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Tan Y, Huang W, Liu J, Duan Z, He X, Li Q, Yang Z. The application of microwaves in axillary hyperhidrosis: Curative effect observation of a pathological examination over 1 year. J Cosmet Dermatol 2024; 23:134-140. [PMID: 37547985 DOI: 10.1111/jocd.15909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/29/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND In Asia, axillary hyperhidrosis is a frequent problem for many people, and the consequent excessive sweating can seriously affect many aspects of daily life and even lead to mental disorders. Microwave therapy is a new, non-invasive treatment method for axillary hyperhidrosis, whose energy and long-term effectiveness still needs to be clinically validated. OBJECTIVE The aim of this study was to evaluate the clinical efficacy, safety, histological changes, and psychological status of microwave devices in the treatment of axillary hyperhidrosis and osmidrosis. METHOD We conducted a prospective self-controlled study in a top-tier Chinese hospital. After a 5/5 energy treatment session, a skin biopsy was taken to observe histological changes both before and after treatment. An iodine starch test was used to determine the sweating range. We evaluated symptoms of improved efficacy using the Hyperhidrosis Disease Severity Scale (HDSS) and assessed changes in life status with the DLQI. In the case of concurrent underarm odor, odor-5, VAS, and Young-Jin Park grading were used to assess odor relief. The effect of odor on psychology was assessed by using a psychological status symptom checklist (scl-90). The study period was 1 year. RESULTS We observed 20 patients in this study. Of those, 90% met the primary treatment endpoint of a decrease in axillary hyperhidrosis symptomatology to below grade 2 on the HDSS score (p < 0.001). Furthermore, 75% of patients achieved a treatment endpoint of at least 50% reduction in VAS (p < 0.001). 70% of patients achieved a treatment endpoint of at least 50% reduction in odor-5 (p < 0.001). The iodine starch test showed that the region decreased 99% from the baseline to 12 months after follow-up had ended (p < 0.001). Eight patients volunteered to undergo histological examination; their average light density of immunohistochemistry decreased from 1.04 (0.4-2.11) to 0.07 (0.04-0.46; p < 0.05). The immunohistochemical positive number for sweat glands was initially 104 (59.75-132.5) but was 41.5 (29.75-62) after the procedure. None of the patients experienced any serious adverse reactions. CONCLUSION The treatment demonstrated high effectiveness, safety, and short-lived adverse reactions.
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Affiliation(s)
- Yaxin Tan
- Department of Dermatology, Panzhou People's Hospital, Panzhou, China
| | - Wanxiao Huang
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianmeng Liu
- Department of Dermatology, Maternal and Child Health Care Hospital of Honghe State, Honghe Hani and Yi Autonomous Prefecture, China
| | - Zhiyi Duan
- Southern Central Hospital of Yunnan Province, Gejiu, China
| | - Xiaolin He
- Department of Dermatology, Yan' an Hospital of Kunming City, Kunming, China
| | - Qiongyan Li
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhi Yang
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Wohlrab J, Bechara FG, Schick C, Naumann M. Hyperhidrosis: A Central Nervous Dysfunction of Sweat Secretion. Dermatol Ther (Heidelb) 2023; 13:453-463. [PMID: 36627476 PMCID: PMC9884722 DOI: 10.1007/s13555-022-00885-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Hyperhidrosis (HH) is a central nervous dysfunction characterized by abnormally increased sweating due to a central dysregulation of sweat secretion. HH significantly affects the quality of life of patients in their private, social and professional environments. Physiologically, sweating is a mechanism that regulates body temperature, but it may also be triggered by emotional or gustatory stimuli. There are two main types of sweat glands: eccrine and apocrine glands. The central nervous system controls sweat secretion through the release of neurotransmitters into the autonomous nervous system (ANS) that activate the sweat glands. The hypothalamus has two separate neuronal pathways, one for thermoregulation and one for emotions. HH may thus be due to either a neuronal dysfunction of ANS regulation leading to a hyperactivity of the sympathetic nervous system, or to abnormal central processing of emotions. Crucially, there is no dysfunction of the sweat glands themselves. Various pathogenic mechanisms have been proposed to be involved in pathological sweat secretion in HH, ranging from structural changes within the ANS to increased expression of aquaporin 5 and upregulation of activin A receptor type 1 in eccrine sweat glands. Although a genetic predisposition has been demonstrated, it remains unclear exactly which genes are involved. To identify new, potential therapeutic targets and to improve treatment options, a good understanding of the signaling pathways involved, the underlying mechanisms, and the genetic components is essential. In this review we discuss the various aspects of sweat physiology and function that are necessary to explain pathological sweating. Our aim is to raise awareness of the complexity of HH to promote a better understanding of the disorder.
