1
|
Yu F, Xiao F, Peng G, Lin G, Wang W, Xie C, Lin L. Repair of distal finger soft-tissue defects with free fibular great toe neurovascular flaps. BMC Musculoskelet Disord 2024; 25:479. [PMID: 38890706 PMCID: PMC11184890 DOI: 10.1186/s12891-024-07563-2] [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: 12/05/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This work aimed to investigate the change in fingerprint depth and the recovery rule of fingerprint biological recognition function after repairing finger abdominal defects and rebuilding fingerprint with a free flap. METHOD From April 2018 to March 2023, we collected a total of 43 cases of repairing finger pulp defects using the free flap of the fibular side of the great toe with the digital nerve. After surgery, irregular follow-up visits were conducted to observe fingerprint clarity, perform the ninhydrin test or detect visible sweating with the naked eye. We recorded fingerprint clarity, nail shape, two-point discrimination, cold perception, warm perception and fingerprint recognition using smartphones. The reconstruction process of the repaired finger was recorded to understand the changes in various observation indicators and their relationship with the depth of the fingerprint. The correlation between fingerprint depth and neural repair was determined, and the process of fingerprint biological recognition function repair was elucidated. RESULT All flaps survived, and we observed various manifestations in different stages of nerve recovery. The reconstructed fingerprint had a clear fuzzy process, and the depth changes of the fingerprint were consistent with the changes in the biological recognition function curve. CONCLUSION The free flap with the digital nerve is used to repair finger pulp defects. The reconstructed fingerprint has a biological recognition function, and the depth of the fingerprint is correlated with the process of nerve repair. The fingerprint morphology has a dynamic recovery process, and it can reach a stable state after 6-8 months.
Collapse
Affiliation(s)
- Fengnian Yu
- Department of Orthopedics, Jiangmen People's Hospital, Jiangmen, 529020, Guangdong, P. R. China
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, P. R. China
| | - Fen Xiao
- Department of Orthopedics, Guzhen People's Hospital, Zhongshan, 528421, Guangdong, P.R. China
| | - Guorui Peng
- Department of Orthopedics, Guzhen People's Hospital, Zhongshan, 528421, Guangdong, P.R. China
| | - Gang Lin
- Department of Orthopedics, Guzhen People's Hospital, Zhongshan, 528421, Guangdong, P.R. China
| | - Wensong Wang
- Department of Orthopedics, Guzhen People's Hospital, Zhongshan, 528421, Guangdong, P.R. China
| | - Chao Xie
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, P. R. China.
| | - Lijun Lin
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, P. R. China.
| |
Collapse
|
2
|
Watanabe H, Ohshima Y, Watanabe D. Therapeutic Effectiveness of Needle Injection Versus Needle-Free Jet Injector System for Botulinum Toxin Type A in Palmar Hyperhidrosis. J Cutan Med Surg 2023; 27:481-486. [PMID: 37537972 DOI: 10.1177/12034754231191062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND The most important problem with local injections of botulinum toxin type A (BTX-A) in palmar hyperhidrosis is pain during the injections. OBJECTIVES We evaluated therapeutic effectiveness and pain of local injections of BTX-A using needle-free direct administration system. METHODS We performed BTX-A local injection therapy using a conventional injection needle in the left hand and a needle-free direct administration system in the right hand. RESULTS A reduction in the quantity of perspiration was observed 4 weeks after administration of both Needle and Needle-free BTX-A, and reduction was maintained throughout 28 weeks observation period. Both hyperhidrosis Disease Severity Scale scores and Dermatology Life Quality Index for hands treated with Needle BTX-A and hands treated with Needle-free BTX-A had decreased significantly by 4 weeks after treatment. Pain visual analog scale scores and the degree of pain were significantly lower in hands treated with Needle-free BTX-A than in hands treated with Needle BTX-A. CONCLUSIONS When the trigger of the pressurized needle-free injector device is activated, the gas powered driving pressure propels BTX-A through an orifice (0.13 mm) about four times narrower than a 30 G needle at very high speed. As most pain occurs during the needle prick itself, the advantage of a small orifice coupled with high-speed penetration of BTX-A through the pressurized device results in reduced pain during administration. The needle-free direct administration system administers the injectate under the skin without a visible needle.
Collapse
Affiliation(s)
- Hitomi Watanabe
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuichiro Ohshima
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Daisuke Watanabe
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
3
|
Lee DG, Kim JE, Lee WS, Kim MB, Huh CH, Lee YW, Choi GS, Lee JB, Yu DS, Shin MK, Roh MR, Ahn HH, Kim WS, Lee JH, Park KY, Park J, Lee WJ, Park MY, Kang H. A Phase 3, Randomized, Multi-center Clinical Trial to Evaluate the Efficacy and Safety of Neu-BoNT/A in Treatment of Primary Axillary Hyperhidrosis. Aesthetic Plast Surg 2022; 46:1400-1406. [PMID: 35132458 DOI: 10.1007/s00266-021-02715-4] [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: 08/20/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Botulinum toxin type A is widely used to treat primary axillary hyperhidrosis and has proven to be an effective and safe approach. Onabotulinumtoxin A was approved by the FDA as a treatment for primary axillary hyperhidrosis. This study aimed to evaluate the efficacy and safety of Neu-BoNT/A in subjects diagnosed with primary axillary hyperhidrosis. METHODS The Hyperhidrosis Disease Severity Scale, gravimetric measurement of sweat, and Global Assessment Scale were analyzed at weeks 4, 8, 12, and 16 to determine the effect of treatment. Adverse events, physical examination, and vital signs were monitored. RESULTS Subjects treated with Neu-BoNT/A showed statistically significant improvement by all 3 methods at weeks 4, 8, 12, and 16 (P value = 0.00). There were no severe adverse events or significant changes in vital signs, physical examination, or laboratory tests. CONCLUSION Neu-BoNT/A can be effectively and safely used for primary axillary hyperhidrosis. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
4
|
Galadari H, Galadari I, Smit R, Prygova I, Redaelli A. Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: A systematic review. J Am Acad Dermatol 2021; 85:1121-1129. [DOI: 10.1016/j.jaad.2020.07.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
|
5
|
Turhan K, Kavurmaci Ö, Akçam Tİ, Ergönül AG, Özdil A, Çakan A, Çağirici U. Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy. Thorac Cardiovasc Surg 2021; 70:167-172. [PMID: 34044464 DOI: 10.1055/s-0041-1728777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathicotomy is an effective approach to the treatment of idiopathic localized hyperhidrosis, and compensatory sweating is the main reason for patient dissatisfaction. Our study discusses both the long-term outcomes of sympathicotomy and the course of compensatory sweating. METHODS Patients with palmar and/or axillary hyperhidrosis who were operated by the same surgical team between January 2008 and December 2014 were included in the study. After at least 5 years (60 months) from operation, patients were questioned about their treatment outcomes by using an original survey form. RESULTS Of the 137 patients included in the study, 88 (64.2%) were female and 49 (35.8%) were male. The mean time from the operation to the survey interview was 80.9 ± 14.1 (64-136) months. After operation, complaints disappeared in 95.1% of the patients, and decreased in 4.9% with palmar hyperhidrosis. Complaints completely disappeared in 12.9% and decreased in 81.7% of the patients with axillary hyperhidrosis. Ninety-seven (70.8%) of the patients described increased sweating in some parts of their body after operation but only 47 reached an uncomfortable intensity. The number of patients who regretted the operation due to the compensatory sweating was 13 (9.5%). The patients' overall scoring of the operation and procedure was calculated as 8.0 ± 2.1 (0-10 points) out of 10. CONCLUSION Endoscopic thoracic sympathicotomy's long-term outcomes are also satisfactory in the treatment of palmar and axillary hyperhidrosis. Compensatory sweating may decrease over time, only a minority of patients will express regret at undergoing the treatment.
