1
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Jubran RM, Sabiq S. Hyperhidrosis and Neurofibromatosis Type 1: A Case Report. Cureus 2024; 16:e63021. [PMID: 39050311 PMCID: PMC11267592 DOI: 10.7759/cureus.63021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
In this report, we present the case of a 20-year-old male with childhood-onset hyperhidrosis affecting his fingers and palm flexor surfaces. Dermatological examination revealed café-au-lait macules, palm and sole involvement, and axillary freckling. A starch-iodine test confirmed localized sweating. Neuroimaging identified neurofibromatosis type 1 (NF1) with subcutaneous nodules and dural ectasia in the thoracic spine. The patient was diagnosed with hyperhidrosis and NF1 based on diagnostic criteria, and he responded well to 20% aluminum chloride for treatment of hyperhidrosis. This case represents a unique occurrence of hyperhidrosis with NF1 in Saudi Arabia. Comprehensive evaluation, including systemic assessment, radiology, and starch-iodine testing, aids in diagnosis and understanding of the underlying mechanisms of this disorder, which remains unexplained.
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Affiliation(s)
- Rana M Jubran
- Family Medicine, Ministry of Health, Saudi Arabia, Jeddah, SAU
| | - Samar Sabiq
- Consultant Dermatology and Hair Disease, King Abdullah Medical Complex - Jeddah, Jeddah, SAU
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2
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Nastase F, Verenca MC, Niculet E, Radaschin DS, Busila C, Vasile CI, Tatu AL. Primary Hyperhidrosis in Children-A Retrospective Study and a Short Review. Life (Basel) 2024; 14:645. [PMID: 38792665 PMCID: PMC11122639 DOI: 10.3390/life14050645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/02/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Primary hyperhidrosis (PH) is a relatively common chronic disorder, characterized by significant and uncontrollable sweating. The predominant areas of occurrence are hands, feet, head and armpits, and it affects both men and women equally, with a false impression of increased prevalence in women. This study aims to determine the incidence of cases of hyperhidrosis, the gender of the patients and the environment of origin and to identify the most affected age groups and the distribution of hyperhidrosis, as well as creating a curve of cases within the time interval studied and their comparison with those in the specialized literature.
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Affiliation(s)
- Florentina Nastase
- Department of Neuropsychomotor Rehabilitation, Sf. Ioan Clinical Hospital for Children, 800487 Galati, Romania; (F.N.); (M.C.V.)
| | - Madalina Codruta Verenca
- Department of Neuropsychomotor Rehabilitation, Sf. Ioan Clinical Hospital for Children, 800487 Galati, Romania; (F.N.); (M.C.V.)
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania;
| | - Diana Sabina Radaschin
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica—CIM-CID), Dunărea de Jos University, 800201 Galati, Romania; (D.S.R.); (A.L.T.)
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, Sfanta Cuvioasa Parascheva Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Camelia Busila
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University of Medicine and Pharmacy, 800008 Galati, Romania
- “Sf. Ioan” Emergency Clinical Paediatric Hospital, Str Gheorghe Asachi nr 2, 800487 Galati, Romania
| | - Claudiu Ionut Vasile
- Department of Psychiatry, Elisabeta Doamna Psychiatric Hospital, 800179 Galati, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica—CIM-CID), Dunărea de Jos University, 800201 Galati, Romania; (D.S.R.); (A.L.T.)
