1
|
Campanati A, Gregoriou S, Milia-Argyti A, Kontochristopoulos G, Radi G, Diotallevi F, Martina E, Offidani A. THE PHARMACOLOGICAL TREATMENT AND MANAGEMENT OF HYPERHIDROSIS. Expert Opin Pharmacother 2022; 23:1217-1231. [PMID: 35686667 DOI: 10.1080/14656566.2022.2083499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Idiopathichyperhidrosis is a dysfunctional disorder involving eccrine sweat glands and its impact on patients' daily quality of life is well-known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options. AREAS COVERED The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatments flow-chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar and craniofacial hyperhidrosis. EXPERT OPINION Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis can represent an additive therapeutic option for patients with insufficient response to topical treatment according to a step wise therapeutic approach. Until the pathophysiological mechanisms underlying hyperhidrosis are clear, and the etiological therapeutic approach become realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms.
Collapse
Affiliation(s)
- Anna Campanati
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Stamatis Gregoriou
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Adamantia Milia-Argyti
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - George Kontochristopoulos
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Giulia Radi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Federico Diotallevi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Emanuela Martina
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Annamaria Offidani
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| |
Collapse
|
2
|
Park HH, Conic RRZ, Zhang S, Lieu A, Haft M, Hightower GK. Oral glycopyrrolate for primary focal hyperhidrosis in a pediatric population: A cross-sectional study. JAAD Int 2021; 4:65-66. [PMID: 34409395 PMCID: PMC8361902 DOI: 10.1016/j.jdin.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Helen H Park
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California.,School of Medicine, University of California, San Diego, La Jolla, California
| | - Rosalynn R Z Conic
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Sijia Zhang
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California.,School of Medicine, University of California, San Diego, La Jolla, California
| | - Alexander Lieu
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California.,School of Medicine, University of California, San Diego, La Jolla, California
| | - Michael Haft
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California.,School of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - George K Hightower
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California.,School of Medicine, University of California, San Diego, La Jolla, California
| |
Collapse
|
3
|
Abstract
Primary hyperhidrosis, an idiopathic disease that commonly affects the palms, soles, axillae, or craniofacial region, is characterized by perspiration in excess of what is required for physiologic cooling. This disease begins in childhood or adolescence and negatively impacts emotional, physical, and psychologic well-being. This review explores current therapeutic options for primary hyperhidrosis in the pediatric population, including topical therapies, oral therapies, non-surgical and procedural interventions, and adjunctive therapies. In addition, this review identifies new and emerging treatments and highlights the need for further research and therapeutic options for this impactful disease.
Collapse
Affiliation(s)
- Courtney Remington
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Jennifer Ruth
- Dell Children's Medical Group, Pediatric and Adolescent Dermatology, Austin, TX, USA.,Dell Medical School, Division of Dermatology, The University of Texas at Austin, Austin, TX, USA
| | - Adelaide A Hebert
- McGovern Medical School, Departments of Dermatology and Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
4
|
Kuijpers M, Peeters G, Harms PW, Bouma W, DeJongste MJ, Mariani MA, Klinkenberg TJ. Bilateral one-stage single-port sympathicotomy in primary focal hyperhidrosis, a prospective cohort study: treat earlier? J Cardiothorac Surg 2021; 16:50. [PMID: 33766091 PMCID: PMC7992325 DOI: 10.1186/s13019-021-01430-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary Focal Hyperhidrosis (PFH) has a detrimental effect on Quality of Life. Repetitive, non-curative symptomatic strategies dominate current treatment of PFH, in spite of the availability of an effective and permanent curative treatment like Endoscopic Thoracic Sympathectomy (ETS). Current surgical optimization may allow for a re-established position of sympathetic modulation in this treatment algorithm. We sought to evaluate the safety, effectiveness, and long-term results of a Bilateral One-stage Single-port Sympathicotomy (BOSS) procedure in PFH patients and to identify subgroups benefitting most. Methods Prospective analysis of 163 patients, 35 (21.5%) underwent Rib-3 (R3) BOSS for palmar PFH, 58 (35.6%) R3-R5 BOSS for axillary PFH and 70 (42.9%) R3-R5 BOSS for combined palmar/axillary PFH. Effectiveness was measured using Skindex-29 