Collapse
Affiliation(s)
- Kutsal Turhan
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Önder Kavurmaci
- Department of Thoracic Surgery, University of Health Sciences Bozyaka Izmir Training and Research Hospital, Izmir, Turkey
| | - Tevfik İlker Akçam
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ayşe Gül Ergönül
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ali Özdil
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Alpaslan Çakan
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ufuk Çağirici
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| |
Collapse
|
6
|
Lin JB, Kang MQ, Chen JF, Du Q, Li X, Lai FC, Tu YR. Transareolar single-port endoscopic thoracic sympathectomy with a flexible endoscope for primary palmar hyperhidrosis: a prospective randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1659. [PMID: 33490171 PMCID: PMC7812235 DOI: 10.21037/atm-20-7399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Transareolar single-port endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been reported. This study assessed the performance of this novel minimally invasive technique for primary palmar hyperhidrosis (PPH). Methods From January 2019 to September 2019, 118 males with severe PPH requiring single-port and bilateral ETS were randomly allocated to undergo transareolar ETS using a flexible endoscope (group A, n=58) or transaxillary ETS using a 5 mm thoracoscope (group B, n=60). Results Both groups had similar patient characteristics. All procedures were performed successfully, with no mortality or conversion to open surgery. All patients had dry and warm palms immediately after surgery. Compared with group B, group A had a significantly shorter median incision length [5.1 (5.0–5.2) vs. 10.9 (10.8–11.9) mm; P<0.001], and significantly lower median postoperative pain score [1 (1.0–2.0) vs. 3 (3.0–4.0); P<0.001]. There were no differences between the two groups in operative time, palmar temperature increase, and transient postoperative sweating. After complete follow-up, group A had a significantly higher median cosmetic score than group B [4.0 (3.0–4.0) vs. 3.0 (3.0–3.0); P<0.001]. There were no differences between the two groups regarding symptom resolution, compensatory hyperhidrosis, and satisfaction score. No patient reported residual pain or symptom recurrence. Conclusions Transareolar single-port ETS with a flexible endoscope is safe, effective, and minimally invasive with a small incision, minimal pain, and excellent cosmetic results. This novel procedure is suitable for routine treatment of PPH in males.
Collapse
Affiliation(s)
- Jian-Bo Lin
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ming-Qiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Feng Chen
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Quan Du
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xu Li
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fan-Cai Lai
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan-Rong Tu
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
7
|
Lin Y, He Y, Woo DM, Chen B, Zhu X, Liu J, Chen X. Tumescent Liposuction Combined with Power-Assisted Dermal Curettage Through Small Incisions for Axillary Osmidrosis. Aesthetic Plast Surg 2020; 44:849-854. [PMID: 32152707 DOI: 10.1007/s00266-020-01659-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Osmidrosis is a troublesome disease characterized by excessive bodily malodor. Invasive surgical treatments have proven effective and permanent in treating this disease. This study sets out to evaluate the effect of tumescent liposuction with power-assisted dermal curettage for the treatment of axillary osmidrosis. METHODS Twenty-eight patients with axillary osmidrosis (56 axillae) were treated with tumescent liposuction and power-assisted dermal curettage between January 2016 and May 2019. Patients were followed up and evaluated using survey questionnaire at least 3 months after the procedure. RESULTS Twenty-four (85.7%) patients responded excellent for malodor elimination, 4 (14.3%) patients evaluated it as good and no patients evaluated it as fair or poor. One patient reported mild pigmentation in the axilla after the procedure. No recurrence and no serious side effects were reported. CONCLUSION Tumescent liposuction with power-assisted dermal curettage is a safe and effective surgical treatment of axillary osmidrosis with high patient satisfaction, rapid recovery time and minimal complications or recurrences. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
8
|
Five-year follow-up of patients treated with intra-dermal botulinum toxin for axillary hyperhidrosis. Ir J Med Sci 2020; 189:1023-1026. [PMID: 31898163 DOI: 10.1007/s11845-019-02131-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Axillary hyperhidrosis is a common complaint affecting 5% of the general population. It can significantly impact quality of life (QOL) and may be extremely debilitating. Administration of intra-dermal botulinum toxin type-A (Botox) has been proven to be effective in managing axillary hyperhidrosis; however, to date, no long-term data has assessed its efficacy. AIM We aim to assess long-term (> 5 years) QOL outcomes in this patient cohort. METHODS In this single-centre series, all patients attending for axillary botox, with five or more years of follow-up, were prospectively included. QOL was assessed in all patients using the validated assessment tool, the modified Dermatology Life Quality Index (DLQI). Standard statistical methods were utilised with data reported as mean (± standard deviation). Subgroup analysis utilising previously published departmental data allowed for further assessment of change in QOL over time. RESULTS A total of 75 patients (83% female) met the inclusion criteria with 67% completing the DLQI assessment. Follow-up ranged from 5 to 10 years with a mean age of 37.6 years (± 8.82). The mean number of treatments over the study period was 12 (± 3.1). Mean overall post-treatment DLQI score was 1.6 (± 2.01). This represented a significant improvement in patient QOL (p = < 0.0001) associated with long-term botox application. This statistical significance was identified consistently across all components of the DLQI tool. CONCLUSION These data suggest that the established early QOL benefits associated with intra-dermal botox administration for AH are sustained in the long term. This benefit was seen across all subsets of the DLQI tool.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Rosen R, Stewart T. Results of a 10-year follow-up study of botulinum toxin A therapy for primary axillary hyperhidrosis in Australia. Intern Med J 2018; 48:343-347. [PMID: 29512329 DOI: 10.1111/imj.13727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
Primary hyperhidrosis has a prevalence of 3-5% in the United States. It is a psychosocially disabling condition leading to low self-esteem, chronic stress and depressive symptoms. Several medical and surgical treatments exist, including botulinum toxin A, which internationally, has been shown effectively and safely to treat this condition achieving high patient satisfaction. In Australia, botulinum toxin A has been available under the Medicare benefits scheme for axillary hyperhidrosis since 2013, but efficacy and treatment satisfaction had not been evaluated. We present the results of the first Australian study on efficacy and patient satisfaction with botulinum toxin A in primary axillary hyperhidrosis with evaluation of possible prognostic factors.
