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Hyperhidrosis Prevalence: A Disease Underreported by Patients and Underdiagnosed by Physicians.

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Hyperhidrosis Prevalence: A Disease Underreported by Patients and Underdiagnosed by Physicians.

Indian Dermatol Online J. 2019 Nov-Dec;10(6):676-681

Authors: Wadhawa S, Agrawal S, Chaudhary M, Sharma S

Abstract
Background: Hyperhidrosis (HH) is a disorder characterized by excessive sweating beyond required for normal thermoregulation, as a result of the excessive functioning of the sudomotor sweat control system. HH is broadly classified into 2 categories: primary HH and secondary. Our aim was to study the prevalence of HH in patients attending dermatological outpatients.
Methods: Randomly selected 832 attendees of dermatology outpatient department were requested to fill out a questionnaire for their presenting concerns to attend, the demography information (age, gender, and occupation), and presence of excessive visible sweating symptoms after the informed, written, and understood consent. This questionnaire was then evaluated by the researchers. And those who had a history of excessive sweating were evaluated in detail about HH by another questionnaire.
Results: The overall prevalence of HH was 17.9% (149/832), whereas only self-reported prevalence was 10.2% (85/832) in the dermatology outpatients. Of 149 patients, 110 (73.8%) were of primary HH followed by 39 (26.2%) of secondary HH.
Conclusion: This study showed a higher prevalence of HH in the attendees of dermatology outpatients of a tertiary care center but estimates that this disease affects a much larger proportion of individuals in the Nepalese population.

PMID: 31807447 [PubMed]

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Effects of Direct Current Administration on Hyperhidrosis Disease Severity Scale in Patients with Axillary Hyperhidrosis.

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Effects of Direct Current Administration on Hyperhidrosis Disease Severity Scale in Patients with Axillary Hyperhidrosis.

Biomed Res Int. 2019;2019:3232015

Authors: Şener S, Karakoç Y

Abstract
Background: Focal hyperhidrosis mostly affects the axillae, hands, feet, and face. For the management, several techniques are used. The aim of this study was to investigate the effects of direct current administration on the hyperhidrosis disease severity scale (HDSS) in patients with axillary hyperhidrosis that have various HDSS scores.
Design and Setting: Original article, University Hospital.
Methods: Sixty patients with primary axillary hyperhidrosis were inquired about the HDSS scores and the scores were noted at the onset and at the end of the 10th application. One month after the last session, HDSS scores were also inquired. At the end of 1-month follow-up, the patients whose HDSS scores rose after the 10th session were accepted as nonresponder. For the current delivery, a new iontophoresis application module (Sweat CureR) designed by Dr. Karakoc was used.
Results: Direct current application decreased axillary sweat intensity by 70% at both sides, and lowered the HDSS by about 1.5 degree. Major reduction in sweat intensity was in the patients with low HDSS scores (75%). Negative correlation was found between initial HDSS scores and median values of decreased sweat intensity (r = -0.317, p = 0.022). Minimal temporary side effects including skin irritation and one or more vesicle formation were inspected in 29 patients and, the permanent punctual pigmentation was observed only in one patient.
Conclusions: Decrease in axillary hyperhidrosis is satisfactory for these patients. Since iontophoresis application has beneficial effect and minimal side effects, it should be recommended to the patients before advanced management or surgical techniques.

PMID: 31781610 [PubMed – in process]

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C-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial.

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C-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial.

Pain Physician. 2019 Nov;22(6):591-599

Authors: Mostafa TAH, Hamed AA, Mohammed BM, El Sheikh NA, Shama AAA

Abstract
BACKGROUND: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of life, occupational activities, and social interactions.
OBJECTIVES: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up.
STUDY DESIGN: This is a randomized single-blinded trial.
SETTING: This study took place in a single hospital.
METHODS: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed.
RESULTS: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year follow-up. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups.
LIMITATIONS: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described.
CONCLUSIONS: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection.
KEY WORDS: Botulinum toxin, hyperhidrosis, quality, radiofrequency ablation.

PMID: 31775406 [PubMed – in process]

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Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions.

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Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions.

Clin Cosmet Investig Dermatol. 2019;12:733-744

Authors: Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D

Abstract
Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.

PMID: 31632121 [PubMed]

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[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience].

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[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience].

Cir Pediatr. 2019 Oct 01;32(4):177-180

Authors: Esteva Miró C, Núñez García B, Brun Lozano N, Pérez Gaspar M, Álvarez García N, Betancourth Alvarenga JE, Santiago Martínez S, Jiménez Gómez J

Abstract
INTRODUCTION: Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis. The aim of our study is to evaluate the results of surgery in paediatric patients.
MATERIAL AND METHODS: Retrospective study of patients with primary palmar or palmo-axillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years.
RESULTS: We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications. 1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction.
CONCLUSIONS: Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment.

PMID: 31626401 [PubMed – in process]

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T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis.

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T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis.

