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Yuen MMA. Health Complications of Obesity: 224 Obesity-Associated Comorbidities from a Mechanistic Perspective. Gastroenterol Clin North Am 2023; 52:363-380. [PMID: 37197879 DOI: 10.1016/j.gtc.2023.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Obesity is associated with a wide range of comorbidities that transverse multiple specialties in clinical medicine. The development of these comorbidities is driven by various mechanistic changes including chronic inflammation and oxidative stress, increased growth-promoting adipokines, insulin resistance, endothelial dysfunction, direct loading and infiltrative effect of adiposity, heightened activities of the renin-angiotensin-aldosterone system and sympathetic nervous system, impaired immunity, altered sex hormones, altered brain structure, elevated cortisol levels, and increased uric acid production, among others. Some of the comorbidities might develop secondary to one or more other comorbidities. Considering the obesity-associated comorbidities in the context of the mechanistic changes is helpful in understanding these conditions and in guiding treatment and future research.
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Affiliation(s)
- Michele M A Yuen
- Department of Medicine, Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital; University of Hong Kong, 102 Pokfulam Road, Pok Fu Lam, Hong Kong.
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Nationwide Cross-sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis Over 12 years in Brazil: Epidemiology, Costs, and Mortality. Ann Surg 2023; 277:e483-e487. [PMID: 34417365 DOI: 10.1097/sla.0000000000005178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements, and the in-hospital mortality rates. BACKGROUND Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate. METHODS Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 million inhabitants. RESULTS Thirteen thousand two hundred one endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with an average of U$ 512.68 per patient. CONCLUSIONS We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis' treatment per 10 million inhabitants per year. The inhospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths after endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.
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da Silva MFA, Louzada ACS, Teivelis MP, Stabellini N, Leiderman DBD, de Campos JRM, Amaro E, Wolosker N. Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study. SAO PAULO MED J 2022; 140:775-780. [PMID: 36102451 PMCID: PMC9671571 DOI: 10.1590/1516-3180.2021.0773.r2.14022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING Population-based retrospective cross-sectional study. METHODS Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.
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Affiliation(s)
| | | | - Marcelo Passos Teivelis
- MD, PhD. Attending Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Nickolas Stabellini
- Undergraduate Medical Student, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Dafne Braga Diamante Leiderman
- MD, PhD. Attending Physician, Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - José Ribas Milanez de Campos
- MD, PhD. Associate Professor, Department of Surgery, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Edson Amaro
- MD, PhD. Associate Professor, Department of Radiology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Nelson Wolosker
- MD, PhD. Full Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
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Wolosker N, de Campos JRM, Kauffman P, da Silva MFA, Faustino CB, Tedde ML, Puech-Leão P, Fernandes PMP. Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients. SAO PAULO MED J 2022; 140:284-289. [PMID: 35195234 PMCID: PMC9610237 DOI: 10.1590/1516-3180.2021.0078.r1.23072021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.
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Affiliation(s)
- Nelson Wolosker
- MD, PhD. Full Professor, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - José Ribas Milanez de Campos
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Kauffman
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Marcelo Fiorelli Alexandrino da Silva
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Carolina Brito Faustino
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Miguel Lia Tedde
- MD, PhD. Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Pedro Puech-Leão
- MD, PhD. Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Manuel Pêgo Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil; and Cardiothoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
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Yazbek G, Ishy A, Alexandrino da Silva MF, Sposato Louzada AC, de Campos JRM, Kauffman P, Tedde ML, Puech-Leão P, Pêgo-Fernandes PM, Wolosker N. Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method. Ann Vasc Surg 2021; 77:25-30. [PMID: 34411664 DOI: 10.1016/j.avsg.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. METHODS Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). RESULTS In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. CONCLUSIONS Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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Affiliation(s)
- Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, Rua Tamandaré, São Paulo, Brazil.