Collapse
Affiliation(s)
- Robert Rosen
- Southern Suburbs Dermatology, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Stewart
- Southern Suburbs Dermatology, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Chen J, Du Q, Lin M, Lin J, Li X, Lai F, Tu Y. Transareolar Single-Port Needlescopic Thoracic Sympathectomy Under Intravenous Anesthesia Without Intubation: A Randomized Controlled Trial. J Laparoendosc Adv Surg Tech A 2016; 26:958-964. [PMID: 27556596 DOI: 10.1089/lap.2015.0470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Transareolar single-port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation has rarely been attempted in managing primary palmar hyperhidrosis (PPH). The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique. MATERIALS AND METHODS From May 2012 to May 2015, 168 male patients with severe PPH underwent single-port endoscopic thoracic sympathectomy (ETS) and were randomly allocated to groups A or B. Patients in group A underwent nonintubated transareolar ETS with a 2-mm needle endoscope, while those in group B underwent intubated transaxillary ETS with a 5-mm thoracoscope. RESULTS All procedures were performed successfully. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients. Postoperative sore throat occurred in 4 patients in group A and in 32 patients in group B (P < .01). The mean incision length was significantly shorter in group A than in group B. The mean postoperative pain scores were markedly higher in group B than in group A. The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients. The mean cosmetic scores were higher in group A than in group B (P < .01). CONCLUSIONS Nonintubated transareolar single-port ETS with a needle endoscope is a safe, effective, and minimally invasive therapeutic procedure, which allows a smaller incision with less pain and excellent cosmetic results. This novel procedure can be performed in a routine clinical practice for male patients with severe PPH.
Collapse
Affiliation(s)
- Jianfeng Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Quan Du
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Min Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Jianbo Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Xu Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Fancai Lai
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| | - Yuanrong Tu
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China
| |
Collapse
|
12
|
Nonintubated Needlescopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2016; 26:328-33. [PMID: 27438170 DOI: 10.1097/sle.0000000000000287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis. METHODS From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope. RESULTS ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (P<0.01). Postoperative sore throat occurred in 37 patients in group B, whereas none of the patients in group A complained about sore throat after surgery (P<0.01). The mean incision length was 5.1±0.1 mm with needle endoscope and 11.0±0.8 mm with traditional thoracoscope (P<0.01). The mean postoperative pain score was 1.1±0.8 in group A and 3.2±0.8 in group B (P<0.01). The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients (P<0.01). Follow-up was 100% completed. The mean cosmetic scores were higher in group A than in group B (P<0.01). Residual pain occurred in 2 patients in group A and in 18 patients in group B (P<0.01). CONCLUSIONS Nonintubated needlescopic thoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.
Collapse
|
13
|
Galazka M, Soszynski D, Dmitruk K. Central Action of Botulinum Toxin Type A – Is It Possible? NEUROPHYSIOLOGY+ 2015. [DOI: 10.1007/s11062-015-9540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
González-Ramos J, Sendagorta-Cudós E, González-López G, Mayor-Ibarguren A, Feltes-Ochoa R, Herranz-Pinto P. Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases. Dermatol Ther 2015; 29:32-6. [PMID: 26445325 DOI: 10.1111/dth.12297] [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] [Indexed: 11/28/2022]
Abstract
Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six-month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.
Collapse
Affiliation(s)
| | | | | | | | - Rosa Feltes-Ochoa
- Department of Dermatology, La Paz University Hospital, Madrid, Spain
| | | |
Collapse
|
15
|
Brehmer F, Lockmann A, Grönemeyer LL, Kretschmer L, Schön MP, Thoms KM. Wiederholte Injektionen von Botulinumtoxin Typ A steigern kontinuierlich die Wirkdauer bei primärer axillärer Hyperhidrose: Eine retrospektive Analyse von 101 Patienten. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.50_12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Franziska Brehmer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Anike Lockmann
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Lisa-Lena Grönemeyer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Lutz Kretschmer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Michael P. Schön
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Kai-Martin Thoms
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| |
Collapse
|
16
|
Brehmer F, Lockmann A, Grönemeyer LL, Kretschmer L, Schön MP, Thoms KM. Repetitive injections of botulinum toxin A continuously increase the duration of efficacy in primary axillary hyperhidrosis: a retrospective analysis in 101 patients. J Dtsch Dermatol Ges 2015; 13:799-805. [PMID: 26176740 DOI: 10.1111/ddg.12623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Botulinum toxin type A is an effective, well-tolerated, albeit temporary treatment for primary axillary hyperhidrosis. However, little is known about the influence of repetitive injections on the duration of efficacy. PATIENTS AND METHODS 139 patients with primary axillary hyperhidrosis were injected with 50 units of botulinum toxin per axilla. In 101 patients, who received at least three treatments, the duration of efficacy after the first, second, and last treatment was evaluated. RESULTS The median duration of efficacy was 4.0 months, 4.5 months, and 5.0 months after the first, second, and last injection, respectively. Overall, the duration of efficacy was significantly longer after the last injection compared to the duration of efficacy after the first injection (p = 0.0055, Wilcoxon matched-pairs signed-rank test). Likewise, the difference between the first and second injection (p = 0.0302) as well as the difference between the second and the last injection (p = 0.0381) were significant. In 25.7 % of patients, the duration of efficacy remained unchanged over the entire treatment period. CONCLUSIONS Repetitive botulinum toxin treatments led to a significantly increased duration of efficacy in axillary hyperhidrosis. While the average duration of efficacy continued to increase with each treatment, there were considerable interindividual differences.