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Affiliation(s)
- Johannes Wohlrab
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergy, Ruhr University, Bochum, Germany
| | | | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
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Cao M, Zhang L, Cheng J, Wang C, Zhao J, Liu X, Yan Y, Tang Y, Chen Z, Li H. Differential antigen expression between human apocrine sweat glands and eccrine sweat glands. Eur J Histochem 2022; 67:3559. [PMID: 36546419 PMCID: PMC9827426 DOI: 10.4081/ejh.2023.3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Bromhidrosis has a great negative impact on personal occupation and social psychology. It is not yet clear whether bromhidrosis is caused by apocrine sweat glands or the co-action of apocrine sweat glands and eccrine sweat glands. To distinguish between apocrine sweat glands and eccrine sweat glands, specific antigen markers for apocrine sweat glands and eccrine sweat glands must be found first. In the study, we detected the expression of K7, K18, K19, Na+-K+-2Cl- cotransporter 1 (NKCC1), carbonic anhydrase II (CAII), Forkhead transcription factor a1 (Foxa1), homeobox transcription factor engrailed homeobox1 (En1), gross cystic disease fluid protein-15 (GCDFP-15), mucin-1 (MUC-1), cluster of differentiation 15 (CD15) and apolipoprotein (APOD) in eccrine sweat glands and apocrine sweat glands by immunofluorescence staining. The results showed that K7, K18, K19, Foxa1, GCDFP-15 and MUC-1 were expressed in both apocrine and eccrine sweat glands, CD15 and APOD were only expressed in apocrine sweat glands, and CAII, NKCC1 and En1 were only expressed in eccrine sweat glands. We conclude that CD15 and APOD can serve as specific markers for apocrine sweat glands, while CAII, NKCC1 and En1 can serve as specific markers for eccrine sweat glands to differentiate the two sweat glands.
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Affiliation(s)
- Manxiu Cao
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei,*These authors contributed equally to this work
| | - Lei Zhang
- Department of Mental Health, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, Guangdong,*These authors contributed equally to this work
| | - Jiaqi Cheng
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei,*These authors contributed equally to this work
| | - Cangyu Wang
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Junhong Zhao
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Xiang Liu
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Yongjing Yan
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Yue Tang
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Zixiu Chen
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei
| | - Haihong Li
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei,Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, Guangdong, China,Correspondence: Prof. Haihong Li, Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei, China.
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Campanati A, Gregoriou S, Milia-Argyti A, Kontochristopoulos G, Radi G, Diotallevi F, Martina E, Offidani A. THE PHARMACOLOGICAL TREATMENT AND MANAGEMENT OF HYPERHIDROSIS. Expert Opin Pharmacother 2022; 23:1217-1231. [PMID: 35686667 DOI: 10.1080/14656566.2022.2083499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Idiopathichyperhidrosis is a dysfunctional disorder involving eccrine sweat glands and its impact on patients' daily quality of life is well-known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options. AREAS COVERED The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatments flow-chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar and craniofacial hyperhidrosis. EXPERT OPINION Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis can represent an additive therapeutic option for patients with insufficient response to topical treatment according to a step wise therapeutic approach. Until the pathophysiological mechanisms underlying hyperhidrosis are clear, and the etiological therapeutic approach become realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms.
