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Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy. J Thorac Cardiovasc Surg 2014; 148:2673-6. [PMID: 25131173 DOI: 10.1016/j.jtcvs.2014.06.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Compensatory hyperhidrosis is a common devastating adverse effect after endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine whether a correlation existed in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. METHODS All patients undergoing endoscopic thoracic sympathectomy in the T2-T3, T2-T4, T2-T5, or T2-T6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n = 97) from January 2004 to January 2013 were retrospectively reviewed. RESULTS Differences in the preoperative patient characteristics were not statistically significant among the patients receiving T2-T3, T2-T4, T2-T5, or T2-T6 level resections. Of the 97 included patients, 28 (29%) experienced transient compensatory hyperhidrosis and 4 (4%) complained of severe compensatory hyperhidrosis and required additional treatment. No operative mortalities occurred, and the morbidity was similar among the groups. CONCLUSIONS Most patients had successful outcomes after undergoing extensive resection without changes in the incidence of compensatory hyperhidrosis. Therefore, we recommend performing complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis.
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152
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Iannitti T, Palmieri B, Aspiro A, Di Cerbo A. A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:931-5. [PMID: 25075176 PMCID: PMC4106921 DOI: 10.2147/dddt.s60389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. Aim We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Materials and methods Twenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied). Results Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups. Conclusion Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.
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Affiliation(s)
- Tommaso Iannitti
- School of Biomedical Sciences, University of Leeds, Leeds, UK ; Poliambulatorio del Secondo Parere, Modena, Italy
| | - Beniamino Palmieri
- Department of Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
| | - Anna Aspiro
- Department of Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
| | - Alessandro Di Cerbo
- Poliambulatorio del Secondo Parere, Modena, Italy ; Department of Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
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153
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Rajagopal R, Mallya NB. Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis. Med J Armed Forces India 2014; 70:247-52. [PMID: 25378778 PMCID: PMC4213906 DOI: 10.1016/j.mjafi.2014.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 01/27/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hyperhidrosis is generalised or focal excessive sweating and carries a substantial psychological and social burden. This study compares botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in palmar hyperhidrosis. METHODS The study included 60 cases of palmar hyperhidrosis randomly allocated to 2 groups. One group was given botulinum toxin type A 100 units per palm and the other group subjected to digital iontophoresis with topical application of aluminium chloride hexahydrate lotion for 4 weeks. They were assessed 4 weeks later and those without improvement were crossed over to the other arm for another 4 weeks. Those with improvement were followed up in the same arm for 6 months. RESULTS Botulinum therapy showed significant improvement in the initial (80%) as well as cross over cases (75%) as compared to iontophoresis and aluminium chloride (47%) for initial cases and (17%) for cross over cases. CONCLUSION Better improvements were seen with botulinum therapy than with iontophoresis and topical therapy. Residual effects of relief lasted on an average for 4 months for botulinum toxin whereas it was one month with iontophoresis and topical therapy. Advantage with iontophoresis and topical therapy was that it was non invasive and did not require regional anaesthesia as with botulinum therapy.
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Affiliation(s)
- R. Rajagopal
- Classified Specialist (Dermatology & Venereology), Command Hospital (Air Force), Bangalore 07, India
| | - Nikhitha B. Mallya
- Resident, (Dermatology), Command Hospital (Air Force), Bangalore 07, India
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154
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Hyun MY, Son IP, Lee Y, Choi HG, Park KY, Li K, Kim BJ, Seo SJ, Kim MN, Hong CK. Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study. J Eur Acad Dermatol Venereol 2014; 29:278-282. [PMID: 24909188 DOI: 10.1111/jdv.12518] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although facial hyperhidrosis has been frequently associated with a diminished quality of life, various conservative modalities for its management are still far from satisfactory. OBJECTIVE To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals. METHODS Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one-half of the forehead, whereas the other half of the forehead was treated with a placebo. All patients applied topical glycopyrrolate or placebo once a day for nine successive days. Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale (HDSS) score and any adverse effects. RESULTS Compared with the placebo-treated sides, topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 ± 10.30% (mean ± SD) at 90 min after the first application (day 1), 29.63 ± 7.74% at 24 h after the first application (day 2) and 36.68 ± 11.41% at 24 h after eight additional successive daily applications (day 10) (all P < 0.025). There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead, but the difference was not statistically significant (P > 0.025). No serious adverse events were reported during the course of this study. Only one patient developed a transient headache after treatment. CONCLUSION Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration.
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Affiliation(s)
- M Y Hyun
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - I P Son
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Y Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H G Choi
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - M N Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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155
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Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol 2014; 70:1083-7. [DOI: 10.1016/j.jaad.2013.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
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156
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Hessam S, Bechara FG. [Hyperhidrosis]. MMW Fortschr Med 2014; 156:46. [PMID: 24930231 DOI: 10.1007/s15006-014-3076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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157
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Abstract
Hyperhidrosis is a common and under-recognized disease in the pediatric population that has a significant impact on quality of life. Focal and generalized forms of hyperhidrosis exist, which can be idiopathic or secondary to underlying medical conditions or medications. Treatment is tailored to the specific patient needs, characteristics and goals. These include topical preparations, iontophoresis, botulinum toxin and anticholinergic medications.