Collapse
Affiliation(s)
- Franziska Brehmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Anike Lockmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Lisa-Lena Grönemeyer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Lutz Kretschmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
17
|
Prise en charge d’une hyperhidrose. Ann Dermatol Venereol 2015; 142:252-61. [DOI: 10.1016/j.annder.2014.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
|
18
|
Kouris A, Agiasofitou E, Gregoriou S, Sofouri E, Kontochristopoulos G, Panagopoulos G. Generalized neurological symptoms following treatment of focal hyperhidrosis with botulinum toxin A. Int J Dermatol 2014; 53:e544-7. [PMID: 25209010 DOI: 10.1111/ijd.12625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anargyros Kouris
- Department of Dermatology and Venereology, Hospital Andreas Sygros, Athens, Greece
| | | | | | | | | | | |
Collapse
|
19
|
Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol 2014; 70:1083-7. [DOI: 10.1016/j.jaad.2013.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
|
20
|
Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients. J Am Acad Dermatol 2013; 69:960-4. [PMID: 24035554 DOI: 10.1016/j.jaad.2013.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradermal injections of botulinum toxin are effective but transitory in primary axillary hyperhidrosis. These injections are repeated when the symptoms recur. The reported duration of efficacy is variable, from 2 to 24 months, but it is unknown how the duration of efficacy changes when injections are repeated. OBJECTIVE In this retrospective study, we aimed to evaluate changes in the duration of efficacy of botulinum toxin injections (Dysport, Ipsen, Boulogne-Billancourt, France) with the repetition of injections in patients with axillary hyperhidrosis. METHODS From May 2001 to April 2012 inclusive, 83 patients were treated with a dose of 125 U per underarm. We compared the duration of effect of the first and last toxin injections. RESULTS The median duration of efficacy for the first injection was 5.5 months, whereas that for the last injection was 8.5 months. The difference between these 2 durations is statistically significant (P = .0002). LIMITATIONS Although retrospective and based on the declarative, this work is the first to our knowledge to highlight this benefit of treatment and to evaluate botulinum toxin over such a long period (11 years). CONCLUSION There appears to be an increase in the duration of efficacy of botulinum toxin A injections with the repetition of injections in patients with primary axillary hyperhidrosis. The reasons for this effect may be linked to the mechanism of action of botulinum toxin, and may improve our understanding of its pharmacologic effects.
Collapse
Affiliation(s)
- Marie Lecouflet
- Department of Dermatology, Le Mans Hospital, Le Mans, France.
| | | | | | | | | |
Collapse
|
21
|
Campanati A, Giuliodori K, Giuliano A, Martina E, Ganzetti G, Marconi B, Chiarici A, Offidani A. Treatment of palmar hyperhidrosis with botulinum toxin type A: results of a pilot study based on a novel injective approach. Arch Dermatol Res 2013; 305:691-7. [DOI: 10.1007/s00403-013-1380-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/30/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
|
22
|
Mannava S, Mannava KA, Nazir OF, Plate JF, Smith BP, Koman LA, Tuohy CJ. Treatment of palmar hyperhidrosis with botulinum neurotoxin a. J Hand Surg Am 2013; 38:398-400. [PMID: 23267759 DOI: 10.1016/j.jhsa.2012.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/18/2012] [Accepted: 11/02/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system. J Neurol 2012; 260:701-13. [DOI: 10.1007/s00415-012-6615-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/06/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
|
24
|
Treatment of axillary hyperhidrosis with botulinum toxin: a single surgeon's experience with 53 consecutive patients. Aesthetic Plast Surg 2011; 35:1079-86. [PMID: 21559989 DOI: 10.1007/s00266-011-9738-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Axillary hyperhidrosis is a debilitating disease that affects the social and occupational lives of many Americans. It can be treated with subdermal injections of botulinum toxin. This study aimed to determine the interval between injections during which patients are symptom free and whether that interval varies depending on the number of treatments a patient has received. METHODS The study enrolled all the patients treated with botulinum toxin for axillary hyperhidrosis by the senior author between 2004 and 2010. Patient responses to the treatment with regard to both satisfaction and length of the symptom-free interval were collected prospectively and analyzed. An in-depth PubMed search was performed through July 2010 to compile the published data on using botulinum toxin injections to treat axillary hyperhidrosis. These data served as a benchmark to which the trends at our institution were compared. RESULTS The 53 patients included in the study had an average age of 29 years, and 64% were women. Of the 53 patients, 23 (43%) underwent multiple injections of botulinum toxin. The average symptom-free interval was 261 days. There was no statistically significant difference in symptom-free intervals after multiple treatments. Patient satisfaction rates were very high, similar to the high degrees of satisfaction found in the published data. CONCLUSION Botulinum toxin injections provide an effective treatment for axillary hyperhidrosis with a rapid onset and high patient satisfaction. Many patients have a symptom-free interval of 6-9 months after each botulinum toxin injection. This interval does not change significantly after multiple treatments.
