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Castiglione L, Murariu M, Boeriu E, Enatescu I. Assessing Botulinum Toxin Effectiveness and Quality of Life in Axillary Hyperhidrosis: A One-Year Prospective Study. Diseases 2024; 12:15. [PMID: 38248366 PMCID: PMC10814778 DOI: 10.3390/diseases12010015] [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: 12/14/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
This study hypothesized that botulinum toxin (Botox) therapy would sustainably reduce sweat production in axillary hyperhidrosis patients over one year and significantly improve various quality-of-life aspects, including psychological well-being, social interactions, and daily functioning. The objectives were to quantitatively measure changes in sweat production and qualitatively assess the evolving impact on patients' quality of life over one year. Conducted prospectively at the Pius Brinzeu Clinical Emergency Hospital in Timisoara, Romania, this study complied with ethical standards and included adults with primary axillary hyperhidrosis unresponsive to conventional treatments. Participants underwent Botox injections and were evaluated at baseline, six months, and one year, using the Hyperhidrosis Disease Severity Scale (HDSS), WHOQOL-BREF, and the Dermatology Life Quality Index (DLQI), among other tools. Involving 81 patients, the study showed significant improvements in sweat production and quality-of-life metrics. Sweat production decreased from 0.81 g to 0.23 g per 15 min over one year (p < 0.001). HDSS scores reduced from 3.4 to 1.5, indicating a decrease in symptom severity (p < 0.001). The DLQI total score, assessing life quality impact, notably dropped from 19.9 to 6.9 (p < 0.001). Quality-of-life domains also showed significant improvements, especially in the social (from 65.3 to 73.4, p < 0.001) and environmental aspects (from 68.0 to 72.1, p < 0.001). Higher HDSS and sweat production were significantly associated with a lower quality of life on the DLQI (B coefficients of -4.1 and -2.5, respectively). Botulinum toxin therapy proved effective in reducing sweat production and improving the quality of life in axillary hyperhidrosis patients over a one-year period. These improvements were statistically significant in both physical and psychosocial domains. The study highlights the potential long-term benefits of Botox therapy for hyperhidrosis.
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Affiliation(s)
- Luca Castiglione
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Marius Murariu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Estera Boeriu
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ileana Enatescu
- Department of Obstetrics and Gynecology, Discipline of Childcare and Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Dunford L, Clifton AV, Stephenson J, Radley K, McDonald L, Fretwell L, Cheung ST, Hague L, Boyle RJ. Interventions for hyperhidrosis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Louise Dunford
- Institute of Allied Health Sciences; De Montfort University; Leicester UK
| | - Andrew V Clifton
- School of Health and Sports Science; University of Suffolk; Ipswich UK
| | - John Stephenson
- School of Human and Health Sciences; University of Huddersfield; Huddersfield UK
| | - Kathy Radley
- Postgraduate Medicine; University of Hertfordshire; Hatfield UK
| | | | | | | | - Lynne Hague
- c/o Cochrane Skin Group; University of Nottingham; Nottingham UK
| | - Robert J Boyle
- National Heart and Lung Institute; Imperial College London; London UK
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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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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Affiliation(s)
- Jason E. Sammons
- Department of Clinical Medicine, Avalon University School of Medicine, Willemstad, CW, USA
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Budamakuntla L, Loganathan E, George A, Revanth BN, Sankeerth V, Sarvjnamurthy SA. Comparative Study of Efficacy and Safety of Botulinum Toxin a Injections and Subcutaneous Curettage in the Treatment of Axillary Hyperhidrosis. J Cutan Aesthet Surg 2017; 10:33-39. [PMID: 28529419 PMCID: PMC5418980 DOI: 10.4103/jcas.jcas_104_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands. AIMS AND OBJECTIVES The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis. MATERIALS AND METHODS Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure. RESULTS At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method. CONCLUSION Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events.
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Affiliation(s)
- Leelavathy Budamakuntla
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Eswari Loganathan
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anju George
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - B N Revanth
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - V Sankeerth
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Rezende RMD, Luz FB. Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands. An Bras Dermatol 2015; 89:940-54. [PMID: 25387499 PMCID: PMC4230663 DOI: 10.1590/abd1806-4841.20142873] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/05/2013] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular. OBJECTIVE The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety. CONCLUSION Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities.