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, Sfanta Cuvioasa Parascheva Hospital of Infectious Diseases, 800179 Galati, Romania
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3
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Lowe N, Naumann M, Eadie N. Treatment of hyperhidrosis with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32764. [PMID: 37499084 PMCID: PMC10374185 DOI: 10.1097/md.0000000000032764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Hyperhidrosis (chronic excessive sweating) may substantially affect an individual's emotional and social well-being. Therapies available before onabotulinumtoxinA were generally topical, with limited effectiveness, application-site skin reactions, and frequent, time-consuming treatments. Intradermal injection of onabotulinumtoxinA to treat sweat glands arose as a novel therapeutic approach. To develop this treatment, appropriate dosing needed to be established, and training on administration was required. Further, no previous scale existed to measure the effects of hyperhidrosis on patients' lives, leading Allergan to develop and validate the 4-point Hyperhidrosis Disease Severity Scale (HDSS), which measures the disease's impact on daily activities. The onabotulinumtoxinA clinical development program for hyperhidrosis included 2 double-blind, placebo-controlled pivotal trials, immunogenicity studies, long-term studies of safety and efficacy, and quality of life assessments. In Europe and North America, the primary efficacy measures were, respectively, axillary sweat production measured gravimetrically and HDSS improvement. Compared with placebo, onabotulinumtoxinA treatment significantly reduced axillary sweat production and axillary hyperhidrosis severity, as measured by a 2-point or greater reduction on the HDSS. The effects of onabotulinumtoxinA occurred rapidly, within 1 week after injection, and lasted ≥6 months. Treatment with onabotulinumtoxinA was associated with significant quality of life improvements based on Short Form-12 physical and mental component scores. The Hyperhidrosis Impact Questionnaire also indicated greater treatment satisfaction, reduced negative impact on aspects of daily life, and improved emotional well-being with onabotulinumtoxinA versus placebo. The clinical development program and subsequent clinical experience showed that onabotulinumtoxinA treatment for hyperhidrosis was well tolerated with no new safety signals, and led to greater disease awareness.
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Affiliation(s)
| | | | - Nina Eadie
- Former employee of Allergan plc, Irvine, CA, USA
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4
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Rocha Melo J, Rodrigues MA, Caetano M, Cantista P. Botulinum toxin in the treatment of residual limb hyperhidrosis: A systematic review. Rehabilitacion (Madr) 2023; 57:100754. [PMID: 36791670 DOI: 10.1016/j.rh.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/09/2022] [Indexed: 06/18/2023]
Abstract
The aim of the study was to analyze the current evidence regarding the effect of intradermal injections of botulinum toxin on residual limb hyperhidrosis. A comprehensive search of the MEDLINE and Scopus databases from inception until December 2021 was performed according to the PRISMA guidelines. The search terms used were "botulinum toxins", "botulinum toxins, Type A", "rimabotulinumtoxinB", "amputees", "amputation stumps", "amputation" and "residual limbs". The specific controlled vocabulary of each database was also used (e.g., MeSH). One hundred and thirty-one different studies met this search criteria and were reviewed. Two independent reviewers assessed the quality of the manuscripts. Eight studies met the inclusion criteria for this review. The results demonstrated an improvement in residual limb hyperhidrosis in all studies. Botulinum toxin A or B can be regarded as safe and effective for the treatment of residual limb hyperhidrosis, as well as improving prosthesis use and quality of life.
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Affiliation(s)
- J Rocha Melo
- Serviço de Medicina Física e de Reabilitação do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - M A Rodrigues
- Serviço de Dermatologia do Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - M Caetano
- Serviço de Dermatologia do Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - P Cantista
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal; Serviço de Medicina Física e de Reabilitação do Centro Hospitalar e Universitário do Porto, Porto, Portugal
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5
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Lütgerath C, Weiß C, Faulhaber J, Karsai S. Comparison of a novel aluminum lactate-based with an aluminum chloride-based antiperspirant in excessive axillary and inguinal perspiration: first randomized controlled trial. J Dtsch Dermatol Ges 2022; 20:1589-1601. [PMID: 36495093 DOI: 10.1111/ddg.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Topical aluminum salts are a commonly used remedy for excessive axillary perspiration. To the contrary, less is known about their anhidrotic potential in the groin. This study sought to compare the anhidrotic efficacy and tolerability of an aluminum chloride-based antiperspirant to an innovative aluminum lactate-based antiperspirant in healthy study participants presenting with excessive axillary and inguinal perspiration. PARTICIPANTS AND METHODS Fifty participants were enrolled in this open open-labeled, randomized, controlled trial. Following a baseline assessment, efficacy was analyzed at two time points throughout the study period by means of four physiological parameters (pH value, transepidermal water loss, gravimetric analysis, Minor test) and two questionnaires (Dermatology Life Quality Index, Hyperhidrosis Disease Severity Scale). Tolerability was evaluated via symptom diaries. RESULTS Both study preparations were comparably effective in reducing axillary and inguinal perspiration and exhibited increasing effectiveness over time. In both treatment regions, the aluminum lactate-based antiperspirant had a more favorable tolerability profile than the aluminum chloride-based antiperspirant. CONCLUSIONS Due to its comparable efficacy and - most noticeably in the groin - superior tolerability, this study supports the use of topical aluminum lactate as a first-line option to control excessive axillary and inguinal perspiration.