and the Hyperhidrosis Disease Severity Scale (HDSS). Results Overall Skindex-29-rating (46.5 ± 14.8 preoperatively vs 20.1 ± 20.6 postoperatively, p < 0.001), and HDSS score (3.71 ± 0.45 preoperatively vs 1.82 ± 0.86 postoperatively, p < 0.001) indicated a significant improvement in health-related quality of life after BOSS. R3 BOSS was superior to R3-R5 BOSS in terms of HDSS score (1.49 vs 1.91 respectively, p = 0.004) and in terms of severe compensatory hyperhidrosis, a frequently reported side-effect (17.1% vs 32.8% respectively, p < 0.001). No major complications occurred. Conclusions BOSS is safe, effective, and offers a long-term curative solution in the treatment of PFH. Especially in the palmar PFH subgroup, R3 BOSS treatment results compare favorably to the treatment results of non-curative alternatives published in the current literature. Therefore, R3 BOSS should be offered to all patients with severe PFH, reporting insufficient benefit of treatment options such as oral and/or local agents.
Collapse
Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands. .,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands.
| | - Gwen Peeters
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Petra W Harms
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | | | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| |
Collapse
|
5
|
Patra S, Kaur M, Sharma VK. Stepwise treatment of primary focal hyperhidrosis with aluminum chloride hexahydrate lotion (20%) and oral glycopyrrolate: a retrospective study from a tertiary care center. Dermatol Ther 2020; 33:e13914. [DOI: 10.1111/dth.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Suman Patra
- Department of Dermatology All India Institute of Medical Sciences Bhopal India
| | - Maninder Kaur
- Department of Dermatology All India Institute of Medical Sciences Bhopal India
| | - Vinod Kumar Sharma
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| |
Collapse
|
6
|
Garcia-Souto F, Del Boz J, Polo-Padillo J. Adjusting oral glycopyrrolate medication for hyperhidrosis to reflect seasonal temperature variations. Dermatol Ther 2020; 33:e14249. [PMID: 32860330 DOI: 10.1111/dth.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
The condition of most patients with hyperhidrosis (HH) is known to worsen with increased temperature. However, most prior studies of oral glycopyrrolate (OGly) for the treatment of HH have assumed a stable treatment protocol, without taking into account seasonal variations in temperature. The main aim of this study is to evaluate the outcomes derived from performing a seasonal adjustment of the dose of OGly for patients with HH. A prospective study of patients who began OGly for HH, and maintained treatment for at least 1 year, was performed. All patients had experienced treatment failure with oral oxybutynin. All were recommended to vary the dose of medication according to the time of year. Of the 35 patients included in the study, 20 (57.14%) varied the dose. Those with palmar and plantar HH had a greater propensity to do so. The patients who varied the dose according to the time of year were significantly more likely to report an "Excellent" response after 12 months of treatment. The frequency of adverse effects was 71.4% with no significant differences among the study groups. However, there was a significantly higher proportion of adverse effects other than oral xerosis in the group that did not vary the dose.
Collapse
Affiliation(s)
- Fernando Garcia-Souto
- Dermatology Department, Hospital Universitario de Valme, Seville, Spain.,Faculty of Medicine, University of Seville, Seville, Spain
| | - Javier Del Boz
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | |
Collapse
|
7
|
Del Boz J, García-Souto F, Rivas-Ruiz F, Polo-Padillo J. Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin. Dermatol Ther 2020; 33:e14210. [PMID: 32827198 DOI: 10.1111/dth.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
Oral anticholinergics such as oxybutynin (OOx) and glycopyrrolate (OGly) are frequently used in the management of hyperhidrosis. Although OOx is considered currently the anticholinergic drug of first choice, OGly is a safe and effective alternative if OOx fails. The aim of this study was to identify the main variables associated with treatment adherence by patients receiving OGly, for whom previous treatment with OOx had failed. A prospective study was conducted of patients with hyperhidrosis receiving treatment with OGly in the period 2012 to 2019. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. A total of 58 patients (41 women), with a mean age of 35.9 years, were included in the study. The median follow-up period was 32 months. At 3 months, 70.7% of the patients had responded to treatment (excellent response: 75.6%), and adverse effects were reported by 70.7%. At 12 months, 53.4% had responded (excellent response: 74.2%), with adverse effects in 70.9%. The variables associated with poorer adherence were affected areas: palms of the hands, soles of the feet and armpits. The only variable associated with greater adherence was the generalized presence of hyperhidrosis. Our results provide valuable insights into the outcomes achieved when OGly is used to treat hyperhidrosis.