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Leclère FM, Moreno-Moraga J, Alcolea JM, Vogt PM, Royo J, Cornejo P, Casoli V, Mordon S, Trelles MA. Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow-up: A randomized blinded controlled trial. Lasers Surg Med 2015; 47:173-9. [DOI: 10.1002/lsm.22324] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Franck Marie Leclère
- Department Plastic-, Hand-, Burn-, and Transsexual Surgery; CHU University of Bordeaux; Bordeaux France
- INSERM U703; CHU Lille; Lille France
- Department of Plastic Surgery MHH; Hannover Medical School; Hannover Germany
| | | | - Justo M. Alcolea
- Instituto Médico Vilafortuny; FUNDACION ANTONI DE GIMBERNAT; Cambrils Tarragona
| | - Peter M. Vogt
- Department of Plastic Surgery MHH; Hannover Medical School; Hannover Germany
| | | | | | - Vincent Casoli
- Department Plastic-, Hand-, Burn-, and Transsexual Surgery; CHU University of Bordeaux; Bordeaux France
| | | | - Mario A. Trelles
- Instituto Médico Vilafortuny; FUNDACION ANTONI DE GIMBERNAT; Cambrils Tarragona
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Ibrahim O, Kakar R, Bolotin D, Nodzenski M, Disphanurat W, Pace N, Becker L, West DP, Poon E, Veledar E, Alam M. The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: A randomized control trial. J Am Acad Dermatol 2013; 69:88-95. [DOI: 10.1016/j.jaad.2013.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/21/2013] [Indexed: 11/16/2022]
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Hoorens I, Ongenae K. Primary focal hyperhidrosis: current treatment options and a step-by-step approach. J Eur Acad Dermatol Venereol 2011; 26:1-8. [PMID: 21749468 DOI: 10.1111/j.1468-3083.2011.04173.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).
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Affiliation(s)
- I Hoorens
- Department of Dermatology, University Hospital, Ghent, Belgium.
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Park EJ, Han KR, Choi H, Kim DW, Kim C. An epidemiological study of hyperhidrosis patients visiting the Ajou University Hospital hyperhidrosis center in Korea. J Korean Med Sci 2010; 25:772-5. [PMID: 20436716 PMCID: PMC2858839 DOI: 10.3346/jkms.2010.25.5.772] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 09/24/2009] [Indexed: 11/20/2022] Open
Abstract
Hyperhidrosis is a disorder of perspiration in excess of the body's physiologic need and significantly impacts one's occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21+/-5.80 yr vs. 16.04+/-9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history.
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Affiliation(s)
- Eun Jung Park
- Hyperhidrosis Center, Ajou University Hospital, Suwon, Korea
| | - Kyung Ream Han
- Hyperhidrosis Center, Ajou University Hospital, Suwon, Korea
| | - Ho Choi
- Hyperhidrosis Center, Ajou University Hospital, Suwon, Korea
| | - Do Wan Kim
- Hyperhidrosis Center, Ajou University Hospital, Suwon, Korea
| | - Chan Kim
- Hyperhidrosis Center, Ajou University Hospital, Suwon, Korea
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Commons GW, Lim AF. Treatment of axillary hyperhidrosis/bromidrosis using VASER ultrasound. Aesthetic Plast Surg 2009; 33:312-23. [PMID: 19123021 DOI: 10.1007/s00266-008-9283-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 11/11/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current methods of treatment for axillary hyperhidrosis and/or bromidrosis are palliative (use of topical aluminum chloride or injections of botulinum toxin type A) or surgically based for more permanence (excisional surgery, endoscopic transthoracic sympathectomy, liposuction/curettage). The surgical approaches have mixed effectiveness and incur the risk of significant side effects and complications. METHODS Thirteen patients (3 males, 10 females) with significant axillary hyperhidrosis and/or bromidrosis were recruited, treated with the VASER ultrasound, and followed for 6 months. Preoperative assessment of the impact of hyperhidrosis and/or bromidrosis on lifestyle and the degree of sweat/odor were completed. Postoperative assessment of changes relative to lifestyle and degree of sweat/odor reduction and patient and surgeon satisfaction were completed. RESULTS Eleven of 13 patients had significant reduction in sweat/odor and had no recurrence of significant symptoms at 6 months. Two patients had a reduction in sweat/odor but not to the degree desired by the patients. No significant complications were noted. A simple amplitude and time protocol was established that provides consistent and predictable therapy. The complete procedure takes less than 1 h to treat two axillae using local anesthetic. CONCLUSION The VASER is safe and effective for treatment of axillary hyperhidrosis/bromidrosis. The method is minimally invasive with immediate return to basic activities and only temporary minor restriction of arm movement. At 6 months the treatment appears to be long-lasting, but further follow-up is required for verification of permanence. This method has become the standard of care for the treatment of axillary hyperhidrosis/bromidrosis in the authors' practice.