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Affiliation(s)
- Jennifer R S Gordon
- Department of Dermatology, University of Texas Southwestern Austin, Austin, Texas
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158
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Basciani M, Di Rienzo F, Bizzarrini M, Zanchi M, Copetti M, Intiso D. Efficacy of botulinum toxin type B for the treatment of primary palmar hyperhidrosis: a prospective, open, single-blind, multi-centre study. Arch Dermatol Res 2014; 306:497-503. [PMID: 24522897 DOI: 10.1007/s00403-014-1449-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
Primary palmar hyperhidrosis is a distressing and disabling condition that can produce social, psychological and occupational problems. Although the use of botulinum toxin type A (BoNT-A) has been reported as an efficacious and safe intervention to improve palmar hyperhidrosis, only one study concerned botulinum toxin type B (BoNT-B) in this disorder. The aim of study was to evaluate the efficacy and safety of BoNT-B in treating primary palmar hyperhidrosis. Participants were injected with 5,000 IU of BoNT-B in each palm. Visual analogue test (VAS) to evaluate the intensity of decrease in sweat production, Minor's iodine starch test and measurement of paper towels' weight were used to ascertain palmar sweating at baseline, 4, 12 and 24 weeks after BoNT-B injections by a blind examiner. Thirty-two subjects (12 males, 20 females, mean age 31 ± 11) were enrolled. Significant reduction of palmar sweating was detected after BoNT-B injection: 2.9 ± 1.4, 0.3 ± 0.4, 0.9 ± 0.8, and 2.1 ± 1.5 g (p < 0.001) of paper towels' weight for the right palm at baseline, 4, 12 and 24 weeks; and 2.8 ± 1.7, 0.5 ± 0.6, 0.8 ± 0.7, and 1.8 ± 1.25 g (p < 0.001) at same time, respectively for the left palm. Significant reduction of mean VAS values were also detected after BoNT-B injections: 8.6 ± 1.1, 0.6 ± 0.8, 3.5 ± 2.5, and 7.1 ± 2.4 (p < 0.0001) at baseline, 4, 12 and 24 weeks, respectively. Mild side effects consisting in local pain and hand weakness were observed in 4 (12.5%) subjects. The findings indicated that the use of 5,000 IU BoNT-B injection in each palm was safe and significantly improved the severity of palmar hyperhidrosis.
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Affiliation(s)
- Mario Basciani
- Unit of Neuro-rehabilitation, Hospital Scientific Institute "Casa Sollievo Della Sofferenza", Viale dei Cappuccini, 71013, San Giovanni Rotondo (FG), Italy
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159
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Morphometric analysis of thoracic ganglion neurons in subjects with and without primary palmar hyperhidrosis. Ann Vasc Surg 2013; 28:1023-9. [PMID: 24342829 DOI: 10.1016/j.avsg.2013.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hyperhidrosis (HH) is a disease whose physiopathology remains poorly understood and that adversely affects quality of life. There is no morphologic study that includes an adequate control group that allows for comparison of the ganglion of HH to those of normal individuals. The purpose of study was to analyze morphologic and morphometric characteristics of the ganglion from patients with HH and normal individuals (organ donators). METHODS This was a transversal study. The sympathetic thoracic ganglia were obtained from 2 groups of patients. Group PH (palmar hyperhidrosis), 40 patients with palmar HH submitted to surgery by video-assisted thoracoscopy, and group C (control group), 14 deceased individuals (control group of organ donators) without any history of HH. The third left sympathetic thoracic ganglion was resected in all patients. RESULTS We observed higher number of cells in the PH group than in the control group (14.25 + 3.81 vs. 10.65 + 4.93) with P = 0.007; the mean percentage of ganglion cells stained by caspases-3 in the PH group was significantly greater than that of the C group (2.37 + 0.79 vs. 0.77 + 0.28) with P < 0.001; the mean value of area of collagen in the PH group was 0.80 IQ (0.08-1.87), and in the control group it was 2.36 IQ (0.49-5.98) with P = 0.061. CONCLUSIONS Subjects with primary palmar HH have a higher number of ganglion cells within the ganglion and a higher number of cells in apoptosis. Also, the subjects of PH group have less collagen in the sympathetic ganglion when compared with the control group, but not statistically significant.
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160
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Kuijpers M, Klinkenberg TJ, Bouma W, DeJongste MJ, Mariani MA. Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: prospective analysis of a standardized approach. J Cardiothorac Surg 2013; 8:216. [PMID: 24279511 PMCID: PMC4222053 DOI: 10.1186/1749-8090-8-216] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary palmar and/or axillary focal hyperhidrosis is a frequent disorder characterized by excessive sweating beyond physiological needs, often leading to a substantial impairment of quality of life. Over the years several minimally invasive surgical treatments have been described, however results vary, and due to a lack of uniform surgical approach, technique and nomenclature are often difficult to compare. In this prospective study we sought to evaluate the safety and effectiveness of our standardized technique of single-port, one-stage bilateral thoracoscopic sympathicotomy. METHODS On a prospective basis a hundred consecutive patients with severe or intolerable primary hyperhidrosis underwent one-stage bilateral single-port thoracoscopic sympathicotomy. Primary outcome was measured in pre- vs. post-operative Hyperhidrosis Disease Severity Scale scores. Location and extend of compensatory hyperhidrosis, and satisfaction with the procedure were registered. RESULTS A significant reduction in mean Hyperhidrosis Disease Severity Scale score (3.69 ± 0.47 preoperatively vs. 1.06 ± 0.34 postoperatively) (p < 0.001) was observed. In 97 (97%) out of the 100 enrolled patients a >80% reduction in sweat production was achieved. Compensatory hyperhidrosis was seen in 27 patients (27%). It was rated as mild by 21 patients (78%) and as moderate by 6 (22%) of these patients. No severe compensatory hyperhidrosis was reported. Major complications, such as intraoperative bleeding, infections, and Horner's syndrome were not observed. CONCLUSIONS Highly selective sympathicotomy at well-defined levels with a one-stage bilateral single-port transaxillary thoracoscopic approach is a save procedure, with excellent and reproducible immediate results in the treatment of primary palmar and/or axillary hyperhidrosis.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Mike J DeJongste
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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161
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Karlqvist M, Rosell K, Rystedt A, Hymnelius K, Swartling C. Botulinum toxin B in the treatment of craniofacial hyperhidrosis. J Eur Acad Dermatol Venereol 2013; 28:1313-7. [DOI: 10.1111/jdv.12278] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M. Karlqvist