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Affiliation(s)
- Anna Campanati
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Stamatis Gregoriou
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Adamantia Milia-Argyti
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - George Kontochristopoulos
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Giulia Radi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Federico Diotallevi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Emanuela Martina
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Annamaria Offidani
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
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Chen W, Zhang X, Zhang L, Xu Y. Treatment of axillary bromhidrosis in adolescents by combining electrocauterization with ultrasound-guided botulinum toxin type A injection. J Plast Reconstr Aesthet Surg 2021; 74:3114-3119. [PMID: 34238698 DOI: 10.1016/j.bjps.2021.03.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/27/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study is to investigate the efficacy of treatment-combined electrocauterization after removal of apocrine sweat glands with ultrasound-guided (BOTOX) injection for adolescents with axillary bromhidrosis. From January 2015 to January 2018, 90 adolescents with axillary bromhidrosis were recruited and randomly divided into three groups (group A, B, and C). Patients in group A underwent electrocauterization after removal of apocrine sweat glands, patients in group B received ultrasound-guided BOTOX injection, and patients in group C had electrocauterization after the removal of apocrine sweat glands followed by ultrasound-guided BOTOX administration after two weeks. All patients were followed up for one year. The percentages of axillary malodor score at twelve months after treatments compared with pre-operation for group A, group B, and group C were 20.2%, 27.5%, and 12.5%, respectively. Significant statistical differences were observed in changes of axillary malodor score among the three groups at three, six, nine and twelve months postoperatively. Satisfaction rates of group A, group B, and group C were 90.0%, 93.3%, and 96.7%, respectively. The side effects after surgery in group A were similar to group C, and no side effect was observed in group B. One-year postoperative scar formation rate of group A was 16.7%, which was significantly higher than that of group B (0) and group C (6.66%). Combination of electrocauterization after removal of apocrine sweat glands with ultrasound-guided BOTOX injection showed better treatment effects.
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Affiliation(s)
- Wanying Chen
- Department of Plastic Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, Jilin 130000, China
| | - Xiaoyu Zhang
- Department of Gastrointestinal and Colorectal Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, Jilin 130000, China
| | - Lianbo Zhang
- Department of Plastic Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, Jilin 130000, China.
| | - Yingying Xu
- Department of Ultrasound, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, Jilin 130000, China.
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Manav V, Türk CB, Kara Polat A, Erdil D, Baş S, Koku Aksu AE. Evaluation of the serum magnesium and vitamin D levels and the risk of anxiety in primary hyperhidrosis. J Cosmet Dermatol 2021; 21:373-379. [PMID: 33738914 DOI: 10.1111/jocd.14075] [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: 11/24/2020] [Revised: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Excessive sweating is considered primary hyperhidrosis if it is triggered by emotional states without any thermogenic or other underlying disease from the eccrine glands. This may be due to dysfunction in the autonomic nervous system. AIMS To investigate the relationship between Vitamin D and Mg deficiency and the risk of anxiety and depression in patients with primary hyperhidrosis. PATIENTS/METHODS This cross-sectional, case-control study was conducted between July and October 2019. 49 primary hyperhidrosis patients in Group I and 47 age and gender matched healthy individuals in Group II were included in the study. RESULTS The mean 25 (OH) D and Mg levels in Group I were statistically significantly lower than in Group II (p < 0.001 and p = 0.002, respectively). Statistically significant differences were found between the groups in terms of anxiety and depression (p < 0.001 and p = 0.033, respectively). There was no significant relationship between the HADS-A / HADS-D scores and the severity of primary hyperhidrosis (r = -0.131, p = 0.096; correlation coefficient = 0.232, p = 0.447). However, a significant correlation was observed between HADS-A scores and serum Mg levels (r = -0.439, p = 0.007). CONCLUSION Anxiety and depression are common in patients with primary hyperhidrosis. As shown in this study, both anxiety and depression can be seen with low Mg levels in patients with primary hyperhidrosis. This could possibly be related to the pathological mechanism involving Vitamin D and Mg, which determines the common pathway affecting primary hyperhidrosis and anxiety/depression.