Collapse
|
25
|
Bilateral forearm intravenous regional anesthesia with prilocaine for botulinum toxin treatment of palmar hyperhidrosis. J Am Acad Dermatol 2010; 63:466-74. [DOI: 10.1016/j.jaad.2009.10.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 10/07/2009] [Accepted: 10/22/2009] [Indexed: 11/18/2022]
|
26
|
Schulte TL, Adolphs B, Oberdiek D, Osada N, Liljenqvist U, Filler TJ, Marziniak M, Bullmann V. Approach-related lesions of the sympathetic chain in anterior correction and instrumentation of idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1558-68. [PMID: 20502925 DOI: 10.1007/s00586-010-1455-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 03/31/2010] [Accepted: 05/09/2010] [Indexed: 12/22/2022]
Abstract
During anterior scoliosis instrumentation with a dual-rod system, the vertebrae are dissected anterolaterally. After surgery, some patients report a change in temperature perception and perspiration in the lower extremities. Sympathetic lesions might be an explanation for this. The aim of this clinical study was to investigate sympathetic function after anterior scoliosis instrumentation. A total of 24 female patients with idiopathic scoliosis (mean age at follow-up, 23.8 years) who had undergone anterior instrumentation on average 6.6 years earlier were included. Due to the suspected relevance of the sympathetic L2 ganglion, two groups were created: a T12 group, in which instrumentation down to T12 was carried out (n = 12), and an L3 group, in which instrumentation down to L3 was done (n = 12). Sympathetic function was assessed by measuring skin temperature at the back of the foot, a plantar ninhydrin sweat test and sympathetic skin responses (SSRs) following electrical stimulation. The side on which the surgical approach was carried out was compared with the contralateral, control side. Health-related quality of life was investigated using the Scoliosis Research Society SRS-22 patient questionnaire. In the T12 group, mean temperatures of 29.6 degrees C on the side of the approach versus 29.5 degrees C on the control side were measured (P > 0.05); in the L3 group, the mean temperatures were 33.2 degrees C on the approach side versus 30.5 degrees C on the control side (P = 0.001). A significant difference between the T12 group and the L3 group (P < 0.001) was observed on the approach side, but not on the control side (P = 0.15). The ninhydrin sweat test showed reduced perspiration in 11 of 12 patients in the L3 group on the approach side in comparison with the control side (P = 0.002). In the T12 group, no significant differences were noted between the left and right feet. SSRs differed significantly between the two groups (P = 0.005). They were detected in all nine analyzable patients in the T12 group on both sides. In the L3 group, they were found on the approach side only in 4 of 11 analyzable patients versus 11 patients on the control side. The results of the SRS-22 questionnaire did not show any significant differences between the two groups. In conclusion, anterior scoliosis instrumentation with a dual-rod system including vertebrae down to L3 regularly leads to lesions in the sympathetic trunk. These are detectable with an increase in temperature, reduced perspiration and reduced SSRs. The caudal level of instrumentation (T12 vs. L3) has an impact on the extent of impairment, supporting the suspected importance of the L2 ganglion. The clinical outcome does not seem to be significantly limited by sympathetic trunk lesions.
Collapse
Affiliation(s)
- Tobias L Schulte
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Kranz G, Haubenberger D, Voller B, Posch M, Schnider P, Auff E, Sycha T. Respective potencies of Botox and Dysport in a human skin model: a randomized, double-blind study. Mov Disord 2009; 24:231-6. [PMID: 18951439 DOI: 10.1002/mds.22336] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mouse units used to quantify the activity of botulinum A toxin preparations are not equivalent and issues concerning efficacy and safety remain with regard to their respective potencies and diffusion qualities in human tissue. We compared the effects of Botox (BOT) and Dysport (DYS) in different doses and dilutions in a human skin model. Eighteen (8 women, 10 men) healthy volunteers, aged 28.4 years +/- 5.7 years were injected intradermally with pure saline, BOT and DYS at 16 points in the abdomen in random order and in a double-blind condition, using two conversion ratios (1:3 and 1:4) and three different dilution schemes. For an objective outcome, the Ninhydrin sweat test was used to compare the anhidrotic areas. Both preparations showed a linear dose and dilution relationship with similar variances of responses for anhidrosis and hypohidrosis, indicating the same reliability of response. The dose equivalence conversion ratios (BOT: DYS) were 1:1.3 for anhidrosis and 1:1.6 for hypohidrosis (1:1.1-1.5 and 1:1.4-1.8 95% confidence intervals). The diffusion characteristics of both products were similar. A dose equivalence factor of more than 1:2 (BOT:DYS) is not supported by these objective and reproducible data.
Collapse
Affiliation(s)
- Gottfried Kranz
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | | | | | | | | | | | | |
Collapse
|
28
|
Shibasaki M, Davis SL, Cui J, Low DA, Keller DM, Crandall CG. Botulinum toxin abolishes sweating via impaired sweat gland responsiveness to exogenous acetylcholine. Br J Dermatol 2009; 161:757-61. [PMID: 19538183 DOI: 10.1111/j.1365-2133.2009.09248.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Botulinum toxin A (BTX) disrupts neurotransmitter release from cholinergic nerves. The effective duration of impaired sweat secretion with BTX is longer relative to that of impaired muscle contraction, suggesting different mechanisms in these tissues. OBJECTIVES The aim of this study was to test the hypothesis that BTX is capable of altering sweating by reducing the responsiveness of the sweat gland to acetylcholine. METHODS BTX was injected into the dorsal forearm skin of healthy subjects at least 3 days before subsequent assessment. On the day of the experiment, intradermal microdialysis probes were placed within the BTX-treated area and in an adjacent untreated area. Incremental doses of acetylcholine were administered through the microdialysis membranes while the sweat rate (protocol 1; n = 8) or a combination of sweat rate and skin blood flow (protocol 2; n = 8) were assessed. RESULTS A relative absence of sweating was observed at the BTX site for both protocols (protocol 1: 0.05 +/- 0.09 mg cm(-2) min(-1); protocol 2: 0.03 +/- 0.04 mg cm(-2) min(-1), both at the highest dose of acetylcholine), while the sweat rate increased appropriately at the control sites (protocol 1: 0.90 +/- 0.46 mg cm(-2) min(-1); protocol 2: 1.07 +/- 0.67 mg cm(-2) min(-1)). Cutaneous vascular conductance increased to a similar level at both the BTX and control sites. CONCLUSIONS These results demonstrate that BTX is capable of inhibiting sweat secretion by reducing the responsiveness of the sweat gland to acetylcholine, while not altering acetylcholine-mediated cutaneous vasodilatation.
Collapse
Affiliation(s)
- M Shibasaki
- Department of Environmental Health, Nara Women's University, Nara, Japan
| | | | | | | | | | | |
Collapse
|
29
|
Kavanagh GM, Shams K. Botulinum toxin type A by iontophoresis for primary palmar hyperhidrosis. J Am Acad Dermatol 2007; 55:S115-7. [PMID: 17052528 DOI: 10.1016/j.jaad.2005.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Revised: 06/24/2005] [Accepted: 07/06/2005] [Indexed: 11/29/2022]
|
30
|
Talarico-Filho S, Mendonça DO Nascimento M, Sperandeo DE Macedo F, DE Sanctis Pecora C. A Double-Blind, Randomized, Comparative Study of Two Type A Botulinum Toxins in the Treatment of Primary Axillary Hyperhidrosis. Dermatol Surg 2007; 33:S44-50. [PMID: 17241414 DOI: 10.1111/j.1524-4725.2006.32331.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Botulinum toxin (BTX) is an effective treatment for primary axillary hyperhidrosis. In this study we used two toxins not bioequivalent: BOTOX (Allergan, Inc.) and Dysport (Beaufour Ipsen Biotech). OBJECTIVE The objective was to compare the efficacy, safety, and tolerability of BOTOX and Dysport in the treatment of primary axillary hyperhidrosis using a conversion factor of 1:3, respectively. METHODS In a double-blind, randomized prospective study, 10 patients with primary axillary hyperhidrosis and sweat production exceeding 50 mg/minute received 50 U of BOTOX in one axilla and 150 U of Dysport in the other. We performed Minor's test and gravimetry at 0 days, at 15 days, and monthly for 1 year. RESULTS No significant difference was observed in the sweating quantity at baseline. After 1 month all patients had achieved success for both axillae. The sweat rate was reduced by a mean of 97.7% for BOTOX and 99.4% for Dysport, without statistical difference. The duration of benefits was similar between both toxins, with a mean of 260 days for BOTOX and 290 days for Dysport, without statistical difference. The longest symptom-free interval was 12 months (5 patients, 55.6%). CONCLUSIONS BOTOX and Dysport presented similar levels of safety and efficacy in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used.
