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Low-Dose OnabotulinumtoxinA using Seven-Point Pattern Intradermal Injections in Patients with Moderate-to-intolerable Primary Axillary Hyperhidrosis: A Single-Blinded, Side-by-Side Randomized Trial

J Clin Aesthet Dermatol. 2023 Jun;16(6):37-43.

ABSTRACT

BACKGROUND: The axilla is the most common site for primary hyperhidrosis (HH) affecting quality of life. No consensus on the optimal doses of botulinum toxin (BTX) has been established.

OBJECTIVE: This study aimed to scrutinize the effectiveness of 25- and 50-U onabotulinumtoxinA in patients with moderate-to-intolerable primary axillary HH as well as pain scores after BTX injection.

METHODS: A single-blinded, side-by-side randomized trial was conducted between January and June 2022. Participants were randomly treated with 25-unit (U) onabotulinumtoxinA in one axilla and 50-U onabotulinumtoxinA in the other. The Minor starch-iodine test and gravimetric testing, the Hyperhidrosis Disease Severity Scale (HDSS), Hyperhidrosis Quality of Life Index (HidroQoL), global self-assessment scale (GSAS), and satisfaction scores were collected and analyzed.

RESULTS: A total of 12 participants were included in the final analysis; six (50.0%) were female. The median age was 30.3 (interquartile range: 28.7-32.3) years. No statistically significant differences were noted in the sweat rate production, hyperhidrotic area, HDSS, HidroQoL, GSAS, and satisfaction scores between 25- and 50-U BTX at any follow-up visit. No significant difference was noted in pain scores between the two groups (p=0.810).

CONCLUSION: Low-dose onabotulinumtoxinA is associated with similar efficacy and safety outcomes in primary axillary HH treatment as is conventional-dose onabotulinumtoxinA. No difference was noted in injection site pain between the two groups.

PMID:37361360 | PMC:PMC10286880

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Urinary retention and mydriasis secondary to topical glycopyrronium for axillary hyperhidrosis

Am J Health Syst Pharm. 2023 Jun 22:zxad141. doi: 10.1093/ajhp/zxad141. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: Glycopyrronium, also known as glycopyrrolate, is an antimuscarinic competitive inhibitor of acetylcholine widely utilized topically for its anticholinergic properties in dermatology. A single topical glycopyrronium tosylate (GT) formulation is available on the market, and prescription of this medication has become increasingly popular among dermatologists. This medication has a relatively notable adverse effect profile and carries risks that patients need to be counseled on before initiation.

SUMMARY: A 22-year-old female presented to our emergency department (ED) with a chief complaint of difficulty urinating for 48 hours and blurred vision for 2 weeks. Over the course of a week, she visited the ED once and urgent care multiple times due to complications associated with combination use of GT and cetirizine. Although these clinical effects were reversible, the patient impact in our case was profound given the time, cost, and invasive nature of these visits.

CONCLUSION: The notable adverse effects of GT should be considered when prescribing this agent.

PMID:37348110 | DOI:10.1093/ajhp/zxad141

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Shapiro syndrome: a cause of episodic hyperhidrosis, hypothermia and altered mental status

QJM. 2023 Jun 20:hcad145. doi: 10.1093/qjmed/hcad145. Online ahead of print.

ABSTRACT

INTRODUCTION: Shapiro syndrome is characterized by recurrent episodes of hypothermia and hyperhidrosis, with agenesis of the corpus callosum. This is a rare condition with only approximately 60 cases described worldwide. We describe a case of Shapiro syndrome.

METHODS/RESULTS: A 50-year-old Indian man with diabetes and hypertension presented with a 3-month history of frequent episodic profuse hyperhidrosis, accompanied by postural giddiness and confusion. He had episodes of isolated hyperhidrosis 20 years ago which had spontaneously resolved. These episodes re-emerged 3 years prior to presentation, with increasing frequency over the last 3 months. Previous extensive investigations, including a positron emission tomography (PET) scan were normal and he was treated for anxiety. During his inpatient stay, he was observed to have recurrent episodes of hypothermia (lowest temperature recorded 31.3 degrees Celsius), labile blood pressure (systolic ranging from 71mmHg to 175mmHg) and pulse rate (38/min to 214/min). Apart from slow responses to routine questioning, the rest of his neurological examination was normal. Extensive investigations looking for malignancy, autoimmune diseases and infections were unremarkable. CSF studies were negative for inflammation or infection. Magnetic resonance imaging of the brain demonstrated agenesis of the corpus callosum and schizencephaly. Based on his symptoms of hyperhidrosis, hypothermia and imaging findings, a diagnosis of Shapiro syndrome was made. He was treated with clonidine and levetiracetam with good response.

CONCLUSION: Shapiro syndrome is characterized by a triad of episodic hyperhidrosis, hypothermia and agenesis of the corpus callosum. Recognition of this rare condition is important to direct effective treatment.

PMID:37338563 | DOI:10.1093/qjmed/hcad145

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Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

Front Surg. 2023 May 31;10:1126596. doi: 10.3389/fsurg.2023.1126596. eCollection 2023.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand’s exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient’s daily activities and quality of life.