| | - Augusto Ishy
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - José Ribas Milanez de Campos
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
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Kamikava DYF, Wolosker N, da Silva MFA, de Campos JRM, Puech-Leão P. Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin. Clinics (Sao Paulo) 2021; 76:e2892. [PMID: 34190853 PMCID: PMC8221552 DOI: 10.6061/clinics/2021/e2892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Studies have identified correlations between the psychological characteristics of individuals with primary hyperhidrosis (HH), the degree of sweating, and the quality of life (QoL). This study aimed to evaluate the prevalence of anxiety and depression symptoms in patients with HH before and after oxybutynin treatment. METHODS Data were collected from 81 patients. Palmar or axillary HH was the most frequent complaint (84.0%). All patients were evaluated before the medication was prescribed and after five weeks of treatment. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety. RESULTS Improvement in HH occurred in 58 patients (71.6%), but there was no improvement in 23 patients (28.4%). The QoL before treatment in all patients was either "poor" or "very poor." Patients who experienced improvement in sweating rates also experienced a greater improvement in QoL than patients who did not experience improvement in sweating at the main site (87.9% vs. 34.7%) (p<0.001). A total of 19.7% of patients showed an improvement in their level of depression, and a total of 46.9% of patients exhibited improvements in their level of anxiety. A significant correlation was observed between sweating and anxiety (p=0.015). CONCLUSION Patients with HH who experienced improvements in sweating immediately after treatment with oxybutynin exhibited small improvements in their levels of depression and significant improvements in their levels of anxiety and QoL.
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Affiliation(s)
- Débora Yumi Ferreira Kamikava
- Divisao de Psicologia, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Nelson Wolosker
- Disciplina de Cirurgia Vascular e Endovascular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - José Ribas Milanez de Campos
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Pedro Puech-Leão
- Disciplina de Cirurgia Vascular e Endovascular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Andresen JR, Scheer F, Schlöricke E, Andresen R. CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects. ROFO-FORTSCHR RONTG 2020; 193:574-581. [PMID: 33348382 DOI: 10.1055/a-1299-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of the present study was to evaluate the benefit of a thoracic, computed tomography-guided sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis of the hands. In addition, the influence of the amount and distribution of the administered sympathicolytic agent was to be assessed. PATIENTS AND METHODS Retrospectively, 78 patients [13 (16.7 %) men, mean age 31.2 ± 9 years and 65 (83.3 %) women, mean age 34.2 ± 12 years], who had been treated using CTSy, were included in the study. The indication for treatment was primary focal palmar hyperhidrosis grade II and grade III after exhaustion of all conservative treatment options and a continued high level of suffering. CTSy was performed after establishing the entry plane at the level of the intervertebral space T2 / T3 via a dorsolateral approach using a 22-G coaxial needle. On average 5 (2-10) ml of a sympathicolytic mixture (10 ml consisting of 8 ml 96 % alcohol, 1.6 ml 0.5 % Carbostesin and 0.4 ml 0.9 % NaCl solution, with added amounts of contrast medium) were instilled. The volume of distribution of the sympathicolytic agent was determined in craniocaudal direction using CT images. The patients evaluated their sense of discomfort preinterventionally, 2 days postinterventionally, and 6 and 12 months after the intervention, on the basis of a Dermatology life Quality Index (DLQI) as well as the side effects that occurred. RESULTS The technical success rate of CTSy was 100 %. No major complications occurred. The interventions performed led to a significant reduction (p < 0.001) in the preinterventional sense of discomfort 2 days, 6 and 12 months after CTSy. As the most common side effect, compensatory sweating was reported by 16/78 (20.5 %) of the patients over the further course. In all of these patients, the volume of sympathicolytic agent administered was below 5 ml. In no case did the sympathicolytic agent extend caudally beyond the base plate of Th 3. No compensatory sweating of the back was observed in 5/78 (6.4 %) patients; here the sympathicolytic volume was above 5 ml and extended significantly caudally below the baseplate of T3.Transient miosis and ptosis was found in 8/78 (10.3 %) patients. In all of these patients, the volume of sympathicolytic agent administered was above 5 ml and it extended markedly cranially beyond the upper plate of T2. A mild to moderate recurrent sweating developed in 35/78 (44.9 %) patients, which was more marked if the volume of sympathicolytic administered was below 5 ml and slightly more pronounced on the left than on the right. Given a high level of satisfaction overall, 71/78 (91.0 %) patients said that they would undergo the intervention again. CONCLUSION For patients with primary, focal palmar hyperhidrosis CTSy represents a therapeutic option that offers good benefit and has few side effects. The amount and spatial distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects. KEY POINTS · CT-assisted thoracic sympathicolysis is a minimally invasive, low-complication therapy for treatment of severe forms of primary hyperhidrosis palmaris.. · CT-assisted thoracic sympathicolysis can usually be performed on an outpatient basis.. · The quantity and local distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects.. CITATION FORMAT · Andresen J, Scheer F, Schlöricke E et al. CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects. Fortschr Röntgenstr 2021; 193: 574 - 581.