- Department of Dermatology; Uppsala University; University Hospital
- Centre for Research and Development; County Council of Gävleborg; Uppsala University; University Hospital; Uppsala
| | - K. Rosell
- Sophiahemmet AB; Hidrosis Clinic; Stockholm Sweden
| | - A. Rystedt
- Sophiahemmet AB; Hidrosis Clinic; Stockholm Sweden
| | - K. Hymnelius
- Sophiahemmet AB; Hidrosis Clinic; Stockholm Sweden
| | - C. Swartling
- Department of Dermatology; Uppsala University; University Hospital
- Sophiahemmet AB; Hidrosis Clinic; Stockholm Sweden
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162
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Fujimoto T, Kawahara K, Yokozeki H. Epidemiological study and considerations of primary focal hyperhidrosis in Japan: From questionnaire analysis. J Dermatol 2013; 40:886-90. [DOI: 10.1111/1346-8138.12258] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoko Fujimoto
- Department of Dermatology; Graduate School of Medical and Dental Sciences
| | - Kazuo Kawahara
- Department of Health Policy Science; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Hiroo Yokozeki
- Department of Dermatology; Graduate School of Medical and Dental Sciences
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163
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Campanati A, Giuliodori K, Martina E, Giuliano A, Ganzetti G, Offidani A. Onabotulinumtoxin type A (Botox®) versus Incobotulinumtoxin type A (Xeomin®) in the treatment of focal idiopathic palmar hyperhidrosis: results of a comparative double-blind clinical trial. J Neural Transm (Vienna) 2013; 121:21-6. [DOI: 10.1007/s00702-013-1074-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
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164
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Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients. J Am Acad Dermatol 2013; 69:960-4. [PMID: 24035554 DOI: 10.1016/j.jaad.2013.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradermal injections of botulinum toxin are effective but transitory in primary axillary hyperhidrosis. These injections are repeated when the symptoms recur. The reported duration of efficacy is variable, from 2 to 24 months, but it is unknown how the duration of efficacy changes when injections are repeated. OBJECTIVE In this retrospective study, we aimed to evaluate changes in the duration of efficacy of botulinum toxin injections (Dysport, Ipsen, Boulogne-Billancourt, France) with the repetition of injections in patients with axillary hyperhidrosis. METHODS From May 2001 to April 2012 inclusive, 83 patients were treated with a dose of 125 U per underarm. We compared the duration of effect of the first and last toxin injections. RESULTS The median duration of efficacy for the first injection was 5.5 months, whereas that for the last injection was 8.5 months. The difference between these 2 durations is statistically significant (P = .0002). LIMITATIONS Although retrospective and based on the declarative, this work is the first to our knowledge to highlight this benefit of treatment and to evaluate botulinum toxin over such a long period (11 years). CONCLUSION There appears to be an increase in the duration of efficacy of botulinum toxin A injections with the repetition of injections in patients with primary axillary hyperhidrosis. The reasons for this effect may be linked to the mechanism of action of botulinum toxin, and may improve our understanding of its pharmacologic effects.
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Affiliation(s)
- Marie Lecouflet
- Department of Dermatology, Le Mans Hospital, Le Mans, France.
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165
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McAleer MA, Collins P. A study investigating patients' experience of hospital and home iontophoresis for hyperhidrosis. J DERMATOL TREAT 2013; 25:342-4. [DOI: 10.3109/09546634.2012.757287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Maeve Aine McAleer
- Department of Dermatology, St Vincent's University Hospital,
Elm Park, Dublin 4, Ireland
| | - Paul Collins
- Department of Dermatology, St Vincent's University Hospital,
Elm Park, Dublin 4, Ireland
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166
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Öncel M. Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases. Cardiovasc J Afr 2013; 24:137-40. [PMID: 24217046 PMCID: PMC3734871 DOI: 10.5830/cvja-2013-007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis. METHODS Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively. RESULTS Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6-48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients. CONCLUSION Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.
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Affiliation(s)
- Murat Öncel
- Department of Thoracic Surgery, Selcuklu Medicine Faculty, Selcuk University, Konya, Turkey
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167
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Lakraj AAD, Moghimi N, Jabbari B. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel) 2013; 5:821-40. [PMID: 23612753 PMCID: PMC3705293 DOI: 10.3390/toxins5040821] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/27/2013] [Accepted: 04/12/2013] [Indexed: 11/18/2022] Open
Abstract
Clinical features, anatomy and physiology of hyperhidrosis are presented with a review of the world literature on treatment. Level of drug efficacy is defined according to the guidelines of the American Academy of Neurology. Topical agents (glycopyrrolate and methylsulfate) are evidence level B (probably effective). Oral agents (oxybutynin and methantheline bromide) are also level B. In a total of 831 patients, 1 class I and 2 class II blinded studies showed level B efficacy of OnabotulinumtoxinA (A/Ona), while 1 class I and 1 class II study also demonstrated level B efficacy of AbobotulinumtoxinA (A/Abo) in axillary hyperhidrosis (AH), collectively depicting Level A evidence (established) for botulinumtoxinA (BoNT-A). In a comparator study, A/Ona and A/Inco toxins demonstrated comparable efficacy in AH. For IncobotulinumtoxinA (A/Inco) no placebo controlled studies exist; thus, efficacy is Level C (possibly effective) based solely on the aforementioned class II comparator study. For RimabotulinumtoxinB (B/Rima), one class III study has suggested Level U efficacy (insufficient data). In palmar hyperhidrosis (PH), there are 3 class II studies for A/Ona and 2 for A/Abo (individually and collectively level B for BoNT-A) and no blinded study for A/Inco (level U). For B/Rima the level of evidence is C (possibly effective) based on 1 class II study. Botulinum toxins (BoNT) provide a long lasting effect of 3–9 months after one injection session. Studies on BoNT-A iontophoresis are emerging (2 class II studies; level B); however, data on duration and frequency of application is inconsistent.
