in compensatory sweating, better dexterity, loss of tremors, better visualization, and better accuracy. Although the overall success rates seem to be similar between robotic and video-assisted approaches, more studies are needed.

PMID:36660238 | PMC:PMC9844667 | DOI:10.7759/cureus.33885

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Comparison of the Efficacy of Tap Water Iontophoresis Versus Aluminum Chloride Hexahydrate in the Treatment of Palmoplantar Hyperhidrosis

Cureus. 2022 Dec 9;14(12):e32367. doi: 10.7759/cureus.32367. eCollection 2022 Dec.

ABSTRACT

OBJECTIVE: To compare the efficacy of tap water iontophoresis (TWI) versus aluminum chloride (AC) hexahydrate in the treatment of palmoplantar hyperhidrosis.

METHODS: The study was a randomized control trial performed at the dermatology department of Pakistan Navy Station (PNS) Shifa Hospital, Karachi from March 2022 to September 2022. A total of 70 palmoplantar hyperhidrosis patients were included in the study after getting approval from the ethical committee. Patients were divided into two groups. Group A patients were treated with TWI three times a week for four weeks. Group B patients were treated with a 20% AC topical solution applied at night to the affected areas for four weeks. The Hyperhidrosis Disease Severity Scale (HDSS) score for both groups was calculated at baseline, one, two, three, and four weeks. The final response was labeled at four weeks by comparing mean HDSS reduction in both groups. SPSS version 28 (IBM Corp., Armonk, NY) was used for data analysis.

RESULTS: Mean HDSS was compared for both groups at the end of the study, which showed a significant reduction in the mean score from 3.40 ± 0.65 to 1.48 ± 0.78 in group A, as compared to a decline in scores in group B from 3.28 ± 0.67 to 2.14 ± 0.94 (p = 0.002). In group A, zero, one, two, and three points HDSS improvement was 2.9%, 25.7%, 48.6%, and 22.9%, respectively. Whereas in group B, it was 34.3%, 22.9%, 34.3%, and 8.6%, respectively (p = 0.001).

CONCLUSION: As compared to AC topical solution, TWI is an effective, safe, and inexpensive management option for palmoplantar hyperhidrosis. It causes more improvement in HDSS scores and has lesser side effects.

PMID:36627989 | PMC:PMC9826940 | DOI:10.7759/cureus.32367