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Affiliation(s)
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, University Medical Centre, Mannheim, Germany
| | - Jörg Faulhaber
- MVZ Hautzentrum am Kalten Markt GmbH, Schwäbisch Gmünd, Germany
| | - Syrus Karsai
- Dermatologikum Hamburg GmbH, Hamburg, Germany.,Department of Dermatology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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6
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Lütgerath C, Weiß C, Faulhaber J, Karsai S. Vergleich eines neuen Aluminiumlactat-basierten mit einem Aluminiumchlorid-basierten Antitranspirant bei übermäßigem axillären und inguinalen Schwitzen: Erste randomisierte kontrollierte Studie. J Dtsch Dermatol Ges 2022; 20:1589-1602. [PMID: 36508376 DOI: 10.1111/ddg.14898_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
| | - Christel Weiß
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim
| | | | - Syrus Karsai
- Dermatologikum Hamburg GmbH, Hamburg.,Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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7
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Abdelshaheed M, Attallah H, El-Gilany AH, Bayoumy Youssef Y, Ahmed Sharaf E. Efficacy, safety and quality of life of oxybutynin versus aluminum chloride hexahydrate in treating primary palmar hyperhidrosis. Indian J Dermatol 2022; 67:222-227. [DOI: 10.4103/ijd.ijd_799_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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Arora G, Kassir M, Patil A, Sadeghi P, Gold MH, Adatto M, Grabbe S, Goldust M. Treatment of Axillary hyperhidrosis. J Cosmet Dermatol 2021; 21:62-70. [PMID: 34416078 DOI: 10.1111/jocd.14378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Axillary hyperhidrosis characterized by excessive sweating in the axillary regions is a frustrating chronic autonomic disorder leading to social embarrassment, impaired quality of life and usually associated with palmoplantar hyperhidrosis. Identifying the condition and its cause is central to the management. AIM The aim of this article is to discuss treatment options for axillary hyperhidrosis. METHODS Comprehensive literature search using PubMed and Google Scholar was performed to review relevant published articles related to diagnosis and treatment of axillary hyperhidrosis. RESULTS Treatment modalities for axillary hyperhydrosis vary from topical and systemic agents to injectables, newer devices and surgical measures. None except for physical measures using devices or surgery, which destroys the sweat glands to remove them, is possibly permanent and most are associated with attendant side effects. CONCLUSION Several treatments including medical and surgical option are available for the treatment of axillary hyperhydrosis. Patient education is important component of its management. Individualized approach of management is necessary for optimal outcome of treatment.