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Affiliation(s)
- Amanda-Amrita D. Lakraj
- Department of Neurology, Yale University School of Medicine; New Haven, CT 06520, USA; E-Mail:
| | - Narges Moghimi
- Department of Neurology, Case Western Reserve University; Cleveland, OH 44106, USA; E-Mail:
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine; New Haven, CT 06520, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-203-737-2464; Fax: +1-203-737-1122
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Nakahigashi K, Nomura T, Miyachi Y, Kabashima K. Reduction of Skin pH during Treatment for Palmoplantar Hyperhidrosis: A Conjecture on the Role of pH-Regulated Water Channel, i.e. Aquaporin. Case Rep Dermatol 2013; 5:126-8. [PMID: 23687491 PMCID: PMC3656688 DOI: 10.1159/000348855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary palmoplantar hyperhidrosis (PPH) is a disorder that involves excessive sweating on the palms and soles. Although the pathophysiology of PPH remains unknown, some treatments, including topical aluminum chloride (AC) and tap water iontophoresis (TWI), are effective at suppressing the perspiration. Herein, we report the kinetics of the skin pH of two cases of PPH treated with AC and TWI. We found that the skin pH decreased in accordance with the reduction in sweating. This finding indicates that the reduction in sweating may be attributed to the reduction of skin pH in AC and TWI. Whether or not the pH-regulated function of aquaporin can explain this finding remains unknown.
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Affiliation(s)
| | | | | | - Kenji Kabashima
- *Kenji Kabashima, MD, PhD, Department of Dermatology, Kyoto University Graduate School of Medicine, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan), E-Mail
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169
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Immunolocalization and translocation of aquaporin-5 water channel in sweat glands. J Dermatol Sci 2013; 70:26-33. [DOI: 10.1016/j.jdermsci.2013.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/21/2013] [Accepted: 01/31/2013] [Indexed: 01/10/2023]
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170
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Morioka D, Ohkubo F, Amikura Y. Clinical features of axillary osmidrosis: A retrospective chart review of 723 Japanese patients. J Dermatol 2013; 40:384-8. [DOI: 10.1111/1346-8138.12115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 12/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Daichi Morioka
- Department of Plastic and Reconstructive Surgery; Showa University; Tokyo; Japan
| | - Fumio Ohkubo
- Department of Plastic and Reconstructive Surgery; Showa University; Tokyo; Japan
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171
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Choi YH, Lee SJ, Kim DW, Lee WJ, Na GY. Open clinical trial for evaluation of efficacy and safety of a portable "dry-type" iontophoretic device in treatment of palmar hyperhidrosis. Dermatol Surg 2013; 39:578-83. [PMID: 23379993 DOI: 10.1111/dsu.12099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palmar hyperhidrosis is characterized by excessive sweating on the palm. Although botulinum toxin is effective and safe treatment for palmar hyperhidrosis, some patients require inexpensive, easy-to-use therapeutic modalities. OBJECTIVE To evaluate the efficacy and safety of a portable "dry-type" iontophoretic device for treatment of palmar hyperhidrosis. PARTICIPANTS Twenty-three volunteers with idiopathic palmar hyperhidrosis were enrolled; 20 completed the study. METHODS Participants were instructed to grasp the device with the left palm for 20 minutes once a day for 4 weeks. Follow-up evaluation was conducted during 4 weeks after termination of the treatment session. Sweat intensity, Investigator Global Assessment (IGA), patient satisfaction assessment (PSA), and hydration capacitance were measured for evaluation of efficacy. Adverse effects were investigated for evaluation of safety. RESULTS Statistically significantly greater improvement in IGA and hydration capacitance was achieved in the treated palm than in the untreated palm. Improvement in sweat intensity and PSA was not statistically significantly different in the treated and untreated palms. Two cases of mild local adverse effects were noted. CONCLUSION The device is an effective therapeutic modality for palmar hyperhidrosis in addition to local injection of botulinum toxin, endoscopic sympathectomy, and conventional iontophoretic treatments.
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Affiliation(s)
- Yoon Hyuk Choi
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
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172
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Expression of Acetylcholine and Its Receptor in Human Sympathetic Ganglia in Primary Hyperhidrosis. Ann Thorac Surg 2013; 95:465-70. [DOI: 10.1016/j.athoracsur.2012.10.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/21/2012] [Accepted: 10/25/2012] [Indexed: 02/05/2023]
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173
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OHSHIMA Y, TAMADA Y, YOKOZEKI H, MAEDA T, ENDO A, SENTA T, NAGAKI T. The Efficacy and Safety of Botulinum Toxin Type A in Patients with Primary Axillary Hyperhidrosis. ACTA ACUST UNITED AC 2013. [DOI: 10.2336/nishinihonhifu.75.357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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174
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Lee HJ, Lee SH, Jeong JH. Temporary Accommodation Difficulties after Botulinum Toxin Type B Injection for the Treatment of Hyperhidrosis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.2.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hye Jin Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Ho Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Jin Ho Jeong
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
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175
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Augustin M, Radtke M, Herberger K, Kornek T, Heigel H, Schaefer I. Prevalence and Disease Burden of Hyperhidrosis in the Adult Population. Dermatology 2013; 227:10-3. [DOI: 10.1159/000351292] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
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Abstract
In Europe often no clear distinction is made between deodorant and antiperspirant. Particularly in Germany, the labeling "deo" is used for both. Only antiperspirants are capable of influencing the activity of eccrine sweat glands. In the treatment of focal hyperhidrosis, the use of aluminum chloride solutions represents the first choice. The efficacy is well documented in a variety of studies. Subjective side effects include pruritus and - less often - irritant dermatitis, which can be treated symptomatically and usually does not require discontinuation of the treatment. Rare variants of focal hyperhidrosis like auriculotemporal syndrome, Ross syndrome and nevus sudoriferus also are suitable for treatment with topical aluminum chloride hexahydrate solutions.
