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Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics

Dermatol Ther (Heidelb). 2022 Nov 3. doi: 10.1007/s13555-022-00838-3. Online ahead of print.

ABSTRACT

BACKGROUND: Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate.

OBJECTIVE: This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options.

METHODS: We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH.

RESULTS: The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate.

CONCLUSION: Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.

PMID:36329359 | DOI:10.1007/s13555-022-00838-3

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Computed Tomography-Guided Percutaneous T4 Thoracic Sympathetic Radiofrequency Thermocoagulation for Primary Palmar Hyperhidrosis: A Retrospective Observational Trial

Cardiovasc Intervent Radiol. 2022 Oct 31. doi: 10.1007/s00270-022-03305-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy, safety, and patient satisfaction of computed tomography (CT)-guided percutaneous T4 thoracic sympathetic radiofrequency thermocoagulation (RFT) for the treatment of primary palmar hyperhidrosis (PPHH).

MATERIALS AND METHODS: A total of 158 patients who underwent bilateral thoracic sympathetic RFT at the T4 level were analysed. Hyperhidrosis Severity Scale (HDSS), Dermatologic Quality of Life Index (DLQI), patient satisfaction, and adverse events were evaluated within 12 months after RFT.

RESULTS: The mean age of the patients was 25.27 years, and 95 (60.1%) were females. The technical success, defined as planned needle placement and completion of RFT, was 99.4%. After the procedure, 243 hands (77.4%) were completely dry; and 58 hands (18.4%) were partially dry. From before RFT to 12 months after RFT, the proportion of hands with the HDSS grades 3 and 4 from 100% decreased to 31.9%; and that with the DLQI scores D and E from 100% decreased to 4.0% (P < .001). The clinical success rate was 76.6%, and the patient satisfaction rate was 80.8% at 12 months after RFT. During the procedures, there was unilateral local bleeding in two patients (0.6%) and bradycardia in five patients (3.2%); after the procedures, unilateral pneumothorax occurred in 15 patients (4.7%) and closed thoracic drainage was performed in two patients (0.6%); thoracic neuralgia occurred in 24 patients (15.2%). The incidence of compensatory hyperhidrosis (CH) 12 months after RFT was 15.2%.

CONCLUSIONS: CT-guided percutaneous T4 thoracic sympathetic RFT is safe, effective, and minimally invasive for the treatment of PPHH.

LEVEL OF EVIDENCE: Level 2 observational study with dramatic effect.

PMID:36316494 | DOI:10.1007/s00270-022-03305-w

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Association of primary focal hyperhidrosis with anxiety induced by sweating: A cross-sectional study of Japanese university students focusing on the severity of hyperhidrosis and site of sweating

J Dermatol. 2022 Oct 25. doi: 10.1111/1346-8138.16617. Online ahead of print.

ABSTRACT

Hyperhidrosis significantly reduces patients’ quality of life, with many reporting feeling highly anxious. However, the relationship between hyperhidrosis and anxiety induced by sweating has not been examined in detail. The current study examined the relationship between: (1) the presence of hyperhidrosis symptoms, (2) hyperhidrosis severity, and (3) the sites of the most sweating and anxiety induced by sweating. A cross-sectional web-based survey was conducted among university students, and 1080 consenting participants (600 males and 480 females; mean age, 18.8 years) were included in the analysis. The survey items were: (1) diagnostic criteria for hyperhidrosis, (2) Hyperhidrosis Disease Severity Scale, (3) presence of anxiety induced by sweating, and (4) site of the most sweating. The results of multiple logistic regression analysis adjusted for sex and age showed that the odds ratio (OR) for anxiety induced by sweating was significantly higher in participants who screened positive for hyperhidrosis than in those who screened negative (OR, 9.72 [95% CI, 5.80-16.27]). The OR of anxiety induced by sweating was 7.11 (95% CI, 3.99-12.65) for mild/moderate hyperhidrosis and 23.46 (95% CI, 7.15-76.93) for severe hyperhidrosis, compared with those who screened negative for hyperhidrosis. Compared with those who screened negative for hyperhidrosis, the OR for anxiety induced by sweating in those with the palmar, plantar, axillary, and head/face as the site of the most sweating was 7.74 (95% CI, 3.91-15.33), 14.86 (95% CI, 1.83-120.58), 16.92 (95% CI, 5.95-48.14), and 5.38 (95% CI, 1.39-20.74), respectively. Our findings suggest that participants who screened positive for hyperhidrosis, mild/moderate or severe, are at a higher risk of anxiety induced by sweating than participants who screened negative for hyperhidrosis.

PMID:36282908 | DOI:10.1111/1346-8138.16617

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Mydriasis and anisocoria in a pediatric hyperhidrosis patient with interesting findings in the family cat

Pediatr Dermatol. 2022 Oct 19. doi: 10.1111/pde.15157. Online ahead of print.