Collapse
Affiliation(s)
- Javier Del Boz
- Department of Dermatology, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Fernando García-Souto
- Department of Dermatology, Hospital Universitario de Valme, Seville, Spain.,Faculty of Medicine, University of Seville, Seville, Spain
| | | | | |
Collapse
|
8
|
Soeberdt M, Kilic A, Abels C. Current and emerging treatments targeting the neuroendocrine system for disorders of the skin and its appendages. Exp Dermatol 2020; 29:801-813. [DOI: 10.1111/exd.14145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Ana Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
| |
Collapse
|
9
|
Balai M, Vyas K, Singh R, Kumari A. Evaluation of efficacy and safety of low dose glycopyrrolate in management of primary hyperhidrosis---an open label single arm study. Indian Dermatol Online J 2020; 11:1012-1013. [PMID: 33344362 PMCID: PMC7735010 DOI: 10.4103/idoj.idoj_179_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/15/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022] Open
|
10
|
Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions. Clin Cosmet Investig Dermatol 2019; 12:733-744. [PMID: 31632121 PMCID: PMC6781850 DOI: 10.2147/ccid.s210973] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Abstract
Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.
Collapse
Affiliation(s)
- Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Georgios Kontochristopoulos
- State Department of Dermatology-Venereology, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| |
Collapse
|
11
|
The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. J Am Acad Dermatol 2019; 81:669-680. [PMID: 30710603 DOI: 10.1016/j.jaad.2018.11.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
Collapse
|
12
|
Madke B, Pradhan S, Sirka C. Review of oral anticholinergics in the treatment of palmoplantar hyperhidrosis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2019. [DOI: 10.4103/ijdd.ijdd_40_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Nguyen NV, Gralla J, Abbott J, Bruckner AL. Oxybutynin 3% gel for the treatment of primary focal hyperhidrosis in adolescents and young adults. Pediatr Dermatol 2018; 35:208-212. [PMID: 29334132 PMCID: PMC5867207 DOI: 10.1111/pde.13404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES There are no reliably effective, well-tolerated topical agents for the treatment of hyperhidrosis. We sought to evaluate the efficacy and tolerability of oxybutynin 3% gel in adolescents and young adults with primary focal hyperhidrosis. METHODS Patients with severe axillary hyperhidrosis were treated with topical oxybutynin 3% gel for 4 weeks. Response to treatment was assessed by calculating change in Hyperhidrosis Disease Severity Score from baseline to weeks 1 and 4. Change in health-related quality of life was assessed using the Children's Dermatology Life Quality Index or the Dermatology Life Quality Index. Adverse effects were evaluated using patient diaries, investigator global review, and physical examination. RESULTS Of 10 patients aged 13-24 enrolled, seven completed the study. Of those who completed the study, four (57.1%) reported reduction in axillary Hyperhidrosis Disease Severity Score at week 1 and all seven (100%) at week 4. Six patients (85.7%) reported reduction in Children's Dermatology Life Quality Index or Dermatology Life Quality Index score. Anticholinergic adverse effects were infrequent. The majority of treatment-related adverse events were mild to moderate in severity. One patient experienced a severe adverse event. CONCLUSION Oxybutynin 3% gel reduced hyperhidrosis severity and improved health-related quality of life in this small pilot study. Safety and efficacy should be further evaluated in a large, prospective, placebo-controlled study.