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Affiliation(s)
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Erik Schlöricke
- Department of Visceral, Thoracic and Vascular Surgery, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
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Wolosker N, Faustino CB, da Silva MFA, de Campos JRM, Kauffman P. Current treatment options for craniofacial hyperhidrosis. J Vasc Bras 2020; 19:e20190152. [PMID: 34211510 PMCID: PMC8218019 DOI: 10.1590/1677-5449.200152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | | | | | - José Ribas Milanez de Campos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Torácica, São Paulo, SP, Brasil
| | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Wolosker N, Kauffman P, de Campos JRM, Faustino CB, da Silva MFA, Teivelis MP, Puech‐Leão P. Long‐term results of the treatment of primary hyperhidrosis with oxybutynin: follow‐up of 1,658 cases. Int J Dermatol 2020; 59:709-715. [DOI: 10.1111/ijd.14872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Vascular and Endovascular Department of Surgery Hospital das Clínicas da Faculdade de Medicina, Pinheiros University of São Paulo School of Medicine University of São Paulo São Paulo Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Vascular and Endovascular Department of Surgery Hospital das Clínicas da Faculdade de Medicina, Pinheiros University of São Paulo School of Medicine University of São Paulo São Paulo Brazil
| | - José R. M. de Campos
- Division of Thoracic Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Thoracic Surgery Department of Surgery University of São Paulo School of Medicine University of São Paulo Pinheiros, São Paulo Brazil
| | - Carolina B. Faustino
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Vascular and Endovascular Department of Surgery Hospital das Clínicas da Faculdade de Medicina, Pinheiros University of São Paulo School of Medicine University of São Paulo São Paulo Brazil
| | - Marcelo F. A. da Silva
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Vascular and Endovascular Department of Surgery Hospital das Clínicas da Faculdade de Medicina, Pinheiros University of São Paulo School of Medicine University of São Paulo São Paulo Brazil
| | - Marcelo P. Teivelis
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
| | - Pedro Puech‐Leão
- Department of Vascular and Endovascular Surgery Hospital Israelita Albert Einstein, Morumbi São Paulo Brazil
- Division of Vascular and Endovascular Department of Surgery Hospital das Clínicas da Faculdade de Medicina, Pinheiros University of São Paulo School of Medicine University of São Paulo São Paulo Brazil
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10
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Wolosker N, Faustino CB, de Campos JRM, Kauffman P, Yazbek G, Fernandes PP, Cucato G. Comparative analysis of the results of videothoracoscopic sympathectomy in the treatment of hyperhidrosis in adolescent patients. J Pediatr Surg 2020; 55:418-424. [PMID: 32063368 DOI: 10.1016/j.jpedsurg.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 08/25/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (VATS) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of adolescents patients compared to those of adult patients (18-40 years). METHODS We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: adolescents (472 patients) and adult group (1760 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one month after surgery. RESULTS We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the two groups of patients. We observed that all patients undergoing surgery presented poor or very poor quality of life before surgery; however, the two groups were statistically different. The quality of life of the ADOLESCENT group before surgery was statistically worse than that of the ADULT group. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups. CONCLUSIONS Adolescent patients benefit just as much as adult patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results. TYPE OF STUDY Clinical research. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
| | | | - Jose Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein; Department of Surgery, Thoracic Surgery Division, University of São Paulo School of Medicine
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antônio Prudente
| | - Paulo Pêgo Fernandes
- Department of Surgery, Thoracic Surgery Division, University of São Paulo School of Medicine
| | - Gabriel Cucato
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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Felisberto Júnior G, Rubira CJ, Berumudes JPS, Bueno DA-Silveira-Júnior S. Comparison between high and low levels thoracic sympathectomy for the treatment of palmar and axillary primary hyperhidrosis: systematic review and meta-analysis. Rev Col Bras Cir 2018; 43:486-492. [PMID: 28273218 DOI: 10.1590/0100-69912016006009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022] Open
Abstract
Primary hyperhidrosis (PH) is a condition that has a great impact on affected individuals' quality of life, regardless of its location. Its surgical treatment is done through thoracic sympathectomy performed by videothoracoscopy. Standardization of the technique includes section of the sympathetic trunk at different levels, according to the site of symptoms. The aim of this review is to evaluate the efficacy of thoracic sympathectomy through a systematic literature review comparing sympathectomy at different levels of the sympathetic chain.
