1
|
Fujimoto T, Terahara T, Okawa K, Inakura H, Hirayama Y, Yokozeki H. Long-term evaluation of the safety and efficacy of a novel 20% oxybutynin hydrochloride lotion for primary palmar hyperhidrosis: An open-label extension study. J Dermatol 2023; 50:1459-1472. [PMID: 37605375 DOI: 10.1111/1346-8138.16922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
The long-term safety and efficacy of 52-week application of oxybutynin hydrochloride 20% lotion (20% OL) for the treatment of primary palmar hyperhidrosis (PPHH) in Japanese patients aged ≥12 years were evaluated in an open-label extension (OLE) of a 4-week, randomized, double-blind (DB) study. The OLE included 114 patients who completed the DB study and wished to continue treatment and 12 new patients. In the safety analysis population (125 patients), the incidence of adverse events (AEs) and adverse drug reactions (ADRs) was 79.2% and 36.0%, respectively. Serious AEs were observed in two patients but were considered unrelated to the investigational drug. The incidence of AEs that led to study discontinuation was 1.6%. The incidence of application site AEs and ADRs was 35.2% and 26.4%, respectively. The severity of most events was mild. The incidence of anticholinergic AEs related to dry mouth was 3.2% for thirst and 0.8% for dry throat. The long-term efficacy of 20% OL was confirmed by a long-lasting reduction in sweat volume and improvement in the Hyperhidrosis Disease Severity Scale and Dermatology Life Quality Index. This study has several limitations: First the results may include some bias because most of the participants were from the prior DB study; second, the results may not be generalizable because only a few participants were in the age group most susceptible to PPHH (i.e., < 15 years old); and third, the study did not obtain safety information from treatment for more than 52 weeks, so this information must be collected in clinical practice in the future. No reduced therapeutic effect was observed in patients with PPHH in this study after 52-week application of 20% OL. Also, few patients experienced serious AEs or AEs that led to study treatment discontinuation.
Collapse
Affiliation(s)
- Tomoko Fujimoto
- Ikebukuro Nishiguchi Fukurou Dermatology Clinic, Tokyo, Japan
| | | | - Koji Okawa
- Hisamitsu Pharmaceutical Co., Inc, Tokyo, Japan
| | | | | | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Fujimoto T, Terahara T, Okawa K, Inakura H, Hirayama Y, Yokozeki H. A novel lotion formulation of 20% oxybutynin hydrochloride for the treatment of primary palmar hyperhidrosis: A randomized, placebo-controlled, double-blind, phase III study. J Am Acad Dermatol 2023; 89:62-69. [PMID: 36990320 DOI: 10.1016/j.jaad.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND No previous controlled studies have been specifically designed or adequately powered to show the efficacy of topical oxybutynin for palmar hyperhidrosis by using quantitative measures. OBJECTIVE To evaluate efficacy of 20% oxybutynin hydrochloride lotion (20% OL) in reducing palmar sweat volume in patients with primary palmar hyperhidrosis (PPHH). METHODS In a randomized controlled trial, Japanese patients with PPHH aged 12 years and older received either 20% OL (n = 144) or placebo (n = 140) on both palms once daily for 4 weeks. Palmar sweat volume was measured by the ventilated capsule method. For the primary outcome, response was defined as a reduction of sweat volume of at least 50% from baseline. RESULTS At week 4, the responder rate for sweat volume was significantly higher in the 20% OL arm than in the placebo arm (52.8% vs 24.3%, respectively; treatment difference, 28.5% [95% CI, 17.7% to 39.3%]; P < .001). No serious adverse events occurred, and no adverse events led to treatment discontinuation. LIMITATIONS The treatment period was only 4 weeks. CONCLUSIONS In patients with PPHH, 20% OL is superior to placebo in reducing palmar sweat volume.
Collapse
Affiliation(s)
- Tomoko Fujimoto
- Ikebukuro Nishiguchi Fukurou Dermatology Clinic, Tokyo, Japan
| | | | - Koji Okawa
- R&D Division, Hisamitsu Pharmaceutical Co, Inc, Tokyo, Japan
| | - Hiroshi Inakura
- R&D Division, Hisamitsu Pharmaceutical Co, Inc, Tokyo, Japan
| | - Yuta Hirayama
- R&D Division, Hisamitsu Pharmaceutical Co, Inc, Tokyo, Japan.