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Affiliation(s)
- Gulhima Arora
- Department of Dermatology, Mehektagul Dermaclinic, New Delhi, India
| | | | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Payam Sadeghi
- Department of Plastic Surgery, Cleveland Clinic, Cleveland Clinic Main Campus, Cleveland, Ohio, USA
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, Tennessee, USA
| | - Maurice Adatto
- Skinpulse Dermatology and Laser Centre, Geneva, Switzerland
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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9
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Karsai S, Weiß C, Lütgerath C, Ott I, Faulhaber J. Comparison of novel aluminium lactate versus aluminium chloride-based antiperspirant in excessive axillary perspiration: First prospective cohort study. Dermatol Ther 2021; 34:e15020. [PMID: 34085372 DOI: 10.1111/dth.15020] [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: 12/25/2020] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
Aluminium chloride-based antiperspirants are an effective topical therapeutic option for mild to moderate states of excessive perspiration. Its use is primarily limited by the occurrence of skin irritation, especially in sensitive skin types. The objective of this study was to compare the antiperspirant efficacy and tolerability of a novel antiperspirant with 12.5% aluminium lactate, and a 12.5% aluminium chloride-based antiperspirant. This cohort study was conducted as a two-sided self-assessment comparison between both preparations in healthy volunteers to generate selfcare-related data. Almost half of the participants stated that aluminium chloride was more efficacious than aluminium lactate; 22% stated aluminium lactate was more efficacious than aluminium chloride; 28% observed no difference in the efficacy of both preparations (p = 0.04). However, 88% described greater tolerability with aluminium lactate (p < 0.0001). In this study, aluminium lactate showed significantly greater tolerability than aluminium chloride, although the latter tended to show slightly greater efficacy.
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Affiliation(s)
- Syrus Karsai
- Dermatologikum Hamburg GmbH, Hamburg, Germany.,Department of Dermatology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, University Medical Centre, Mannheim, Germany
| | | | - Isabel Ott
- Department of Dermatology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jörg Faulhaber
- MVZ Hautzentrum am Kalten Markt GmbH, Schwäbisch Gmünd, Germany
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10
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Rohleder S, Münsterer O, Gödeke J. [Thoracoscopic Sympathectomy for Palmar and Axillary Hyperhidrosis]. Zentralbl Chir 2020; 145:421-424. [PMID: 32702765 DOI: 10.1055/a-1186-2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This video is a step-by-step description of thoracoscopic sympathectomy. INDICATION Sweating is essential for thermoregulation. Hyperhidrosis is a condition of excess sweating from the eccrine glands and is associated with severe suffering for patients of all ages. It often worsens during adolescence. A generalised and focal type of hyperhidrosis which affects mainly the face, armpits, hands and feet can be distinguished from the focal variant. Thoracic sympathectomy has become the standard treatment for palmar and axillary hyperhidrosis worldwide. METHODS The procedure is performed in the supine position with the upper body elevated about 30° in an adolescent patient. Both arms are abducted at 90° and single tube endotracheal ventilation is employed. A 3 mm trocar is placed in the anterior axillary line for a 3 mm 30° optic. A 5 mm trocar placed on the anterior axillary line (or breast fold in female patients) of the 4th or 5th intercostal space is used for the bipolar forceps. The sympathetic trunk and ganglia T 2 - 4 are identified and coagulated over the heads of ribs. CONCLUSION The thoracoscopic approach to focal palmar and axillary hyperhidrosis allows clear identification of the sympathetic structures on each side. Under direct vision, selective ablation of the ganglia and sympathetic trunk provides long-term benefit for patients.