Collapse
Affiliation(s)
- Nicholas V. Nguyen
- Division of Dermatology, Akron Children’s Hospital, Akron, Ohio, Departments of Internal Medicine and Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
| | - Jane Gralla
- Departments of Pediatrics, Biostatistics & Informatics, School of Medicine, University of Colorado, Aurora, Colorado
| | - James Abbott
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anna L. Bruckner
- Departments of Dermatology and Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| |
Collapse
|
14
|
Nasir A, Bissonnette R, Maari C, DuBois J, Pene Dumitrescu T, Haddad J, Yamaguchi Y, Dalessandro M. A phase 2a randomized controlled study to evaluate the pharmacokinetic, safety, tolerability and clinical effect of topically applied Umeclidinium in subjects with primary axillary hyperhidrosis. J Eur Acad Dermatol Venereol 2017; 32:145-151. [DOI: 10.1111/jdv.14651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Nasir
- Wake Research Institute; Raleigh NC USA
| | | | - C. Maari
- Innovaderm Research Inc.; Montreal QC Canada
| | | | - T. Pene Dumitrescu
- Clinical Pharmacology Modeling and Simulation; GlaxoSmithKline Upper Merion PA USA
| | - J. Haddad
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
| | - Y. Yamaguchi
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
| | - M. Dalessandro
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
| |
Collapse
|
15
|
Abstract
INTRODUCTION Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.
Collapse
Affiliation(s)
- Christine Hosp
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
| | - Henning Hamm
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
| |
Collapse
|
16
|
Affiliation(s)
- Jason E. Sammons
- Department of Clinical Medicine, Avalon University School of Medicine, Willemstad, CW, USA
| | | |
Collapse
|
17
|
Cruddas L, Baker D. Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review. J Eur Acad Dermatol Venereol 2017; 31:952-963. [DOI: 10.1111/jdv.14081] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Cruddas
- University College London Medical School; London UK
| | - D.M. Baker
- Department of Surgery; Royal Free Hospital; London UK
| |
Collapse
|
18
|
Grabell DA, Hebert AA. Current and Emerging Medical Therapies for Primary Hyperhidrosis. Dermatol Ther (Heidelb) 2016; 7:25-36. [PMID: 27787745 PMCID: PMC5336423 DOI: 10.1007/s13555-016-0148-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/08/2022] Open
Abstract
Hyperhidrosis is defined as the production of sweat beyond what is physiologically necessary to maintain thermal homeostasis. This disease state may (and typically does) have a significant impact on the patient’s quality of life. Medications including antiperspirants, anticholinergics, and botulinum toxin have been shown to be effective in the management of hyperhidrosis. Several medical device technologies have also proven to be effective. This review article will explore the current and emerging pharmacological and medical device treatments for hyperhidrosis and provide a framework for treating patients who suffer with primary forms of hyperhidrosis.
Collapse
Affiliation(s)
- Daniel A Grabell
- Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA. .,Department of Pediatrics, UTHealth McGovern Medical School, Houston, TX, USA.
| |
Collapse
|
19
|
Del Boz J, Millán-Cayetano JF, Rivas-Ruiz F, de Troya-Martín M. Oral glycopyrrolate after the failure of oral oxybutynin in the treatment of primary hyperhidrosis. Br J Dermatol 2016; 176:821-823. [PMID: 27436700 DOI: 10.1111/bjd.14876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Del Boz
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J F Millán-Cayetano
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain.,University of Málaga, Málaga, Spain
| | - F Rivas-Ruiz
- Research Unit, Hospital Costa del Sol, Marbella, Málaga, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Marbella, Málaga, Spain
| | - M de Troya-Martín
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Marbella, Málaga, Spain
| |
Collapse
|
20
|
Schollhammer M, Brenaut E, Menard-Andivot N, Pillette-Delarue M, Zagnoli A, Chassain-Le Lay M, Sassolas B, Jouan N, Le Ru Y, Abasq-Thomas C, Greco M, Penven K, Roguedas-Contios AM, Dupré-Goetghebeur D, Gouedard C, Misery L, Le Gal G. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. Br J Dermatol 2015; 173:1163-8. [PMID: 26114588 DOI: 10.1111/bjd.13973] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. OBJECTIVES To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. METHODS We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2·5 mg per day and increased gradually to 7·5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. RESULTS Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0·009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6·9) than in the placebo arm (2·3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. CONCLUSIONS Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth.