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177
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Scamoni S, Valdatta L, Frigo C, Maggiulli F, Cherubino M. Treatment of primary axillary hyperhidrosis with botulinum toxin type a: our experience in 50 patients from 2007 to 2010. ISRN DERMATOLOGY 2012; 2012:702714. [PMID: 23119179 PMCID: PMC3483720 DOI: 10.5402/2012/702714] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/04/2012] [Indexed: 11/23/2022]
Abstract
Background. Local injections of Botulinum toxin type A (BTX-A) are an effective and safe solution for primary bilateral axillary hyperhidrosis. Traditional treatments are often ineffective and difficult to tolerate. This study was performed to assess the efficacy and safety of Botulinum toxin type A in the treatment of these diseases and to evaluate the reliability of patient's subjective rating in the timing of repeat injections. Methods. From 2007 to 2008, we included in the study and treated a total of 50 patients, and we used the Minor's iodine test and the hyperhidrosis diseases severity scale as initial inclusion criteria and also for evaluating the followup, comparing to patient's subjective rating. We used also a specific questionnaire to evaluate the level of pain, the onset of the effect, any eventual adverse effect of the treatment, the onset of compensatory hyperhidrosis, and the global grade of satisfaction. The data were analyzed using standard statistical methods. Results. 88% of patients were totally satisfied and all patients repeated the treatment during all the study. The symptom-free interval was in median 6 months with an average improving of HDSS of 1.5 points. In 86%, there was a complete accordance between the subjective patient's demand of the repetition of the treatment and the positivity to Minor test and HDSS. No major side effects happened. Conclusion. Local injections of Botulinum toxin type A (BTX-A) result in an effective and safe solution for bilateral axillary primary hyperhidrosis for the absence of significant morbidity, side effects, and lack of efficacy or duration. The only defects are the need of repetition of the treatment and relative costs.
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Affiliation(s)
- Stefano Scamoni
- Plastic Surgery Unit, Circolo and Fondazione Macchi Hospital, University of Insubria, Viale Borri 57, 21100 Varese, Italy
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178
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Silva PGD, Cataneo DC, Leite F, Hasimoto EN, Barros GAMD. Intrapleural analgesia after endoscopic thoracic sympathectomy. Acta Cir Bras 2012; 26:508-13. [PMID: 22042116 DOI: 10.1590/s0102-86502011000600017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 07/18/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.
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Affiliation(s)
- Patrícia Gomes da Silva
- Postgraduate Program in Anesthesiology, Botucatu School of Medicine, UNESP, Bauru, SP, Brazil
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179
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Chamcheu JC, Wood GS, Siddiqui IA, Syed DN, Adhami VM, Teng JM, Mukhtar H. Progress towards genetic and pharmacological therapies for keratin genodermatoses: current perspective and future promise. Exp Dermatol 2012; 21:481-9. [PMID: 22716242 PMCID: PMC3556927 DOI: 10.1111/j.1600-0625.2012.01534.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hereditary keratin disorders of the skin and its appendages comprise a large group of clinically heterogeneous disfiguring blistering and ichthyotic diseases, primarily characterized by the loss of tissue integrity, blistering and hyperkeratosis in severely affected tissues. Pathogenic mutations in keratins cause these afflictions. Typically, these mutations in concert with characteristic features have formed the basis for improved disease diagnosis, prognosis and most recently therapy development. Examples include epidermolysis bullosa simplex, keratinopathic ichthyosis, pachyonychia congenita and several other tissue-specific hereditary keratinopathies. Understanding the molecular and genetic events underlying skin dysfunction has initiated alternative treatment approaches that may provide novel therapeutic opportunities for affected patients. Animal and in vitro disease modelling studies have shed more light on molecular pathogenesis, further defining the role of keratins in disease processes and promoting the translational development of new gene and pharmacological therapeutic strategies. Given that the molecular basis for these monogenic disorders is well established, gene therapy and drug discovery targeting pharmacological compounds with the ability to reinforce the compromised cytoskeleton may lead to promising new therapeutic strategies for treating hereditary keratinopathies. In this review, we will summarize and discuss recent advances in the preclinical and clinical modelling and development of gene, natural product, pharmacological and protein-based therapies for these disorders, highlighting the feasibility of new approaches for translational clinical therapy.
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Affiliation(s)
- Jean Christopher Chamcheu
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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180
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Flores LP. Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:398-403. [PMID: 22699534 DOI: 10.1590/s0004-282x2012000600003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/03/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.
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Affiliation(s)
- Leandro Pretto Flores
- Section of Neurological Surgery, Santa Helena Hospital. Unit of Neurosurgery, Hospital de Base do Distrito Federal. Post-Graduate Program in Medical Science, University of Brasília (UnB), Brasília DF, Brazil.
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181
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182
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&NA;. Tailor therapy according to patient needs and anatomical site when treating primary hyperhidrosis. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/1120876-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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183
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184
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Paller AS, Shah PR, Silverio AM, Wagner A, Chamlin SL, Mancini AJ. Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis. J Am Acad Dermatol 2012; 67:918-23. [PMID: 22405644 DOI: 10.1016/j.jaad.2012.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary focal hyperhidrosis not uncommonly begins during the first two decades of life, and can have a profound effect on quality of life. Few treatment options have been studied in children. OBJECTIVE We sought to evaluate the response to oral glycopyrrolate in pediatric patients. METHODS Records of pediatric patients with hyperhidrosis seen at a pediatric hospital in a 10-year period were reviewed retrospectively and, if possible, parents and patients were also interviewed. The efficacy and adverse effects of oral glycopyrrolate were assessed. RESULTS In all, 31 children took at least one dose of oral glycopyrrolate. All had daily hyperhidrosis that affected their quality of life and were resistant or intolerant of aluminum salts. The mean age of hyperhidrosis onset was 10.3 years, and mean age of initiation of glycopyrrolate was 14.8 years. At a mean dosage of 2 mg daily, 90% of patients experienced improvement, which was major in 71% of responders. Improvement occurred within hours of administration and disappeared within a day of discontinuation. Duration of treatment averaged 2.1 years (range to 10 years). Side effects were noted by 29% of children, most commonly dry mouth (26%) and eyes (10%), and were dose-related. One patient developed blurred vision, which resolved with dosing below 5 mg/d; one patient experienced palpitations and discontinued the medication. LIMITATIONS This was a retrospective analysis of a limited number of pediatric patients. CONCLUSION Oral glycopyrrolate is a cost-effective, painless second-line therapy for children and adolescents with primary focal hyperhidrosis that impacts their quality of life.
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Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611-2941, USA.