Collapse
Affiliation(s)
- Sérgio Talarico-Filho
- Department of Dermatology, Universidade Federal de São Paulo-UNIFESP, Hospital São Paulo, São Paulo, Brazil.
| | | | | | | |
Collapse
|
31
|
Benohanian A. Needle-free anesthesia: a promising technique for the treatment of palmoplantar hyperhidrosis with botulinum toxin A. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/14750708.3.5.591] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
|
33
|
Pérez-Bernal AM, Avalos-Peralta P, Moreno-Ramírez D, Camacho F. Treatment of palmar hyperhidrosis with botulinum toxin type A: 44 months of experience. J Cosmet Dermatol 2005; 4:163-6. [PMID: 17129260 DOI: 10.1111/j.1473-2165.2005.00304.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palmar hyperhidrosis (PH) can produce social and occupational difficulties and reduce the quality of life of those who suffer from this kind of problem. When dealing with focal hyperhidrosis, the patients' attitudes and their subjective approaches regarding the process may influence the objective evaluation of the disorder. OBJECTIVE To evaluate, by means of a scale, the subjective improvement of sweat production after treatment with botulinum toxin type A (BTX-A) in a group of patients with severe, invalidating PH. Patients and methods Over a period of 44 months, 69 patients were treated and followed-up, 27 patients had to be treated twice, and 11 patients required a third application; 80-100 U was injected in each palm. Regional nerve block was performed before the procedure. The patients were asked to evaluate their improvement at 1, 3, 6, 9, and 12 months of baseline. RESULTS At 1 month, 53.6% of the patients reported an excellent improvement. Three months later, results were still excellent in 33.3% of the patients, and acceptable in 29%. From then on there was a statistically significant decrease of BTX-A effectiveness. A second application was carried out at an interval of 7.5 +/- 2.6 months, and a third one at 9 +/- 4.4 months. The following complications could be observed: transitory weakness of hand muscles in 13 patients, wrist pain in 5 patients, and cramps in 1 patient. CONCLUSIONS Botulinum toxin is an effective alternative for the treatment of severe, invalidating PH. The maximum improvement persists up to 3 months; from then on, the effects slowly diminish. In our experience, there were no statistically significant differences with further applications of BTX-A. The patients' subjective assessment can be used to evaluate the sweat production after treatment with BTX-A in those medical centers where a more objective evaluation becomes difficult or impossible.
Collapse
|
34
|
Silveira-Moriyama L, Gonçalves LR, Chien HF, Barbosa ER. Botulinum toxin A in the treatment of blepharospasm: a 10-year experience. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:221-4. [PMID: 16100966 DOI: 10.1590/s0004-282x2005000200006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To evaluate the long-term effect of botulinum toxin type A (BTX) in the treatment of blepharospasm, a retrospective analysis was conducted from the patients seen at the Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine from 1993 to 2003. A total of 379 treatments with BTX were administered to 30 patients with blepharospasm. Sixty six per cent of the subjects had used oral medication for dystonia and only 15% of them reported satisfactory response to this treatment. Ninety three per cent of the patients showed significant improvement after the first BTX injection. There was no decrement in response when compared the first and the last injection recorded. Adverse effects, mostly minor, developed at least once in 53% of patients. Six patients (20%) discontinued the treatment but there was no case of secondary resistance.
Collapse
Affiliation(s)
- Laura Silveira-Moriyama
- Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo SP, Brazil (HC- FMUSP)
| | | | | | | |
Collapse
|
35
|
James R, Phillips D, Collin J. Durability of botulinum toxin injection for axillary hyperhidrosis. Br J Surg 2005; 92:834-5. [PMID: 15892160 DOI: 10.1002/bjs.5001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Injections last about 6 months
Collapse
Affiliation(s)
- R James
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, UK
| | | | | |
Collapse
|
36
|
Jaén Olasolo P, Fernández Lorente M. [Therapeutic application of botulogenic toxin]. Rev Clin Esp 2005; 205:123-6. [PMID: 15811281 DOI: 10.1157/13072970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Botulogenic toxin infiltration for the treatment of idiopathic local hyperhidrosis is a safe and well tolerated procedure, with minimum side effects and with an effectiveness demonstrated throughout the years, especially in axillary hyperhidrosis; in the majority of patients with this condition is an effective alternative to surgery. In other locations, the results are more modest and the clinical experience more limited, which forces us to advise the surgery as alternative with an incidence far from desirable.
Collapse
|
37
|
Krogstad AL, Skymne A, Pegenius G, Elam M, Wallin BG. No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis. Br J Dermatol 2005; 152:329-33. [PMID: 15727647 DOI: 10.1111/j.1365-2133.2004.06255.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at the palms, soles and axillae. The underlying mechanism is unclear. In recent years botulinum toxin A has emerged as a useful treatment. Compensatory sweating, which is a major problem in many patients who have undergone transthoracic endoscopic sympathectomy for hyperhidrosis, has only rarely been reported after botulinum toxin. However, this potential side-effect of botulinum toxin treatment has not been systematically examined. OBJECTIVES To investigate if treatment with botulinum toxin A in hyperhidrotic hands may cause compensatory sweating at other skin locations. METHODS In 17 patients with a history of palmar hyperhidrosis repeated measurements of evaporation were made before and up to 6 months after treatment of the hands with botulinum toxin A. Recordings were made at 16 skin areas and compared with subjective estimates of sweating. RESULTS Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area. CONCLUSIONS Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories.