Medicine (Baltimore). 2019 Oct;98(42):e17272

Authors: Chen S, Zhang P, Chai T, Shen Z, Kang M, Lin J

Abstract
BACKGROUND: Palmar hyperhidrosis (PH) is a common sympathetic disorder that reduces patient’ quality of life. Video-assisted thoracoscopic sympathectomy (VTS) is a popular and effective treatment for PH. However, there is substantial controversy about the treatment of PH with VTS at the T3 or T4 level. We will compare the quality metrics of VTS at T3 versus T4 to determine the optimal level for VTS.
METHODS: We will search PubMed, Scopus, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and the Google Scholar databases for relevant clinical trials published in any language before March 31, 2019. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, sex of patient, and ethnicity of patient will be performed.
RESULTS: The results of this study will be published in a peer-reviewed journal.
CONCLUSIONS: The results of this study will provide reliable evidence for the development of optimal treatment strategies for patients with PH. Owing to the characteristics of disease and intervention methods, randomized controlled trials may not be sufficient. We will include high-quality nonrandomized controlled trials, but this may lead to high heterogeneity and may affect the reliability of the results.
PROSPERO REGISTRATION NUMBER: CRD42018116607.

PMID: 31626085 [PubMed – in process]

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Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database.

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Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database.

Int J Environ Res Public Health. 2019 Oct 15;16(20):

Authors: Park JM, Moon DH, Lee HS, Park JY, Lee JW, Lee S

Abstract
Sympathetic overactivity is associated with hyperhidrosis and cardiovascular diseases. Endoscopic thoracic sympathectomy (ETS) is a treatment for hyperhidrosis. We aimed to compare the risk for cardiovascular events between individuals with and without hyperhidrosis and investigate the effects of ETS on cardiovascular outcomes. We conducted a nationwide population-based cohort study using data acquired from the Korean Health Insurance Review and Assessment Service. Subjects newly diagnosed with hyperhidrosis in 2010 were identified and divided into two groups according to whether or not they underwent ETS. Propensity scores were calculated using a logistic regression model to match hyperhidrosis patients with control subjects. Combined cardiovascular events were defined as stroke and ischemic heart diseases. Subjects were followed up until the first cardiovascular event or 31 December 2017. The risk for cardiovascular events with hyperhidrosis and ETS was analyzed using Cox proportional hazards regression analysis. The risk for stroke was significantly higher in the hyperhidrosis group than in the control group (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.08-1.51); nonetheless, no significant difference in the risk for ischemic heart diseases was observed between the hyperhidrosis group and the control group (HR, 1.17; 95% CI, 0.99-1.31). Hyperhidrosis patients who did not undergo ETS were at significantly higher risk for cardiovascular events than the control group (HR, 1.28; 95% CI, 1.13-1.45). However, no significant difference in the risk for cardiovascular events was observed between hyperhidrosis patients who underwent ETS and the control group. Hyperhidrosis increases the risk for cardiovascular events. ETS could reduce this risk and needs to be considered for high-risk patients with cardiovascular diseases.

PMID: 31619017 [PubMed – in process]

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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

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Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.

Mol Pharm. 2019 Oct 15;:

Authors: Shim DH, Nguyen TT, Park PG, Kim MJ, Park BW, Jeong HR, Kim DS, Joo HW, Choi SO, Park JH, Lee JM

Abstract
Hyperhidrosis is a disorder that produces excess amount of sweat. The botulinum neurotoxin A (BoNT/A) has been used to treat hyperhidrosis through multiple intradermal injections at the site of condition. However, due to its toxicity, it is important to precisely deliver the proper dose of toxin to the target site. In addition, the use of conventional hyperdermic needle for multiple injections in the palm makes the approach undesirable and painful. Here, we designed a BoNT/A-coated microneedle (BoNT-MN) array and tested its efficacy as a substitute pain-free method to treat hyperhidrosis. BoNT-MNs were prepared by coating BoNT/A formulation on poly-lactic acid microneedles and were found to successfully penetrate in vitro thick skin. The coating formulations were then tested for its stability at 4°C, 25°C, and 37°C for 24 h. BoNT-MNs were found to be much more stable than its liquid state. Additionally, we carried out in vivo experiments by treating the right paw of mice with BoNT-MNs and found that the treatment induced a significant reduction of sweating response in the mouse’s foot pads. Thus, BoNT/A treatment with microneedles is beneficial and may be used as a more efficient and less painful approach to treat hyperhidrosis.

PMID: 31613636 [PubMed – as supplied by publisher]

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

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Reduction of Injection Site Pain in the Treatment of Axillary Hyperhidrosis With Botulinum Toxin: A Randomized, Side-by-Side, Comparative Study of Two Injection Patterns.

Dermatol Surg. 2019 Oct 04;:

Authors: Awaida CJ, Rayess YA, Jabbour SF, Abouzeid SM, Nasr MW

PMID: 31592920 [PubMed – as supplied by publisher]