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Affiliation(s)
- George W Commons
- Stanford University School of Medicine, 1515 El Camino Real, Suite C, Palo Alto, CA 94306, USA.
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Schweißdrüsensaugkürettage bei Hyperhidrosis axillaris. JOURNAL FUR ASTHETISCHE CHIRURGIE 2009. [DOI: 10.1007/s12631-008-0019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Long-Term Efficacy of Subcutaneous Sweat Gland Suction Curettage for Axillary Hyperhidrosis. Dermatol Surg 2008. [DOI: 10.1097/00042728-200809000-00002] [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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Tumescent Suction Curettage versus Minimal Skin Resection with Subcutaneous Curettage of Sweat Glands in Axillary Hyperhidrosis. Dermatol Surg 2008. [DOI: 10.1097/00042728-200805000-00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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WOLLINA UWE, KÖSTLER ERICH, SCHÖNLEBE JACQUELINE, HAROSKE GUNTER. Tumescent Suction Curettage versus Minimal Skin Resection with Subcutaneous Curettage of Sweat Glands in Axillary Hyperhidrosis. Dermatol Surg 2008; 34:709-16. [DOI: 10.1111/j.1524-4725.2008.34132.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Solish N, Bertucci V, Dansereau A, Hong HCH, Lynde C, Lupin M, Smith KC, Storwick G. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33:908-23. [PMID: 17661933 DOI: 10.1111/j.1524-4725.2007.33192.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.
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Affiliation(s)
- Nowell Solish
- Division of Dermatology, New Women's College Hospital, Toronto, Ontario, Canada.
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A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis. Dermatol Surg 2007. [DOI: 10.1097/00042728-200708000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Focal hyperhidrosis is not rare, affecting over 2.5% of the population. This condition is often socially and professionally debilitating, leading to significant quality of life impairment. It most commonly involves the axillae, palms, soles, and face. OBJECTIVE To review hyperhidrosis and discuss and compare the treatment options currently available. CONCLUSIONS Topical or systemic therapies may be helpful for patients with mild disease. Invasive surgical options, although often effective, are limited by complications. More recently, botulinum toxin injection has proven to be a safe and successful treatment for hyperhidrosis and results in high patient satisfaction. Botulinum toxin A (Botox, Allergan Inc., Irvine, CA) is currently approved in the United States, Canada, the United Kingdom, and many other countries for the treatment of axillary hyperhidrosis and is routinely used off-label for other anatomic sites.
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Affiliation(s)
- Christian A Murray
- Division of Dermatology, University of Toronto, Women's College Hospital, Toronto, ON, Canada.
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Brachial Plexopathy from Tumescent Anesthesia? Dermatol Surg 2007. [DOI: 10.1097/00042728-200703000-00026] [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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Field L, Al-Baqami R, Kadry R, Al Shehri F, Gwaish B, Delvi BM. Letter: Brachial Plexopathy from Tumescent Anesthesia? Dermatol Surg 2007; 33:390-1. [PMID: 17338706 DOI: 10.1111/j.1524-4725.2007.33082.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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