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Affiliation(s)
- Vildan Manav
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Cemre Büşra Türk
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Soysal Baş
- Department of Plastic Reconstructive and Aesthetic Surgery, İstanbul Hamidiye Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
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7
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Aubignat M. [Hyperhidrosis from diagnosis to management]. Rev Med Interne 2020; 42:338-345. [PMID: 33261887 DOI: 10.1016/j.revmed.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 12/26/2022]
Abstract
Hyperhidrosis is defined as uncontrollable, excessive and unpredictable sweating that exceeds the needs related to thermoregulation. It preferentially affects axillary, palms, soles and face but can affect any part of the body. This ostensibly benign symptom can have a major negative impact on quality of life sometimes leading to isolation and depression. Moreover, in some cases hyperhidrosis can be secondary to an underlying pathology sometimes malignant which must be identified quickly. Consequently, each doctor should be able to develop a diagnostic and therapeutic approach for this relatively frequent and probably underdiagnosed and undertreated reason for consultation. In this review, we focus on diagnosis hyperhidrosis and its management.
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Affiliation(s)
- M Aubignat
- Service de neurologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; Centre expert Parkinson, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
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Zamkah A, Hui T, Andrews S, Dey N, Shi F, Sherratt RS. Identification of Suitable Biomarkers for Stress and Emotion Detection for Future Personal Affective Wearable Sensors. BIOSENSORS-BASEL 2020; 10:bios10040040. [PMID: 32316280 PMCID: PMC7235866 DOI: 10.3390/bios10040040] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
Skin conductivity (i.e., sweat) forms the basis of many physiology-based emotion and stress detection systems. However, such systems typically do not detect the biomarkers present in sweat, and thus do not take advantage of the biological information in the sweat. Likewise, such systems do not detect the volatile organic components (VOC’s) created under stressful conditions. This work presents a review into the current status of human emotional stress biomarkers and proposes the major potential biomarkers for future wearable sensors in affective systems. Emotional stress has been classified as a major contributor in several social problems, related to crime, health, the economy, and indeed quality of life. While blood cortisol tests, electroencephalography and physiological parameter methods are the gold standards for measuring stress; however, they are typically invasive or inconvenient and not suitable for wearable real-time stress monitoring. Alternatively, cortisol in biofluids and VOCs emitted from the skin appear to be practical and useful markers for sensors to detect emotional stress events. This work has identified antistress hormones and cortisol metabolites as the primary stress biomarkers that can be used in future sensors for wearable affective systems.
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Affiliation(s)
- Abdulaziz Zamkah
- Biomedical Sciences and Biomedical Engineering, The University of Reading, Reading RG6 6AY, UK; (A.Z.); (T.H.); (S.A.)
| | - Terence Hui
- Biomedical Sciences and Biomedical Engineering, The University of Reading, Reading RG6 6AY, UK; (A.Z.); (T.H.); (S.A.)
| | - Simon Andrews
- Biomedical Sciences and Biomedical Engineering, The University of Reading, Reading RG6 6AY, UK; (A.Z.); (T.H.); (S.A.)
| | - Nilanjan Dey
- Department of Information Technology, Techno India College of Technology, West Bengal 700156, India;
| | - Fuqian Shi
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903, USA;
| | - R. Simon Sherratt
- Biomedical Sciences and Biomedical Engineering, The University of Reading, Reading RG6 6AY, UK; (A.Z.); (T.H.); (S.A.)
- Correspondence: ; Tel.: +44-118-378-8588
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Efficacy and Safety of Botulinum Toxin A in Axillary Bromhidrosis and Associated Histological Changes in Sweat Glands. Dermatol Surg 2019; 45:1605-1609. [DOI: 10.1097/dss.0000000000001906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review. J Am Acad Dermatol 2019; 81:657-666. [DOI: 10.1016/j.jaad.2018.12.071] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
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Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin) 2019; 6:211-259. [PMID: 31608304 PMCID: PMC6773238 DOI: 10.1080/23328940.2019.1632145] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.