Collapse
Affiliation(s)
- A L Krogstad
- Institute of Clinical Neuroscience, Sahlgren Universtiy Hospital, S-413 45 Göteborg, Sweden
| | | | | | | | | |
Collapse
|
38
|
Lowe N, Campanati A, Bodokh I, Cliff S, Jaen P, Kreyden O, Naumann M, Offidani A, Vadoud J, Hamm H. The place of botulinum toxin type A in the treatment of focal hyperhidrosis. Br J Dermatol 2004; 151:1115-22. [PMID: 15606505 DOI: 10.1111/j.1365-2133.2004.06317.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperhidrosis (primary or secondary) is excessive sweating beyond that required to return body temperature to normal. It can be localized or generalized, commonly affecting the axillae, palms, soles or face, and can have a substantial negative effect on a patient's quality of life. IMPACT OF DISEASE Objective evaluation comprising quantitative assessment (gravimetric and Minor's iodine starch test) and subjective evaluation (Dermatology Quality of Life Index and Hyperhidrosis Impact Questionnaire) allow accurate assessment of the impact of hyperhidrosis on patients. BOTULINUM TOXIN TYPE A Botulinum toxin type A acts by inhibiting the release of acetylcholine at the presynaptic membrane of cholinergic neurones. It has proved useful in treating a number of diseases relating to muscular dystonia and is now proving beneficial in treating hyperhidrosis. Clinical trials investigating botulinum toxin type A use in axillary and palmar hyperhidrosis show significant benefits with few side-effects reported, with a favourable impact also being seen on patient quality of life. Botulinum toxin type A injections are generally well-tolerated with beneficial results lasting from 4 to 16 months. CONCLUSIONS Botulinum toxin type A injections are an effective and well-tolerated treatment for hyperhidrosis. This paper proposes a positioning of this treatment along with current established treatments, and highlights the role of botulinum toxin type A as a valuable therapy for the treatment of hyperhidrosis.
Collapse
Affiliation(s)
- N Lowe
- Cranley Clinic, 3 Harcourt House, 19a Cavendish Square, London W1G 0PN, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Inguinal Hyperhidrosis (IH) is a focal and primary form of hyperhidrosis in which the individual has intense sweating in the inguinal region. It usually appears in adolescence, not later than the age of 25, in the most cases, and continues into adulthood. With a sample of 26 patients we described Inguinal Hyperhidrosis (IH). Fifty percent of the patients have a positive family history of this condition or other forms of focal or generalized hyperhidrosis, which suggests a familial pattern. Biopsies performed on the inguinal area in a patient with IH and control patient showed normal histology. Excessive perspiration in the inguinal area significantly affects the quality of life of the patients. It is an embarrassing condition that produces large wet stains on the clothes, therefore making daily activities difficult and compromising the emotional, professional and social life of the affected patients. The therapies commonly used for other forms of focal hyperhidrosis are not yet referred in the literature specifically for IH. Intradermal injections from botulinum toxin provide positive results for the patients and controls the sweating for 6 months or more. It is a simple, safe and effective treatment for this condition and the results significantly improve the quality of life of the affected individuals.
Collapse
Affiliation(s)
- Dóris Maria Hexsel
- Department of Cosmetic Dermatology, Brazilian Society of Dermatology, Porto Alegre, Brazil, Brazil.
| | | | | |
Collapse
|
40
|
A Case of Foul Genital Odor Treated with Botulinum Toxin A. Dermatol Surg 2004. [DOI: 10.1097/00042728-200409000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Lee JB, Kim BS, Kim MB, Oh CK, Jang HS, Kwon KS. A Case of Foul Genital Odor Treated with Botulinum Toxin A. Dermatol Surg 2004; 30:1233-5. [PMID: 15355367 DOI: 10.1111/j.1524-4725.2004.30382.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Genital odor is an uncommon condition characterized by an offensive and malodorous smell in the genital area. Although the etiology of foul genital odor is multifactorial, an important cause is sweat secretion and decomposition of sweat components by bacteria. Different methods are effective in reducing body odor secondary to bromhidrosis. Conservative methods only act for a short period of time, and more invasive surgical methods carry risk of complications or are inapplicable for the genital region. METHODS A patient with localized foul odor in the genital hair bearing area was treated with botulinum toxin A. RESULTS Botulinum toxin A was effective in creating an odorless and anhydrous response in the genital region, and no major adverse effects were noted during a follow-up of 9 months after injection. CONCLUSION Local injection of botulinum toxin A appears to be a useful treatment for foul genital odor related to sweat glands activity.
Collapse
Affiliation(s)
- Jae-Bong Lee
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea.
| | | | | | | | | | | |
Collapse
|
42
|
Campanati A, Lagalla G, Penna L, Gesuita R, Offidani A. Local neural block at the wrist for treatment of palmar hyperhidrosis with botulinum toxin: Technical improvements. J Am Acad Dermatol 2004; 51:345-8. [PMID: 15337974 DOI: 10.1016/j.jaad.2003.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Wrist blockage of median and ulnar nerves before treatment of palmar hyperhidrosis with botulinum toxin (BTX-A) reduces discomfort and improves accuracy of BTX-A injections, but can be associated with mechanical/chemical injury. OBJECTIVES We sought to compare locoregional anesthesia of median and ulnar nerves using conventional 25-G x 0.50 x 13 mm gauge needle with short 30-G x 0.40 x 6 mm gauge needle. METHODS In all, 37 patients with idiopathic, recalcitrant palmar hyperhidrosis were treated with BTX-A after median and ulnar nerve blockage. In 18 patients, a conventional needle was used to achieve nerve blockage and in 19 the short needle was used. The 2 groups of patients were compared for analgesic effects and lag phase. RESULTS No differences were found between groups for lag phase (P=.26) and discomfort of subsequent BTX-A treatment (P=1.0). CONCLUSION The use of a short-gauge needle to block median and ulnar nerves is a suitable method to anesthetize the palm before treatment with BTX-A.
Collapse
|
43
|
Abstract
Focal idiopathic and episodic eccrine sweating of the axillae, palms, soles, and face troubles afflicted individuals with a social curse that can only be imagined by those whose hands or underarms dampen only occasionally. Although there is no accurate incidence in the epidemiology literature, it seems that about half of the patients who have presented to the author with this condition have at least one first-degree relative similarly affected. Social stigma, lack of understanding on the part of medical providers as to the cause and nature of the problem, and lack of effective therapy keeps most of these patients from seeking medical care. This article investigates the treatment of hyperhidrosis with botulinum toxin.