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185
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Abstract
Botulinum toxin type A is a safe and effective method for treating focal hyperhidrosis, providing longer-lasting results than topical treatments without the necessity of invasive surgical procedures. Although more useful for axillary hyperhidrosis, botulinum toxin injections can also be effective in treating palmar and plantar disease. The effects of botulinum toxin last for six to nine months on average, and treatment is associated with a high satisfaction rate among patients. In this article, the authors discuss their preferred methods for treating axillary, palmar, and plantar hyperhidrosis. This article serves as guide for pretreatment evaluation, injection techniques, and posttreatment care.
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Affiliation(s)
- Melissa A Doft
- Division of Plastic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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186
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Bechara FG, Georgas D, Sand M, Stücker M, Othlinghaus N, Altmeyer P, Gambichler T. Effects of a long-pulsed 800-nm diode laser on axillary hyperhidrosis: a randomized controlled half-side comparison study. Dermatol Surg 2012; 38:736-40. [PMID: 22273498 DOI: 10.1111/j.1524-4725.2012.02339.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Generally, axillary hyperhidrosis (AH) is treated with antiperspirant agents, botulinum toxin, or local surgery. The effect of laser treatment on sweat secretion in patients with AH has not been investigated. OBJECTIVE To evaluate the effect of diode laser epilation on the sweat rate of patients with AH. MATERIALS AND METHODS We performed a randomized half-side controlled trial. Twenty-one patients were treated with 5 cycles of an 800-nm diode laser. Sweat rates were documented using gravimetry and a visual analogue scale. Histologic examination was performed in all patients before and after treatment. RESULTS A significant reduction in sweat rate was observed on the laser-treated (median 89 mg/min, range 42-208 mg/min vs 48 mg/min, range 17-119 mg/min; p < .001) and the untreated contralateral (median 78 mg/min, range 25-220 mg/min vs median 65 mg/min, range 24-399 mg/min; p = .04) sides, although no significant difference was found between the treated and untreated sides (p = .10). CONCLUSION Although we observed a significant decrease in sweat rate on laser-treated sites, laser epilation was not able to reduce the sweat rate significantly more than on the untreated contralateral side. These results probably indicate a placebo effect rather than a direct therapeutic effect of laser epilation.
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Affiliation(s)
- Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany.
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187
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Del Sorbo F, Brancati F, De Joanna G, Valente EM, Lauria G, Albanese A. Primary focal hyperhidrosis in a new family not linked to known loci. Dermatology 2012; 223:335-42. [PMID: 22237135 DOI: 10.1159/000334936] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/02/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary focal hyperhidrosis (PFH) is a disabling disorder. A first locus has been mapped in families with only palmar involvement, raising the question whether other unknown genes are responsible for more diffuse phenotypes. OBJECTIVE We investigated a PFH family with a new phenotype, providing evidence that PFH is a clinically and genetically heterogeneous condition. METHODS Family members were examined by autonomic tests, skin biopsy and genetic analysis, and followed up for 4 years. RESULTS Age at onset was early, involving the axillae, palms and soles. Affected members had dysautonomic features also at onset. Cardiovascular dysautonomia was present in affected and unaffected members. Skin biopsy revealed impairment of intraepidermal nerve fibers and reduced innervation of sweat glands. There was no linkage to PFH and aquaporin-5 loci. CONCLUSION This pedigree may serve as a basis for identifying a novel unmapped gene. Skin biopsy and cardiovascular autonomic tests provide important additions to the characterization of PFH.
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188
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Treatment of axillary hyperhidrosis with botulinum toxin: a single surgeon's experience with 53 consecutive patients. Aesthetic Plast Surg 2011; 35:1079-86. [PMID: 21559989 DOI: 10.1007/s00266-011-9738-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Axillary hyperhidrosis is a debilitating disease that affects the social and occupational lives of many Americans. It can be treated with subdermal injections of botulinum toxin. This study aimed to determine the interval between injections during which patients are symptom free and whether that interval varies depending on the number of treatments a patient has received. METHODS The study enrolled all the patients treated with botulinum toxin for axillary hyperhidrosis by the senior author between 2004 and 2010. Patient responses to the treatment with regard to both satisfaction and length of the symptom-free interval were collected prospectively and analyzed. An in-depth PubMed search was performed through July 2010 to compile the published data on using botulinum toxin injections to treat axillary hyperhidrosis. These data served as a benchmark to which the trends at our institution were compared. RESULTS The 53 patients included in the study had an average age of 29 years, and 64% were women. Of the 53 patients, 23 (43%) underwent multiple injections of botulinum toxin. The average symptom-free interval was 261 days. There was no statistically significant difference in symptom-free intervals after multiple treatments. Patient satisfaction rates were very high, similar to the high degrees of satisfaction found in the published data. CONCLUSION Botulinum toxin injections provide an effective treatment for axillary hyperhidrosis with a rapid onset and high patient satisfaction. Many patients have a symptom-free interval of 6-9 months after each botulinum toxin injection. This interval does not change significantly after multiple treatments.
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189
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Güder H, Karaca S, Cemek M, Kulaç M, Güder S. Evaluation of trace elements, calcium, and magnesium levels in the plasma and erythrocytes of patients with essential hyperhidrosis. Int J Dermatol 2011; 50:1071-4. [PMID: 22126867 DOI: 10.1111/j.1365-4632.2010.04862.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Essential hyperhidrosis is a disease that expresses itself with excessive sweating in palmar, plantar, axillary, and craniofacial regions. The etiopathogenesis of the disease, which has particular importance because of leading to psychosocial morbidity, could have not been completely elucidated. In previous studies, it has been shown that oxidative stress might play a role in the pathogenesis. AIMS Assessing the levels of trace elements such as Se, Zn, Cu, Fe, and Mg that have an important role in oxidative stress, as well as Ca and Mg that have an important role in membrane physiology, in patients with essential hyperhidrosis. MATERIALS AND METHODS Blood samples taken from the patient group with essential hyperhidrosis (42) and the control group (37) were separated into plasma and erythrocytes, and the levels of the bioelements were measured by use of ICP-OES device. RESULTS Erythrocyte levels of Se, Fe, Cu, Zn, Ca, and Mg were detected significantly higher in patients with essential hyperhidrosis. Furthermore, plasma levels of Cu, Ca, and Mg were significantly lower in patients with essential hyperhidrosis. Plasma levels of Se, Fe, and Zn showed no statistical difference between two groups. DISCUSSION It was thought that the high levels of Cu and Fe in erythrocytes may play a role in increased intracellular oxidative stress, whereas the increase in Se and Zn levels may be secondary to increased oxidative stress. Low extracellular concentrations of Ca and Mg raise the thought that they play a role either enhancing the membrane excitability of eccrine sweat glands or influencing the autonomic nerve system. CONCLUSION The levels of trace elements, which were determined to be different from the control group, may play a role in the pathogenesis of essential hyperhidrosis either in direct relation with or without oxidative mechanisms.