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
3
|
Wohlrab J, Bechara FG, Schick C, Naumann M. Hyperhidrosis: A Central Nervous Dysfunction of Sweat Secretion. Dermatol Ther (Heidelb) 2023; 13:453-463. [PMID: 36627476 PMCID: PMC9884722 DOI: 10.1007/s13555-022-00885-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Hyperhidrosis (HH) is a central nervous dysfunction characterized by abnormally increased sweating due to a central dysregulation of sweat secretion. HH significantly affects the quality of life of patients in their private, social and professional environments. Physiologically, sweating is a mechanism that regulates body temperature, but it may also be triggered by emotional or gustatory stimuli. There are two main types of sweat glands: eccrine and apocrine glands. The central nervous system controls sweat secretion through the release of neurotransmitters into the autonomous nervous system (ANS) that activate the sweat glands. The hypothalamus has two separate neuronal pathways, one for thermoregulation and one for emotions. HH may thus be due to either a neuronal dysfunction of ANS regulation leading to a hyperactivity of the sympathetic nervous system, or to abnormal central processing of emotions. Crucially, there is no dysfunction of the sweat glands themselves. Various pathogenic mechanisms have been proposed to be involved in pathological sweat secretion in HH, ranging from structural changes within the ANS to increased expression of aquaporin 5 and upregulation of activin A receptor type 1 in eccrine sweat glands. Although a genetic predisposition has been demonstrated, it remains unclear exactly which genes are involved. To identify new, potential therapeutic targets and to improve treatment options, a good understanding of the signaling pathways involved, the underlying mechanisms, and the genetic components is essential. In this review we discuss the various aspects of sweat physiology and function that are necessary to explain pathological sweating. Our aim is to raise awareness of the complexity of HH to promote a better understanding of the disorder.
Collapse
Affiliation(s)
- Johannes Wohlrab
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergy, Ruhr University, Bochum, Germany
| | | | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
4
|
Okawara H, Sawada T, Nakashima D, Maeda Y, Minoji S, Morisue T, Katsumata Y, Matsumoto M, Nakamura M, Nagura T. Realtime Monitoring of Local Sweat Rate Kinetics during Constant-Load Exercise Using Perspiration-Meter with Airflow Compensation System. SENSORS (BASEL, SWITZERLAND) 2022; 22:5473. [PMID: 35897977 PMCID: PMC9331097 DOI: 10.3390/s22155473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Epidermal wearable sweat biomarker sensing technologies are likely affected by sweat rate because of the dilution effect and limited measurement methods. However, there is a dearth of reports on the local sweat rate (LSR) monitored in real-time during exercise. This explorative study investigated the feasibility of real-time LSR monitoring and clarified LSR kinetics on the forehead and upper arm during constant-load exercise using a perspiration meter with an airflow compensation system. This observational cross-sectional study included 18 recreationally trained males (mean age, 20.6 ± 0.8 years). LSR on the forehead and upper arm (mg/cm2/min) were measured during a constant-load exercise test at 25% of their pre-evaluated peak power until exhaustion. The LSR kinetics had two inflection points, with a gradual decrease in the incremental slope for each section. After the second flexion point, the LSR slope slightly decreased and was maintained until exhaustion. However, the degree of change varied among the participants. Although the ratio of forehead LSR to upper arm LSR tended to decrease gradually over time, there was little change in this ratio after a second flexion point of LSR in both. These findings suggest possible differences in LSR control between the forehead and upper arm during constant-load exercise to prolonged exhaustion.
Collapse
Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Tomonori Sawada
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Daisuke Nakashima
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Yuta Maeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Shunsuke Minoji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Takashi Morisue
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (H.O.); (Y.M.); (S.M.); (T.M.); (M.M.); (M.N.); (T.N.)
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| |
Collapse
|
5
|
Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version). Chin Med J (Engl) 2022; 135:1264-1271. [PMID: 35830261 PMCID: PMC9433061 DOI: 10.1097/cm9.0000000000002198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’ social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.