Collapse
Affiliation(s)
- M Schollhammer
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital, Brest, France
| | | | - M Pillette-Delarue
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | | | | | - B Sassolas
- Department of Internal Medicine, University Hospital, Brest, France
| | - N Jouan
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | - Y Le Ru
- Dermatologist, Brest, France
| | - C Abasq-Thomas
- Department of Dermatology, University Hospital, Brest, France
| | - M Greco
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | | | | | | | | | - L Misery
- Department of Dermatology, University Hospital, Brest, France
| | - G Le Gal
- INSERM CIC 1412, Université de Brest, Brest, France
| |
Collapse
|
21
|
Hyperhidrosis in children and review of its current evidence-based management. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000469364.71629.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
22
|
Systemic Treatment of Hyperhidrosis. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
23
|
Tratamiento sistémico de la hiperhidrosis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:271-7. [DOI: 10.1016/j.ad.2014.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/05/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022] Open
|
24
|
Kouris A, Armyra K, Stefanaki C, Christodoulou C, Karimali P, Kontochristopoulos G. Quality of life and social isolation in Greek adolescents with primary focal hyperhidrosis treated with botulinum toxin type A: a case series. Pediatr Dermatol 2015; 32:226-30. [PMID: 25557249 DOI: 10.1111/pde.12480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary hyperhidrosis, although extensively documented in adults, typically has onset that dates back to early childhood. It is an unpleasant and socially disabling problem for the affected child, but little attention has been paid to the disease in adolescents. The objective of the current study was to evaluate the effectiveness of botulinum toxin type A (BTXA) in adolescents with primary palmar and axillary hyperhidrosis and to determine its effect on quality of life and social isolation. Thirty-five individuals (17 girls, 18 boys) with moderate to severe palmar and axillary hyperhidrosis were treated with BTXA (onabotulinum). Patients were examined at baseline and 6 months after treatment. The Hyperhidrosis Disease Severity Scale (HDSS) was used to evaluate disease severity and the Children's Dermatology Life Quality Index (CDLQI) was used to assess quality of life. The University of California at Los Angeles loneliness scale (UCLA version 3) was used to assess personal perception of loneliness and social isolation. The median age of the participants was 14 years, and 48.6% were female. Twenty-one had palmar hyperhidrosis, and 14 had axillary hyperhidrosis. Total CDLQI and social isolation scores decreased significantly after treatment with BTXA (both p < 0.001). There was a significant difference between pre- and post-treatment levels of severity of hyperhidrosis. No statistically significant difference was documented for CDLQI and UCLA scores between boys and girls. Treatment of hyperhidrosis with BTXA resulted in improvement in quality of life, social skills, and activities.
Collapse
Affiliation(s)
- Anargyros Kouris
- Department of Dermatology and Venereology, Andreas Sygros Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
|
27
|
Abstract
PURPOSE OF REVIEW Primary focal hyperhidrosis is a common condition that negatively impacts quality of life for many pediatric patients and can be challenging to treat. Standard treatments for hyperhidrosis can be used with success in many patients, and newer therapies and techniques offer options that have demonstrated efficacy and safety. This review highlights standard therapies for primary focal hyperhidrosis as well as the most recent technique advancements and alternative treatment options. RECENT FINDINGS The standard approach to treating primary focal hyperhidrosis remains initiation of topical preparations, followed by advancement to systemic medications, local administration of medication and/or surgical procedures. Recent studies focus on enhancing tolerability of topical preparations as well as evaluating the efficacy of neuromodulator injections, oral anticholinergic medications and laser therapy. Microwave technology has also been introduced for the treatment of focal hyperhidrosis with promising results. SUMMARY Many therapies exist for hyperhidrosis, and each treatment plan must be evaluated on a patient-by-patient basis. Advances in standard therapies and emergence of new treatment techniques are the main emphases of current published literature on hyperhidrosis. This article presents recent therapeutic options as well as updates on more established strategies to help practitioners treat this challenging condition.