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Affiliation(s)
- Lindsay B. Baker
- Gatorade Sports Science Institute, PepsiCo R&D Physiology and Life Sciences, Barrington, IL, USA
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Kaminaka C, Mikita N, Inaba Y, Kunimoto K, Okuhira H, Jinnin M, Kao B, Tanino R, Tanioka K, Shimokawa T, Yamamoto Y. Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split‐area comparative trial. Lasers Surg Med 2019; 51:592-599. [DOI: 10.1002/lsm.23073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Chikako Kaminaka
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
- Department of Cosmetic Dermatology and PhotomedicineWakayama Medical UniversityWakayamaJapan
| | - Naoya Mikita
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Yutaka Inaba
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Kayo Kunimoto
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Hisako Okuhira
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Masatoshi Jinnin
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Bunsho Kao
- Department of Plastic SurgeryTenjinshita Dermatology and Plastic SurgeryTokyoJapan
| | - Ryuzaburo Tanino
- Department of Plastic SurgeryTenjinshita Dermatology and Plastic SurgeryTokyoJapan
| | - Kensuke Tanioka
- Wakayama Medical UniversityClinical Study Support CenterWakayamaJapan
| | - Toshio Shimokawa
- Wakayama Medical UniversityClinical Study Support CenterWakayamaJapan
| | - Yuki Yamamoto
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
- Department of Cosmetic Dermatology and PhotomedicineWakayama Medical UniversityWakayamaJapan
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13
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. J Am Acad Dermatol 2019; 81:669-680. [PMID: 30710603 DOI: 10.1016/j.jaad.2018.11.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
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Childress KJ, Brown O, Bercaw-Pratt J. Inguinal Hyperhidrosis: Case Report of an Uncommon Cause of Vaginitis. J Pediatr Adolesc Gynecol 2018; 31:420-421. [PMID: 29421341 DOI: 10.1016/j.jpag.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hyperhidrosis (excessive sweating) affects 1%-3% of the population. Primary focal hyperhidrosis most commonly affects the axilla, palms, and soles. There are few case reports of hyperhidrosis of the genital region, typically described as inguinal hyperhidrosis or Hexsel's hyperhidrosis. CASE A 17-year-old girl presented with 3 years of copious, clear "vaginal" discharge causing significant emotional distress. After extensive gynecologic and urologic workup was negative, further review of her history was notable for excessive axillary sweating. Inguinal hyperhidrosis was suspected and she was treated with topical aluminum chloride hexahydrate with complete resolution of her symptoms. SUMMARY AND CONCLUSIONS Inguinal hyperhidrosis, compared with other sites, is not widely described in the literature. Awareness of inguinal hyperhidrosis is important because it causes significant social embarrassment but is a treatable condition.
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Affiliation(s)
- Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Oluwateniola Brown
- Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois
| | - Jennifer Bercaw-Pratt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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15
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The Etiology of Primary Hyperhidrosis: A Systematic Review. Clin Auton Res 2017; 27:379-383. [DOI: 10.1007/s10286-017-0456-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
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16
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Affiliation(s)
- Jason E. Sammons
- Department of Clinical Medicine, Avalon University School of Medicine, Willemstad, CW, USA
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17
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18
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Eccles JA, Owens AP, Mathias CJ, Umeda S, Critchley HD. Neurovisceral phenotypes in the expression of psychiatric symptoms. Front Neurosci 2015; 9:4. [PMID: 25713509 PMCID: PMC4322642 DOI: 10.3389/fnins.2015.00004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/05/2015] [Indexed: 12/01/2022] Open
Abstract
This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brain-body mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in “emotional” brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognized factors causing vasodilatation (as noted post-prandially, post-exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety.
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Affiliation(s)
- Jessica A Eccles
- Psychiatry, Brighton and Sussex Medical School Brighton, UK ; Sussex Partnership National Health Service Foundation Trust Brighton, UK
| | - Andrew P Owens
- National Hospital Neurology and Neurosurgery, UCL National Health Service Trust London, UK ; Institute of Neurology, University College London London, UK
| | - Christopher J Mathias
- National Hospital Neurology and Neurosurgery, UCL National Health Service Trust London, UK ; Institute of Neurology, University College London London, UK
| | - Satoshi Umeda
- National Hospital Neurology and Neurosurgery, UCL National Health Service Trust London, UK ; Department of Psychology, Keio University Tokyo, Japan
| | - Hugo D Critchley
- Psychiatry, Brighton and Sussex Medical School Brighton, UK ; Sussex Partnership National Health Service Foundation Trust Brighton, UK ; Sackler Centre for Consciousness Science, University of Sussex Falmer, UK
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He J, Wang T, Dong J. A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with botulinum toxin A. J DERMATOL TREAT 2011; 23:461-4. [DOI: 10.3109/09546634.2011.594869] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Cerfolio RJ, De Campos JRM, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91:1642-8. [PMID: 21524489 DOI: 10.1016/j.athoracsur.2011.01.105] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/29/2010] [Accepted: 01/11/2011] [Indexed: 11/29/2022]
Abstract
Significant controversies surround the optimal treatment of primary hyperhidrosis of the hands, axillae, feet, and face. The world's literature on hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial hyperhidrosis.