Collapse
|
6
|
Woo W, Oh J, Kim BJ, Won J, Moon DH, Lee S. The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study. J Clin Med 2022; 11:jcm11133576. [PMID: 35806865 PMCID: PMC9267178 DOI: 10.3390/jcm11133576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Background: We aimed to investigate the impact of the COVID-19 pandemic on the degree of depression among hyperhidrosis patients and their quality of life. Methods: 222 patients were contacted through an online questionnaire. Patients reported quality of life (QoL), including treatment and changes in symptoms during the pandemic, and also responded to the Patient Health Questionnaire-9 (PHQ-9) to evaluate the severity of depression. Those were compared with the result from the general population. Spearman correlation and multiple linear regression were performed to identify the factors related to the PHQ-9 score. Results: Half of the patients were female. The mean PHQ-9 score (5.25) of hyperhidrosis patients was higher than the general population, and female patients displayed significantly higher PHQ-9 scores than males (p = 0.002). QoL was impaired more in females. About 10% of patients experienced worsening symptoms, and 30% had difficulties getting appropriate management. Significant negative correlations were found between the PHQ-9 and age or disease duration. Predictive factors for the PHQ-9 were female (p = 0.006) and facial hyperhidrosis (p = 0.024). Conclusions: The level of depression among hyperhidrosis patients was higher than the general population during the COVID-19 pandemic; female and facial hyperhidrosis patients need much more psychiatric attention. Though hyperhidrosis is classified as benign and often neglected by clinicians, we need to give more awareness to the mental burden imposed by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (W.W.); (B.J.K.); (J.W.); (D.H.M.)
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (W.W.); (B.J.K.); (J.W.); (D.H.M.)
| | - Jongeun Won
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (W.W.); (B.J.K.); (J.W.); (D.H.M.)
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (W.W.); (B.J.K.); (J.W.); (D.H.M.)
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (W.W.); (B.J.K.); (J.W.); (D.H.M.)
- Correspondence: ; Tel.: +82-02-2019-3381; Fax: +82-02-3461-8282
| |
Collapse
|
7
|
Okawara H, Sawada T, Nakashima D, Maeda Y, Minoji S, Morisue T, Katsumata Y, Matsumoto M, Nakamura M, Nagura T. Kinetic changes in sweat lactate following fatigue during constant workload exercise. Physiol Rep 2022; 10:e15169. [PMID: 35043587 PMCID: PMC8767313 DOI: 10.14814/phy2.15169] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
It is useful to investigate various physiological responses induced by fatigue in athletes. Moreover, wearable noninvasive sensors, including sweat sensors, are compatible with fatigue evaluation because of their ease of use, and ability to measure repeatedly and continual data. This cross-sectional study aimed to clarify how sweat lactate elimination curves obtained during constant workload exercise changed following fatigue. Seventeen recreationally trained males (average age, 20.6 ± 0.8 years) completed two consecutive constant workload exercise tests (at 25% peak power) with rest intervals; the participants were encouraged to perform Test 1 until exhaustion and Test 2 only for 10 min. Subjective fatigue (numerical rating scale with face rating scale), sweat lactate, and sweat rate were measured for 10 min in each test. Subjective fatigue was compared using the Wilcoxon signed-rank test and time to each constant value between Tests 1 and 2 was compared using paired t-test. Subjective fatigue significantly increased during Test 2 compared with that during Test 1. After Test 1, the sweat lactate elimination curve demonstrated a leftward shift, as proved by the significantly sooner observation of the peak and constant values of sweat lactate (2, 3, and 4 μA) (p < 0.01). Our preliminary results suggest that the sweat lactate elimination curve is different in the fatigue state. Further research may provide insight in the application of this curve to the evaluation for fatigue.
Collapse
Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Tomonori Sawada
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Daisuke Nakashima
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Yuta Maeda
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Shunsuke Minoji
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Takashi Morisue
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Yoshinori Katsumata
- Institute for Integrated Sports MedicineKeio University School of MedicineShinjukuJapan
- Department of CardiologyKeio University School of MedicineShinjukuJapan
| | - Morio Matsumoto
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Masaya Nakamura
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
| | - Takeo Nagura
- Department of Orthopaedic SurgeryKeio University School of MedicineShinjukuJapan
- Department of Clinical BiomechanicsKeio University School of MedicineShinjukuJapan
| |
Collapse
|