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Affiliation(s)
- Hüsna Güder
- Department of Dermatology, Medical Faculty, Yidız Technical University, Istanbul, Turkey
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Abstract
Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.
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Streker M, Reuther T, Hagen L, Kerscher M. Hyperhidrosis plantaris - a randomized, half-side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride. J Dtsch Dermatol Ges 2011; 10:115-9. [PMID: 21848980 DOI: 10.1111/j.1610-0387.2011.07750.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary focal hyperhidrosis plantaris can cause impairment in social, physical, leisure and occupational activities. Topical treatment with aluminium chloride is the first-line treatment. The aim of this trial was to evaluate efficacy and safety of two different concentrations of aluminium chloride hexa-hydrate (12.5%, 30%) for 6 weeks. PATIENTS AND METHODS 20 volunteers with hyperhidrosis plantaris were included. Efficacy was evaluated using a clinical rating scale of the hyperhidrosis level and qualitative assessments including Minor's (iodine-starch) test and a standardized sniff test. Furthermore a patient questionnaire and measurements of skin surface pH were done to evaluate the subjective assessments and side effects. RESULTS The hyperhidrosis level significantly decreased in both concentrations. There were no differences in tolerability regarding the skin surface pH and the patient questionnaires. In addition the hidrotic areas decreased after application of both products and the sniff test improved. CONCLUSION Topical application of an antiperspirant containing aluminium chloride reduced sweat production in plantar hyperhidrosis significantly. As both 12.5% and 30% were efficacious and safe, we would recommend 12.5% for outpatient treatment.
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Affiliation(s)
- Meike Streker
- Cosmetic Science (FB 13), University of Hamburg, Germany
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192
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Hoorens I, Ongenae K. Primary focal hyperhidrosis: current treatment options and a step-by-step approach. J Eur Acad Dermatol Venereol 2011; 26:1-8. [PMID: 21749468 DOI: 10.1111/j.1468-3083.2011.04173.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).
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Affiliation(s)
- I Hoorens
- Department of Dermatology, University Hospital, Ghent, Belgium.
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193
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Larson DL. Definitive diagnosis and management of axillary hyperhidrosis: the VapoMeter and suction-assisted arthroscopic shaving. Aesthet Surg J 2011; 31:552-9. [PMID: 21719868 DOI: 10.1177/1090820x11410869] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Axillary hyperhidrosis is a benign, yet significant, disability that not only impairs social interaction but also affects occupational activities. OBJECTIVES The author provides a detailed description of axillary shaving, a procedure with proven results. He also describes the use of the VapoMeter (Delfin Technologies, Stamford, Connecticut), which accurately and easily measures sweating in g/m(2)/h. METHODS Although a total of 45 patients have received this surgery since 2005, this report includes only the last eight patients (16 axilla) for whom both pre- and postoperative VapoMeter readings are available. RESULTS The average preoperative VapoMeter reading was 473 g/m(2)/h (range, 98-998), which improved to an average of 58 g/m(2)/h postoperatively (range, 21-227). As a comparison, controls for all axilla had an average measurement of 23.7 g/m(2)/h (range, 18-31). CONCLUSIONS When combined with the effective surgical technique of axillary shaving, the VapoMeter provides an objective measure to both definitively diagnose and confirm results of the shaving. With this protocol, patients who require surgical intervention for their hyperhidrosis can be reassured that the procedure is indeed effective in improving their condition.
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Affiliation(s)
- David L. Larson
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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194
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Abstract
Hcyperhidrosis is a condition in which individuals suffer from excessive and uncontrollable sweating. While its prevalence within the UK is unknown, it is a relatively common dermatological complaint encountered by GPs. It can cause a great deal of embarrassment for many sufferers as well as interference with daily activities. A holistic approach is therefore essential in the assessment and management of this condition. Clinicians should be aware of the treatment options available in both primary and secondary care.
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Affiliation(s)
- Baber Qadir
- ST3 GP registrar, Blenheim Medical Centre, Luton
| | - Shazia Hafeez
- ST3 GP Registrar, Rush Green Medical Centre, Dagenham
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195
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Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis. World J Surg 2011; 35:49-53. [PMID: 20862474 DOI: 10.1007/s00268-010-0801-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Palmoplantar hyperhidrosis is a common disease that leads to significant psychosocial strain for the affected person. Although the treatment of palmar symptoms with endoscopic thoracic sympathectomy (ETS) is clinically established, there are few data on the efficacy of an endoscopic lumbar sympathectomy (ELS) for the elimination of plantar symptoms. Especially the occurrence of unwanted side effects associated with sequential ETS and ELS has not been examined sufficiently. METHODS The study includes 130 patients, 8 men and 122 women, with severe palmoplantar hyperhidrosis who were already previously treated with ETS. An average of 28 months after the ETS, bilateral ELS was performed on all patients due to persistent severe plantar hyperhidrosis. After ELS the perioperative morbidity, elimination rate of the plantar hyperhidrosis, the frequency of unwanted side effects, and satisfaction with the result were evaluated. Follow-up examinations were carried out on 96 patients (74%) with a mean follow-up of 37 months (3-90 months). RESULTS A total of 260 lumbar sympathectomies were successfully carried out endoscopically. Mortality was zero, intraoperative complications occurred in three (2.3%) patients and postoperative complications in six (4.6%). Plantar hyperhidrosis was eliminated in 93 patients (97%), 3 (3%) patients developed a one-sided recurrence. Seven patients (7%) developed minor compensatory sweating, and in 17 patients (18%) compensatory sweating that existed before the ELS was slightly increased. Transient postsympathectomy neuralgia was observed in 18 patients (19%), and none of the patients showed a sexual function disorder. Altogether, 77 patients (80%) were very satisfied with the postoperative result, and 16 (17%) were partially satisfied. CONCLUSIONS The sesequential performance of ELS after ETS appears to be a safe, effective therapy option for patients with severe palmoplantar hyperhidrosis. However, more experience with a larger number of patients and longer follow-up investigations are necessary to confirm the safety of four-limb sympathectomy.