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Affiliation(s)
| | - Cláudio José Rubira
- Department of Thoracic Surgery, University of Marília, Marília, São Paulo, Brazil
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13
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Estevan FA, Wolosker MB, Wolosker N, Puech-Leão P. Epidemiologic analysis of prevalence of the hyperhidrosis. An Bras Dermatol 2018; 92:630-634. [PMID: 29166497 PMCID: PMC5674693 DOI: 10.1590/abd1806-4841.20175551] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022] Open
Abstract
Background The present paper aims to study the prevalence of the various manifestations
of hyperhidrosis in patients who sought treatment in a specialized
ambulatory in the state of São Paulo. Objectives Opposite to previous studies, this paper studies the different combinations
of sweating sites, not being restricted to the main complaint site of the
patients, but taking into consideration secondary complaints patients may
present. Methods This was a retrospective approach of a database containing more than 1200
patients in which were mapped: combination of sweating sites, age of onset,
age spectrum, mean age, body mass index and gender of patients. Patients
were categorized into four groups based on their main sweating site -
palmar, plantar, axillary and facial. Results We concluded that hyperhidrosis appears frequently in more than one site,
being the main complaint that affects the most patients palmar
hyperhidrosis, which appears early in the patients during adolescence. When
there are two sites of sweating, the most frequent combination is palmar +
plantar, and when there are three sites of sweating the most frequent
combinations are palmar + plantar + axillary and axillary + palmar +
plantar. Study limitations This research has casuistics limited to a single care service for patients
with hyperhidrosis. Conclusion It is necessary to keep in mind that the disease manifests itself mainly in
more than one location, with different intensities in each of the patients,
generating a significant impairment of their quality of life.
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Affiliation(s)
| | - Marina Borri Wolosker
- School of Medicine of the Universidade de São Paulo (FMUSP) - São Paulo (SP), Brazil
| | - Nelson Wolosker
- Department of Surgery - Division of Vascular and Endovascular Surgery of the Clinics Hospital of the School of Medicine of the Universidade de São Paulo (HCFMUSP) - São Paulo (SP), Brazil.,Department of Vascular and Endovascular Surgery of the Hospital Israelita Albert Einstein - São Paulo (SP), Brazil
| | - Pedro Puech-Leão
- Department of Surgery - Division of Vascular and Endovascular Surgery of the Clinics Hospital of the School of Medicine of the Universidade de São Paulo (HCFMUSP) - São Paulo (SP), Brazil
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14
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Delort S, Marchi E, Corrêa MA. Oxybutynin as an alternative treatment for hyperhidrosis. An Bras Dermatol 2017; 92:217-220. [PMID: 28538882 PMCID: PMC5429108 DOI: 10.1590/abd1806-4841.201755126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/28/2016] [Indexed: 11/22/2022] Open
Abstract
Hyperhidrosis is the excessive production of sweating, which can be primary and focal or secondary to various pathologies. The exact cause of primary focal hyperhidrosis is still unknown, although a genetic basis is recognized, and its prevalence varies from 1% to 2.8%. The most affected sites are the armpits, palms, soles and face. It causes much discomfort, affects the quality of life, and is estimated to be undervalued by health professionals. Many treatment options are proposed, both clinical and surgical. The aim of this review is to focus on the treatment of hyperhidrosis with oxybutynin, an anticholinergic drug originally used to control overactive bladder.
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Affiliation(s)
- Sergio Delort
- Graduate program of the Faculdade de Medicina de Jundiaí (FMJ) - Jundiaí (SP), Brazil
| | - Evaldo Marchi
- Departament of Thoracic Surgery of the Faculdade de Medicina de Jundiaí (FMJ) - Jundiaí (SP), Brazil
| | - Marcos Antônio Corrêa
- Departament of Drugs and Medicines of the Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
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15
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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.
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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
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16
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Fukuda JM, Varella AYM, Teivelis MP, de Campos JRM, Kauffman P, Pinheiro LL, Wolosker N. Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint. Ann Vasc Surg 2017; 46:337-344. [PMID: 28689957 DOI: 10.1016/j.avsg.2017.06.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). METHODS This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). RESULTS Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively (P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. CONCLUSIONS Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.