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Özcan D, Güleç AT. Compliance with Tap Water Iontophoresis in Patients with Palmoplantar Hyperhidrosis. J Cutan Med Surg 2014; 18:109-13. [DOI: 10.2310/7750.2013.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Patients tend to be noncompliant with tap water iontophoresis (TWI), which is an effective treatment option for palmoplantar hyperhidrosis. Objective: To investigate compliance with TWI in patients with palmoplantar hyperhidrosis and identify the factors limiting its utility. Methods: The medical data of 22 patients treated with TWI for palmoplantar hyperhidrosis were collected. A telephone inquiry questioning overall satisfaction with the treatment and the reasons for discontinuation was conducted. Results: Sixteen patients completed the initial treatment period, and all responded well to the therapy. Eight patients started on the maintenance treatment, five of whom gave up before completing five sessions. The reasons for discontinuation were a lack of time in 12 patients, switching to home therapy in 3 patients, and side effects in 1 patient. Conclusion: Patients with palmoplantar hyperhidrosis are noncompliant with TWI, mainly due to a lack of time. They should be well informed before therapy and be encouraged to have a home device for maintenance.
Collapse
Affiliation(s)
- Deren Özcan
- From the Department of Dermatology, BaşLkent University Faculty of Medicine, Ankara, Turkey
| | - A. Tülin Güleç
- From the Department of Dermatology, BaşLkent University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
- Jennifer R S Gordon
- Department of Dermatology, University of Texas Southwestern Austin, Austin, Texas
| | | |
Collapse
|
31
|
Dogruk Kacar S, Ozuguz P, Eroglu S, Polat S, Karaca S. Treatment of primary hyperhidrosis with tap water iontophoresis in paediatric patients: a retrospective analysis. Cutan Ocul Toxicol 2014; 33:313-6. [DOI: 10.3109/15569527.2013.875559] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Kumar MG, Foreman RS, Berk DR, Bayliss SJ. Oral glycopyrrolate for refractory pediatric and adolescent hyperhidrosis. Pediatr Dermatol 2014; 31:e28-30. [PMID: 24266878 DOI: 10.1111/pde.12236] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary hyperhidrosis is a common disorder affecting children and adolescents, and it can have a significant negative psychosocial effect. Treatment for pediatric hyperhidrosis tends to be limited by low efficacy, low adherence, and poor tolerance. Oral glycopyrrolate is emerging as a potential second-line treatment option, but experience with safety, efficacy, and dosing is especially limited in children. We present an institutional review of 12 children with severe, refractory hyperhidrosis treated with oral glycopyrrolate; 11 (92%) noted improvement and 9 (75%) would recommend oral glycopyrrolate to their friends. No significant side effects were noted. Our retrospective analysis suggests that oral glycopyrrolate is safe and effective in children with hyperhidrosis.
Collapse
Affiliation(s)
- Monique G Kumar
- Division of Dermatology, Departments of Internal Medicine and Pediatrics, School of Medicine, Washington University and St. Louis Children's Hospital, St. Louis, Missouri
| | | | | | | |
Collapse
|
33
|
Salvaggio HL, Wagner AM. Suture boots: an aid for the injection of onabotulinum toxin a for primary focal hyperhidrosis. Pediatr Dermatol 2013; 30:396-8. [PMID: 22958236 DOI: 10.1111/j.1525-1470.2012.01849.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary focal hyperhidrosis is a difficult problem for adults, children, and adolescents, causing significant impairment in quality of life. Onabotulinum toxin A injection is an effective third-line treatment for primary focal hyperhidrosis. Here we describe a technique to ensure adequate depth of botulinum toxin placement in the dermis using suture boots as an aid for injection.
Collapse
Affiliation(s)
- Heather L Salvaggio
- Division of Pediatric Dermatology, Children's Memorial Hospital, Chicago, IL 60614, USA.
| | | |
Collapse
|