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Affiliation(s)
- Robert J Cerfolio
- Division of Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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22
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Martin A, Hellhammer J, Hero T, Max H, Schult J, Terstegen L. Effective prevention of stress-induced sweating and axillary malodour formation in teenagers. Int J Cosmet Sci 2011; 33:90-7. [PMID: 20646085 DOI: 10.1111/j.1468-2494.2010.00596.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emotional sweating and malodour production represent a relevant challenge to today's antiperspirant (AP) and deodorant products as stress in everyday life increases continuously. The aim of this study was to investigate stress-induced sweating in teenagers who are known to experience various stressful situations, e.g. exams at school or job interviews. To induce emotional sweating in 20 female and 20 male adolescents (16-18 years of age), we applied the Trier Social Stress Test (TSST), considered today to be the most reliable and standardized stress protocol. In this study, we demonstrate that the TSST induces high amounts of sweat and strong axillary malodour in the tested age group. Notably, male teenagers showed significantly higher stress-induced odour scores than female subjects, although no gender differences were detected concerning other physiological stress markers. Testing of a novel deodorant/AP product developed to specifically address the needs of adolescent consumers revealed excellent deodorant and AP efficacy under the challenging conditions of the TSST.
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Affiliation(s)
- A Martin
- Research & Development, Beiersdorf AG, Unnastrasse 48, Hamburg, Germany.
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23
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Taylor J, Woodcock S, Kavanagh GM, Weller RB. Hyperhidrotic and control subjects have similar sweating responses to pilocarpine administration. J Am Acad Dermatol 2011; 64:603-4. [PMID: 21315961 DOI: 10.1016/j.jaad.2010.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 02/28/2010] [Accepted: 03/03/2010] [Indexed: 11/16/2022]
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Abstract
The axilla, especially its microflora and axillary sweat glands as well as their secretions, is the main target of cosmetic compositions such as deodorants or antiperspirants. There are three types of sweat glands present in the axillary skin, namely apocrine, eccrine and apoeccrine sweat glands. Here, we provide an overview of the morphological, structural and functional characteristics of the different gland types and present techniques that allow their clear distinction. Moreover, we describe different forms of perspiration as physical reactions to external and internal stimuli.
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Bellet JS. Diagnosis and Treatment of Primary Focal Hyperhidrosis in Children and Adolescents. ACTA ACUST UNITED AC 2010; 29:121-6. [PMID: 20579601 DOI: 10.1016/j.sder.2010.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jane Sanders Bellet
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
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26
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Petschnik A, Klatte J, Evers L, Kruse C, Paus R, Danner S. Phenotypic indications that human sweat glands are a rich source of nestin-positive stem cell populations. Br J Dermatol 2009; 162:380-3. [DOI: 10.1111/j.1365-2133.2009.09512.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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[Novel adverse effects of laser-assisted axillary hair removal]. Ann Dermatol Venereol 2009; 136:495-500. [PMID: 19560609 DOI: 10.1016/j.annder.2009.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 04/01/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several adverse effects of depilatory laser may now be commonly expected in relation to skin type and anatomic location. We report and analyse unusual events in patients undergoing laser-assisted axillary hair removal, including hyperhidrosis, bromhidrosis and leukotrichia. OBJECTIVE The aim of this study was to examine a large patient population, assess the frequency of these adverse effects, and establish a correlation with different hair-removal laser protocols. PATIENTS AND METHODS A retrospective case-control study of patients undergoing laser-assisted axillary hair removal was conducted to determine the incidence of these adverse effects in relation to skin type and types of laser used. RESULTS Hyperhidrosis, bromhidrosis and leukotrichia were seen in 11, 4, and 2% of patients respectively. Hyperhidrosis was significantly less frequent in patients with skin types III and IV than in those with skin type II or V. Combined diode and alexandrite laser sessions were associated with a significantly higher incidence of hyperhidrosis compared to diode or alexandrite sessions alone. Regarding bromhidrosis and leukotrichia, no significant correlation with age, skin type or laser settings was revealed by the statistical analysis. CONCLUSION Hyperhidrosis, bromhidrosis and leukotrichia are likely new adverse effects of laser-assisted axillary hair removal.