ABSTRACT

Here, we report a case of unilateral ocular mydriasis in a pediatric patient with longstanding hyperhidrosis, as well as similar findings in her cat. The patient had been undergoing treatment of her hyperhidrosis with topical glycopyrrolate. This case highlights the potential side effect profile of topical antimuscarinics and the importance of counseling patients on proper precautions.

PMID:36263444 | DOI:10.1111/pde.15157

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Squamous Cell Carcinoma of the Lung Presenting Unilateral Thoracic Hyperhidrosis: A Case Report and Review of Literature

Intern Med. 2022 Oct 19. doi: 10.2169/internalmedicine.0312-22. Online ahead of print.

ABSTRACT

Unilateral hyperhidrosis is an uncommon manifestation, and the majority of cases have been attributed to neurological diseases. There are few cases of unilateral hyperhidrosis associated with thoracic malignant tumors. We herein report a 74-year-old Japanese man with squamous cell carcinoma of the lung who presented with unilateral hyperhidrosis in the right thoracic area as one of the first clinical manifestations. We should consider the possibility of pleural diseases, including metastatic lung cancer, when encountering patients presenting with unilateral thoracic hyperhidrosis.

PMID:36261372 | DOI:10.2169/internalmedicine.0312-22

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Impact of microwave thermolysis energy levels on patient-reported outcomes for axillary hyperhidrosis and osmidrosis

Lasers Surg Med. 2022 Oct 13. doi: 10.1002/lsm.23610. Online ahead of print.

ABSTRACT

OBJECTIVE: Microwave thermolysis (MWT) is an emerging treatment for axillary hyperhidrosis reducing both sweat and odor. No prior studies have investigated and compared the different available energy settings of the MWT device. This study evaluated patient-reported outcome measures (PROMs) for axillary hyperhidrosis and osmidrosis following MWT treatment with two different energy levels.

METHODS: Twenty adults with axillary hyperhidrosis and osmidrosis reported sweat on Hyperhidrosis Disease Severity scale (HDSS: 1-4) and odor on Odor scale (OS: 1-10), respectively, supplemented by overall Dermatology Life Quality Index (DLQI: 0-30). This was a prospective, randomized, patient-blinded and intraindividually controlled study with 3 months follow-up (FU). Randomization comprised MWT treatment of one axilla with a standard medium energy setting (energy level 3) and the contralateral axilla with a standard high energy setting (energy level 5).

RESULTS: At baseline, patients reported substantial sweat and odor, negatively affecting their quality of life. At 3 months FU, PROMs showed improved quality of life with significantly reduced odor and sweat. Overall DLQI was reduced from a median of 10 to 4, with a median 6.5-point reduction (p = 0.0002). HDSS was reduced from a median of 4 to 2 on both sides, with a median reduction of 1 for medium energy level and 2 points for high energy level (p = 0.014). OS was reduced from a median of 8 to 3 for both energy levels, with a median reduction of 3.5 and 4.5 points for the medium and high energy level, respectively (p = 0.017). Local skin reactions were mild and transient, but slightly more pronounced following treatment with the high energy level.

CONCLUSION: MWT effectively improved patients’ quality of life, axillary sweat, and odor 3 months after on baseline treatment. Treatment with the high energy level presented a subtle but significant increase of efficacy based on PROMs for both sweat and odor. Patients were willing to accept a higher amount of temporary local skin reactions from a higher energy setting when experiencing greater odor and sweat reduction.

PMID:36229952 | DOI:10.1002/lsm.23610

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Microneedling Delivery of Botulinum Toxin Versus Intradermal Injection in the Treatment of Facial Hyperhidrosis

J Clin Aesthet Dermatol. 2022 Sep;15(9):40-44.

ABSTRACT

BACKGROUND: The current treatments of Facial hyperhidrosis (FH) are often limited and are associated with many adverse effects.

OBJECTIVE: The objective was to study the efficacy and safety of botulinum toxin-A delivery by microneedling versus its intradermal injection in the treatment of FH. Forty-two patients with FH were subjected to microneedling (Mn) followed by topical application of BTX-A on one side of the face and intra-dermal injection of BTX-A on the other side. Two sessions were performed at two week intervals. The assessment tools were Hyperhidrosis Disease Severity Scale (HDSS), the Dermatology Life Quality Index (DLQI), and patient satisfaction.

RESULTS: A score of one of HDSS was achieved in 85.7 percent of patients on the intradermally injected side versus 83.3 percent on the microneedling side (P=0.76%). Most of the patients on the injection side responded with the first session while the microneedling side responded with the second one (P<0.001). The DLQI was highly significant on both sides post-treatment (P<0.001). The side effects were mild in the form of pain on the intradermally injected sides, and mild transient erythema on the microneedling side. The microneedling side showed higher patient satisfaction compared to the intradermally injected side.

CONCLUSION: Both techniques were safe and effective in controlling the FH. Microneedling delivery of BTX-A was less painful and had higher patient satisfaction.

PMID:36213604 | PMC:PMC9529074