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Affiliation(s)
- Juliana Maria Fukuda
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
| | | | - Marcelo Passos Teivelis
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - José Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Thoracic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Kauffman
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Lembrança Pinheiro
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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17
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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
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18
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Del Boz J, Millán-Cayetano JF, Blázquez-Sánchez N, de Troya M. Individualized Dosing of Oral Oxybutynin for the Treatment of Primary Focal Hyperhidrosis in Children and Teenagers. Pediatr Dermatol 2016; 33:327-31. [PMID: 27122197 DOI: 10.1111/pde.12857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Oral anticholinergic drugs, such as oxybutynin, are often used in the treatment of hyperhidrosis, but few studies have focused on dosing strategies for children. The objective was to assess the effectiveness and safety of individualized dosing regimens of oral oxybutynin for treating primary focal hyperhidrosis (PFH) in children and teenagers. METHODS A prospective study was performed including patients who initiated treatment for hyperhidrosis between November 2011 and November 2014. Response to treatment and adverse effects were evaluated using the Hyperhidrosis Disease Severity Scale at baseline and at 3 and 12 months. RESULTS Of 16 patients included in the study, 15 (93.8%) had responded to treatment at the 3-month follow-up (62.5% with excellent response). At the 12-month follow-up, the 11 patients who continued the treatment were still responding (63.6% with excellent response). Adverse effects were reported for 68.8% of the patients at 3 months and 54.5% at 12 months, with a predominance of oropharyngeal xerosis. No serious adverse effects were observed. CONCLUSION Dose individualization of oral oxybutynin according to clinical response and tolerance observed in each patient is a useful management strategy in children and teenagers.
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Affiliation(s)
- Javier Del Boz
- Dermatology Department, Hospital Costa del Sol, Marbella, Spain
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19
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Millán-Cayetano JF, del Boz J, Rivas-Ruiz F, Blázquez-Sánchez N, Hernández Ibáñez C, de Troya-Martín M. Oral oxybutynin for the treatment of hyperhidrosis: outcomes after one-year follow-up. Australas J Dermatol 2016; 58:e31-e35. [DOI: 10.1111/ajd.12473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Javier del Boz
- Department of Dermatology; Hospital Costa del Sol; Marbella Spain
| | - Francisco Rivas-Ruiz
- Research Unit; Hospital Costa del Sol; Marbella Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Marbella Spain
| | | | | | - Magdalena de Troya-Martín
- Department of Dermatology; Hospital Costa del Sol; Marbella Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Marbella Spain
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20
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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: 37] [Impact Index Per Article: 4.1] [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.
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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
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21
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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
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22
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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
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23
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Wolosker N, Teivelis MP, Krutman M, Campbell TPDDA, Kauffman P, Campos JRD, Puech-Leão P. Long-term results of oxybutynin use in treating facial hyperhidrosis. An Bras Dermatol 2015; 89:912-6. [PMID: 25387496 PMCID: PMC4230660 DOI: 10.1590/abd1806-4841.20143272] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/11/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months. METHODS 61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites. RESULTS Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites. CONCLUSION Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.
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Affiliation(s)
| | | | | | | | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Pedro Puech-Leão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Campanati A, Gregoriou S, Kontochristopoulos G, Offidani A. Oxybutynin for the Treatment of Primary Hyperhidrosis: Current State of the Art. Skin Appendage Disord 2015; 1:6-13. [PMID: 27172124 DOI: 10.1159/000371581] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022] Open
Abstract
Oxybutynin is an anticholinergic drug with an emerging role in the treatment of hyperhidrosis. Several recent studies have documented that it is effective both in focal and generalized hyperhidrosis and shows universally good response among different groups of patients regardless of age, gender, and weight. The most common adverse event is dry mouth reported by almost all patients treated. The way this might affect long-term compliance and tolerability should be better investigated in the future.
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Affiliation(s)
- Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Stamatis Gregoriou
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - George Kontochristopoulos
- Hyperhidrosis Clinic, Andreas Sygros Hospital, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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25
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Wolosker N, Krutman M, Teivelis MP, Paula RPD, Kauffman P, Campos JRMD, Puech-Leão P. Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years. EINSTEIN-SAO PAULO 2014; 12:42-7. [PMID: 24728245 PMCID: PMC4898238 DOI: 10.1590/s1679-45082014ao2841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods: Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results: In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion: Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis.
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Affiliation(s)
| | | | | | | | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Pedro Puech-Leão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Wolosker N, Krutman M, Teivelis MP, Campbell TP, Kauffman P, de Campos JRM, Puech-Leão P. Quality of Life before Hyperhidrosis Treatment as a Predictive Factor for Oxybutynin Treatment Outcomes in Palmar and Axillary Hyperhidrosis. Ann Vasc Surg 2014; 28:970-6. [DOI: 10.1016/j.avsg.2013.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/21/2013] [Accepted: 07/31/2013] [Indexed: 11/16/2022]
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