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196
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Guidelines on surgery of the thoracic sympathetic nervous system. Arch Bronconeumol 2011; 47:94-102. [PMID: 21342743 DOI: 10.1016/j.arbres.2010.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/29/2010] [Indexed: 11/23/2022]
Abstract
Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.
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197
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Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol 2011; 64:690-5. [PMID: 21334095 DOI: 10.1016/j.jaad.2010.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 02/28/2010] [Accepted: 03/03/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hyperhidrosis (HH) is excessive sweating that may be primary (idiopathic) or secondary to medication or disease. Clinical features supporting primary or secondary etiology have not been well documented. OBJECTIVE To identify clinical and demographic features predictive of a diagnosis of primary versus secondary HH. METHODS A retrospective chart review was conducted over a 13-year period (1993-2005) of all patients (children and adults) seen at a university-based outpatient dermatology department with an International Classification of Diseases, 9th revision diagnosis code for HH (N = 415). RESULTS Three hundred eighty-seven patients (93.3%) had primary HH (PHH); 28 patients (6.7%) had secondary HH (SHH). SHH patients were older (39.0 ± 18.6 years vs 27.3 ± 12.3 years) with more frequent onset at age older than 25 years (55% for SHH vs12.1% for PHH; odds ratio [OR] 8.7; 95% confidence interval [CI] 3.5-21.4; P < .00001 for each). SHH was more often unilateral/asymmetric (OR: 51; 95% CI: 12.6-208), generalized (vs focal; OR: 18; 95% CI: 7.3-47.6), and present nocturnally (OR: 23.2; 95% CI: 4.3-126; P < .00001 for each). Of SHH cases, endocrine disease accounted for 57% (including diabetes mellitus [11], hyperthyroidism [4], and hyperpituitarism [1]). Neurologic disease accounted for 32% (including peripheral nerve injury [3], Parkinson's disease [2], reflex sympathetic dystrophy [2], spinal injury [1] and Arnold-Chiari malformation [1]). Malignancy (pheochromocytoma), respiratory disease, and psychiatric disease were each represented once. Compared to other secondary causes, asymmetric HH favored neurologic disease (OR: 63; 95% CI: 4.9-810); P = .0002). LIMITATIONS Results were obtained from a single, university-based population. CONCLUSIONS On the basis of these data, the diagnostic criteria for PHH were assessed statistically. Criteria include: excessive sweating of 6 months or more in duration, with 4 or more of the following: primarily involving eccrine-dense (axillae/palms/soles/craniofacial) sites; bilateral and symmetric; absent nocturnally; episodes at least weekly; onset at 25 years of age or younger; positive family history; and impairing daily activities. These criteria discriminate well between PHH and SHH (sensitivity: 0.99; specificity: 0.82; positive predictive value: 0.99; negative predictive value: 0.852) and may facilitate optimal clinical management.
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198
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Marcella S, Goodman G, Cumming S, Foley P, Morgan V. Thirty-five units of botulinum toxin type A for treatment of axillary hyperhidrosis in female patients. Australas J Dermatol 2011; 52:123-6. [PMID: 21605096 DOI: 10.1111/j.1440-0960.2010.00723.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a retrospective audit on efficacy and impact of 35 units of botulinum toxin type A per axilla on quality of life in female patients with axillary hyperhidrosis. This audit shows that 35 units of botulinum toxin type A is a reasonable starting dose and could significantly improve patients' quality of life and reduce the cost of treatment.
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Affiliation(s)
- Stefanie Marcella
- Department of Dermatology, Skin and Cancer Foundation Victoria, Victoria, Australia.
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199
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Swartling C, Karlqvist M, Hymnelius K, Weis J, Vahlquist A. Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita. Br J Dermatol 2011; 163:1072-6. [PMID: 20618323 DOI: 10.1111/j.1365-2133.2010.09927.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Painful foot blistering is a common problem in patients with epidermolysis bullosa simplex (EBS) and pachyonychia congenita (PC). Hyperhidrosis, a condition which can be effectively blocked by plantar injections of botulinum toxin (Btx), often exacerbates the blistering. OBJECTIVES A retrospective evaluation of the effects of Btx injections in 14 patients with EBS and PC with foot blisters and painful callosities. METHODS After informed consent, patients with EBS (n = 6) and PC (n = 8), aged 7-66 years, who had received Btx therapy at our centre since 2003, were included. The treatment consisted of multiple plantar injections of Btx A or Btx B after prior regional or general anaesthesia. Patients were interviewed about the treatment effect and were asked to score the improvement from 0 to 5, where 5 is 'excellent'. One patient with PC with painful callosities was studied by magnetic resonance (MR) spectroscopic microimaging before and after Btx injections to disclose any underlying blisters. RESULTS In total, 76 treatments were evaluated (one to 19 sessions per patient). Thirteen patients (93%) reported reduced plantar blistering and pain; the improvement score was ≥ 4 in four of six patients with EBS and six of eight patients with PC. The mean effect duration was 3 months. No adverse events, apart from mild anticholinergic side-effects in two patients, were noted. MR spectroscopic microimaging showed disappearance of intraepidermal blistering after Btx therapy. CONCLUSIONS Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.
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Affiliation(s)
- C Swartling
- Department of Dermatology, County Council of Gävleborg, Uppsala University, University Hospital, SE-751 85 Uppsala, Sweden.
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New topical photodynamic therapy for management of primary axillary hyperhidrosis. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2011. [DOI: 10.1097/01.ewx.0000392816.83337.a4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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