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29
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Histological and Clinical Findings in Different Surgical Strategies for Focal Axillary Hyperhidrosis. Dermatol Surg 2008. [DOI: 10.1097/00042728-200808000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Bovell DL, Corbett AD, Holmes S, Macdonald A, Harker M. The absence of apoeccrine glands in the human axilla has disease pathogenetic implications, including axillary hyperhidrosis. Br J Dermatol 2007; 156:1278-86. [PMID: 17535227 DOI: 10.1111/j.1365-2133.2007.07917.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The existence of a third type of sweat gland in human axillary skin, the apoeccrine gland, with a capacity to produce much higher sweat output than the eccrine gland, was proposed from examination of microdissected glands. However, previous studies of axillary skin glands did not examine the entire individual glandular structure via serial sections and the markers used to identify the different glands gave conflicting results and, hence, the existence of the apoeccrine gland remains controversial. OBJECTIVES To investigate human axillary sweat glands by serial section histology and immunofluorescence. METHODS Human axillary sweat glands were investigated by serial sectioning of paraffin wax-embedded skin samples taken by biopsy from four male and six female volunteers (age range 20-35 years). Sections were examined by light microscopy and immunofluorescence, using antibodies to antigens reported to be markers for discriminating between eccrine and apocrine gland cells: CD15, CD44, S100 and human milk fat globulin. RESULTS Light microscopy demonstrated that there were hair follicles and a mean +/- SD of 76 +/- 14 sweat glands cm(-2). Eccrine and apocrine glands were found to be present; however, no glands resembling the apoeccrine glands were detected. Both types of sweat gland exhibited signs of being active, with segments of the secretory coils displaying flattened cells and dilated glandular lumina; however, this dilation did not extend to obvious changes in the width of the gland. None of the eccrine glands exhibited evidence of the presence of apocrine cells or vice versa. Immunofluorescence markers were found not to be specific and did not discriminate between the different types of glands or demonstrate the presence of apoeccrine glands. CONCLUSIONS This is the first time that serial sections of axillary skin have been examined by histology and immunofluorescence. The markers reported to discriminate between apocrine and eccrine glands were found to be nonspecific. No evidence of apoeccrine glands was found either by histology or by immunofluorescence.
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Affiliation(s)
- D L Bovell
- School of Life Sciences, Glasgow Caledonian University, Glasgow, UK.
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31
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Ottomann C, Blazek J, Hartmann B, Muehlberger T. Liposuktionskürettage versus Botox® bei axillärer Hyperhidrosis. Chirurg 2007; 78:356-61. [PMID: 17226006 DOI: 10.1007/s00104-006-1288-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Axillary hyperhidrosis is a dysfunction of the secretion of sweat glands. Conservative treatment modalities are mostly ineffective. Liposuction combined with subcutaneous curettage (TLC) destroys the sweat glands, while Botox injections inhibit the cholinergic transmission. MATERIAL AND METHOD Of a total of 88 patients, TLC was carried out in 47 and 41 patients received intradermal Botox injections. The effect of both forms of treatment on the quality of life was assessed using a specific hyperhidrosis questionnaire and was correlated with sweat volumes measured by gravimetry. RESULTS Follow-up after 6 months showed significantly changed sweat volumes of 52+/-41 mg/min of TLC patients versus 78+/-87 mg/min in the Botox group. In the TLC group 91% and in the Botox group 98% were satisfied with the result. CONCLUSION The stress of a single surgical intervention is to be weighed against the necessary repetitive application of multiple Botox injections. Both methods are superior to other, more radical surgical methods in terms of efficacy and complication rates. Botox and TLC lead to a significant improvement of the quality of life.