OBJECTIVE: The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH.

METHODS: A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation.

RESULTS: Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05).

CONCLUSION: Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.

PMID:37325414 | PMC:PMC10264635 | DOI:10.3389/fsurg.2023.1126596

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Attempted treatment of primary axillary hyperhidrosis with one session of either Neodymium YAG laser or Intense Pulsed Light: A within patient randomized trial of treated versus untreated contralateral axilla

Lasers Surg Med. 2023 Jun 14. doi: 10.1002/lsm.23697. Online ahead of print.

ABSTRACT

BACKGROUND: Primary axillary hyperhidrosis (PAH) affects 1-5% of the world’s population who has an unmet need for improved treatments. The heating of sweat glands with specific microwave therapy has shown promising results, yet, treatment with widely available devices such as long-pulsed Neodymium Yttrium Aluminum Garnet (Nd:YAG) lasers, diode lasers or Intense Pulsed Light (IPL) may serve as pragmatic alternatives.

OBJECTIVES: To compare sweat secretion of treated versus untreated contralateral control axilla 1-3 months after one session of Nd:YAG laser or IPL in patients with PAH.

METHODS: A within-person randomized controlled trial. Patients were randomized to receive either one session of Nd:YAG laser or IPL in one axilla with the contra-lateral serving as control. Sweat production was assessed by gravimetry, trans-epidermal water loss, hyperhidrosis disease severity scale and dynamic optical coherence tomography. Mixed-effects models were used to handle the within-person design, containing both fixed effect factors (side, group, and subgroup), and random effects (patients), while also adjusting for the level at baseline.

RESULTS: A total of 20 patients were enrolled. At follow-up 1-3 months after treatment, sweat secretion was not affected in the treated axilla when compared to the control axillae (0.01 [95%CI: -0.04 to 0.05]; p = 0.68). In the Nd:YAG subgroup (10 patients), least squares means for sweat secretion was 0.18 mg/5 min in the treated versus 0.15 mg/5 min in the control axilla, respectively, corresponding to a statistically insignificant mean difference of 0.02 mg/5 min (95% CI: -0.06 to 0.11; p = 0.54). In the IPL subgroup (10 patients), sweat secretion was 0.06 mg/5 min in the treated axilla versus 0.07 mg/5 min in the control axilla with a statistically insignificant difference of -0.01 points (95% CI: -0.03 to 0.02; p = 0.46). Likewise, none of the secondary outcomes were significantly affected by treatment. However, both treatments appeared safe and well tolerated with no adverse effects reported at follow-up.

CONCLUSIONS: One treatment with external 1064 nm Nd:YAG laser or 640 nm IPL at commercially available settings, failed to demonstrate clinical benefit in treating PAH, with narrow confidence intervals implying that this was not due to a type-2 error.

PMID:37313834 | DOI:10.1002/lsm.23697

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Primary Palmar Hyperhidrosis (PPH) Accompanied With Nevus Flammeus: A Case Report

Cureus. 2023 May 8;15(5):e38723. doi: 10.7759/cureus.38723. eCollection 2023 May.

ABSTRACT

Palmar hyperhidrosis (PH) is a medical condition characterized by excessive sweating in the palms of the hands, which can result in significant distress and impairment in daily activities. Flammeus nevus, on the other hand, is a benign vascular lesion that appears as a red or purplish discoloration on the skin, commonly found on the face, neck, or trunk. In some cases, flammeus nevus can co-occur with PH, leading to increased sweating in the affected area. This condition can cause significant psychosocial impact, affecting an individual’s quality of life (QoL) and self-esteem. We present a case report of a patient presenting with PPH with flammeus nevus. There is currently limited information available on the relationship between PH and flammeus nevus, and more research is needed to better understand this phenomenon; here we have reported the presentation of a patient. In conclusion, PH accompanied with flammeus nevus is a condition that requires prompt attention and management to mitigate its adverse effects. We have used ChatGPT to aid in structuring and writing this case report.

PMID:37292575 | PMC:PMC10246863 | DOI:10.7759/cureus.38723

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Hormonal Causes for Excessive Sweating

Praxis (Bern 1994). 2023 Jun;112(7-8):398-402. doi: 10.1024/1661-8157/a004025.

ABSTRACT

Hormonal Causes for Excessive Sweating Abstract: Excessive sweating is a frequent symptom in the general practice, but quite a few patients report their sweating problems only when explicitly asked. The differentiation into night sweats on the one hand and general sweating on the other hand can give us first diagnostic hints. Based on their frequency, night sweats should also trigger questions about panic attacks or sleeping disorders. The most frequent hormonal causes for excessive sweating are the menopause and hyperthyroidism. Hypogonadism in the aging male is a rather rare cause for excessive sweating and must be associated with sexual problems and a repeatedly low morning testosterone. This article provides an overview about the most frequent hormonal causes of excessive sweating and the diagnostic approach.

PMID:37282519 | DOI:10.1024/1661-8157/a004025