Collapse
Affiliation(s)
- Richard G Glogau
- Department of Dermatology, University of California at San Francisco, 350 Parnassus Avenue, Suite 400, San Francisco, CA 94117-3685, USA.
| |
Collapse
|
44
|
Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, Ahn S, Stolman LP. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274-86. [PMID: 15280848 DOI: 10.1016/j.jaad.2003.12.029] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Krogstad AL, Skymne BSA, Göran Pegenius BS, Elam M, Wallin BG. Evaluation of objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin treatment. Clin Neurophysiol 2004; 115:1909-16. [PMID: 15261869 DOI: 10.1016/j.clinph.2004.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate (1) if laboratory tests may be a useful complement in diagnosing palmar hyperhidrosis and (2) if such tests can be used in the follow up examination of treatment effects. METHODS Repeated measurements of evaporation and conductance were made in glabrous skin on hands and compared with subjective estimates of the degree of sweating in 20 control subjects and 20 patients with a history of palmar hyperhidrosis. In addition, 17 patients were monitored for up to 6 months after treatment of the hands with botulinum toxin A. RESULTS Before treatment, evaporation in the palms was higher in the patients than in the control subjects but skin conductance did not differ between the groups. After treatment both evaporation and skin conductance decreased markedly in the patients and then slowly returned towards pretreatment values. CONCLUSIONS Measurements of evaporation, but not skin conductance, may be a useful objective adjunct when diagnosing palmar hyperhidrosis. Both methods can, however, be used to monitor intraindividual changes of sweating over time.
Collapse
Affiliation(s)
- Anne-Lene Krogstad
- Unit of Clinical Neurophysiology, Institute of Clinical Neuroscience, Sahlgren University Hospital, S-413 45 Göteborg, Sweden
| | | | | | | | | |
Collapse
|
46
|
Abstract
Since the commercial launch of Dysport in 1991, after 10 years of clinical studies on its predecessor formulations, this BTX-A product has shown great therapeutic promise with a good safety profile and low incidence of treatment failures. As with all BTX products, Dysport should not be seen as a generic equivalent but as a specific product with individual unit dosing requirements and side effect profiles. Its role as an important BTX-A molecule looks set to expand as new indications for botulinum toxin arise, and as the cosmetic usage of Dysport is approved in countries outside of South America.
Collapse
Affiliation(s)
- Andrew C Markey
- St. John's Institute of Dermatology, St. Thomas' Hospital, London SE17EH, UK.
| |
Collapse
|
47
|
Simonetta Moreau M, Cauhepe C, Magues JP, Senard JM. A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br J Dermatol 2004; 149:1041-5. [PMID: 14632812 DOI: 10.1111/j.1365-2133.2003.05620.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intradermal injections of type A botulinum toxin have been reported to reduce excessive sweating in patients with primary palmar hyperhidrosis. Two preparations are commercially available in Europe: Botox (Allergan; 100 U per vial) and Dysport (Beaufour Ipsen Biotech; 500 U per vial), which are not bioequivalent. A few studies have tried to find an appropriate conversion factor between the two preparations in dystonic patients but results remain controversial. OBJECTIVES To compare the efficacy of Botox and Dysport in palmar hyperhidrosis using a conversion factor of 1 : 4. METHODS In a double-blind, randomized study, eight patients with severe primary palmar hyperhidrosis received in the same session intradermal injections of Dysport in one palm and Botox in the other, after regional median and ulnar nerve blocks. Quantification of sweat production was performed by Minor's iodine starch test at baseline, 1, 3 and 6 months after the treatment. Subjective assessment of sweat production was performed using a visual analogue scale. RESULTS The mean +/- SD number of injection sites (28 +/- 1), mean volume of reconstituted solution injected (2.8 mL) and mean sweating area at baseline (BSA) were similar in each palm group. The mean +/- SD dose injected was 69.3 +/- 3.1 U for the Botox-treated palms and 283.7 +/- 11.3 U for the Dysport-treated palms (1 : 4). At 1 month, Minor's test revealed significant decreases in mean sweating area for each preparation (Dysport palms: -78.6% vs. BSA, P = 0.0002; Botox palms: -56.6% vs. BSA, P = 0.003). The percentage of decrease was more pronounced in Dysport palms compared with Botox palms but the difference did not reach statistical significance. At 3 months, the decrease in sweating area remained significant for Dysport palms (-69.4% vs. BSA, P = 0.008) but not for Botox palms (-48.8% vs. BSA). Self-evaluation showed a similar amount of improvement in both palm groups at 1 and 3 months (77% and 75% for Dysport; 68% and 72% for Botox). Local side-effects were more frequent in Dysport palms (weakness of thumb-index pinch in four cases, lasting 8-30 days) than in Botox palms (weakness of thumb-index pinch in two cases, lasting 15-21 days). The mean duration of positive effect was similar: 17 weeks in Dysport (range 8-32) and 18 weeks in Botox palms (range 8-32). CONCLUSIONS Using a conversion factor of 1 : 4, the efficacy of Botox and Dysport injections was similar. However, there was a trend towards a larger improvement after Dysport treatment but with a higher incidence of adverse effects.
Collapse
Affiliation(s)
- M Simonetta Moreau
- Fédération de Neurologie and Département d'Anesthésie, CHU Purpan, place du Dr Baylac, 31059 Toulouse cedex, France.
| | | | | | | |
Collapse
|
48
|
Abstract
Focal idiopathic excessive eccrine sweating presents most commonly as an affliction of three anatomically distinct area: the axillae, the palms and soles, and the upper face. The true incidence is not known, but about half of the patients referred to us with this condition have at least one first-degree relative similarly affected. Only a fraction of patients afflicted are thought to seek medical care because of the social stigma, lack of understanding on the part of medical providers as to the cause and nature of the problem, and, until now, lack of effective nonsurgical therapy. A large social sample is required to accurately measure both the incidence and the exact nature of the genetic influence.
Collapse
Affiliation(s)
- Richard G Glogau
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco, California 94117-3685, USA.
| |
Collapse
|
49
|
Abstract
The treatment of focal hyperhidrosis and drooling with neurolysis of the neuroglandular junction is a relatively new and useful technique for managing such obvious conditions and improving the patient's quality of life. The treatment is safe, minimally invasive, and an effective alternative to other treatment modalities.
Collapse
Affiliation(s)
- Ib R Odderson
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| |
Collapse
|
50
|
|