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Affiliation(s)
- C Ottomann
- Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie, Unfallkrankenhaus Berlin Marzahn, Berlin
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Hamm H, Naumann MK, Kowalski JW, Kütt S, Kozma C, Teale C. Primary Focal Hyperhidrosis: Disease Characteristics and Functional Impairment. Dermatology 2006; 212:343-53. [PMID: 16707884 DOI: 10.1159/000092285] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 10/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are few published data on the clinical characteristics of hyperhidrosis. OBJECTIVE To describe the functional impairment caused by primary focal hyperhidrosis. METHODS Patients with hyperhidrosis (n = 345) were enrolled at the Department of Dermatology, University of Würzburg. Controls (n = 154) were a convenience sample of subjects without hyperhidrosis. Hyperhidrosis characteristics, health-related quality of life and functional impairment were assessed. RESULTS Patients with axillary hyperhidrosis reported a later age at onset and a higher prevalence of a family history of hyperhidrosis than patients with palmar hyperhidrosis. Sixty-three percent of patients reported occupational impairment related to hyperhidrosis. Hyperhidrosis patients reported emotional and physical impairment, with a greater proportion of the axillary group reporting impairment. More than 50% of patients reported moderate to extreme impairment in personal relationships and in social situations. CONCLUSION Primary focal hyperhidrosis is a serious medical condition, affecting work productivity, daily activities, emotional well-being and personal relationships.
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Affiliation(s)
- Henning Hamm
- Department of Dermatology, University of Würzburg, Würzburg, Germany.
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Lawrence CM, Lonsdale Eccles AA. Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients. Br J Dermatol 2006; 155:115-8. [PMID: 16792762 DOI: 10.1111/j.1365-2133.2006.07320.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited axillary skin excision and selective sweat gland removal from adjacent skin (Shelley's procedure) is currently rarely used for hyperhidrosis. OBJECTIVES To determine whether this technique is a good way of permanently reducing axillary sweating. METHODS This was a prospective, open, nonrandomized trial of the therapy, conducted in a university dermatology department. A small skin ellipse, parallel to the skin crease lines, was excised from the centre of the area of maximal sweating. The wound edges were undermined to the extent of maximal sweating and the skin reflected. Large visible sweat glands attached to the undersurface of the adjacent skin could be readily identified and were snipped off using scissors. We treated 15 axillae in eight patients with axillary hyperhidrosis. Sweat reduction was assessed by the patients who estimated the percentage reduction in sweating postoperatively. The scar appearance was graded by the surgeon. Haematoxylin and eosin-stained transverse sections of eight axillary skin ellipses from five subjects were examined histologically to establish the size, position and depth of the sweat gland tissue. RESULTS All of the patients responded to treatment: mean sweat reduction was 65% (range 40-90%). Mean follow up was 1.3 years (range 0.1-6) and sweat reduction was maintained over this period. Histological material was available from five patients: sweat glands lay slightly deeper than hair follicles; glandular tissue occupied an average thickness of 3.5 mm in the 5-mm thick piece of skin. Apocrine gland lobules were more numerous and larger than eccrine gland lobules. Both gland types were in close apposition and did not occupy distinctly different depths within the skin. CONCLUSIONS Local surgery using limited axillary skin excision and selective sweat gland removal remains one of the safest ways of permanently reducing axillary sweating.
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Affiliation(s)
- C M Lawrence
- Department of Dermatology, Royal Victoria Infirmary, Medical School, University of Newcastle upon Tyne NE1 4LP, UK.
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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.
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Affiliation(s)
- Dóris Maria Hexsel
- Department of Cosmetic Dermatology, Brazilian Society of Dermatology, Porto Alegre, Brazil, Brazil.
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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]
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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.
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Affiliation(s)
- Jae-Bong Lee
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea.
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