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Affiliation(s)
- Stephan Rohleder
- Klinik für Kinderchirurgie, Universitätsklinikum Mainz, Deutschland
| | - Oliver Münsterer
- Klinik für Kinderchirurgie, Universitätsklinikum Mainz, Deutschland
| | - Jan Gödeke
- Klinik für Kinderchirurgie, Universitätsklinikum Mainz, Deutschland
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11
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Niwa ASM, Gregório ML, Leão LEV, de Godoy MF. Heart Rate Variability Assessment and Its Application for Autonomic Function Evaluation in Patients with Hyperhidrosis. Eur Neurol 2020; 83:293-300. [PMID: 32554973 DOI: 10.1159/000507810] [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: 02/10/2020] [Accepted: 03/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pathophysiology mechanism of primary focal hyperhidrosis (PFHH) is controversial. Heart rate variability (HRV) could explain if there is a systemic component present. We aimed to investigate the functions of the autonomic nervous system in patients diagnosed with PFHH compared to controls using the analysis of HRV in the domains of time, frequency, and nonlinearity, as well as analysis of the recurrence plots (RPs). METHODS We selected 34 patients with PFHH (29.4 ± 10.2 years) and 34 controls (29.2 ± 9.6 years) for HRV analysis. Heart beats were recorded with Polar RS800CX monitor (20 min, at rest, in supine position), and RR intervals were analyzed with Kubios Premium HRV software. RPs were constructed with Visual Recurrence Analysis software. Statistical analysis included unpaired t test (p < 0.05). RESULTS Our results showed that HRV parameters in the 3 domains evaluated did not show any differences between the groups. The same was observed with RPs. CONCLUSIONS The findings suggest that PFHH, from the pathophysiological point of view, may be caused by peripheral involvement of the sympathetic nervous system (glandular level or nerve terminals), as there was no difference between the groups studied. More specific studies should help elucidate this issue.
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Affiliation(s)
- Aracy Satoe Mautari Niwa
- São José do Rio Preto Medical School of - FAMERP, Avenida Brigadeiro Faria Lima, São José do Rio Preto, Brazil
| | - Michele Lima Gregório
- São José do Rio Preto - FAMERP Medical School, Transdisciplinary Nucleus for the Study of Chaos and Complexity - NUTECC, São José do Rio Preto, Brazil,
| | | | - Moacir Fernandes de Godoy
- São José do Rio Preto - FAMERP Medical School, Transdisciplinary Nucleus for the Study of Chaos and Complexity - NUTECC, São José do Rio Preto, Brazil.,Department of Cardiology and Cardiovascular Surgery - São José do Rio Preto Medical School - FAMERP, São José do Rio Preto, Brazil
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12
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Massrey C, Abdulkader MM, Hattab E, Iwanaga J, Loukas M, Tubbs RS. Ectopic sympathetic ganglia cells of the ventral root of the spinal cord: an anatomical study. Anat Cell Biol 2020; 53:15-20. [PMID: 32274244 PMCID: PMC7118253 DOI: 10.5115/acb.19.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 11/27/2022] Open
Abstract
The sympathetic trunk ganglia contain the cell bodies of neurons. However, some patients who undergo sympathectomy can develop compensatory hyperhidrosis. To evaluate for ectopic pathways, the present anatomical study was performed. Ten adult cadavers underwent dissection of the spinal canal and removal of randomly selected ventral roots, which were submitted for histological analysis. Random ventral root samples were taken from cervical, thoracic, and lumbosacral regions in each specimen. Each histological section was then analyzed and the presence or absence of sympathetic cells documented for level and position within the ventral root. Of all samples, a sympathetic nerve cell was found in 80% of ventral roots. At least one sympathetic cell was found in these 80%. Most sympathetic cells were found in the proximal one-third of the ventral root. Such cells were found at all spinal levels and no specific level within a vertebral region was found to house a greater concentration of these cells. No statistical significance was found when comparing sides or sex. Our study confirmed that sympathetic cells exist in the majority of human ventral roots. Such data might better explain various clinical presentations and postoperative complications/findings.
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Affiliation(s)
- Chrissie Massrey
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Marwah M Abdulkader
- Department of Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Eyas Hattab
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
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Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203925. [PMID: 31619017 PMCID: PMC6843684 DOI: 10.3390/ijerph16203925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 01/07/2023]
Abstract
Sympathetic overactivity is associated with hyperhidrosis and cardiovascular diseases. Endoscopic thoracic sympathectomy (ETS) is a treatment for hyperhidrosis. We aimed to compare the risk for cardiovascular events between individuals with and without hyperhidrosis and investigate the effects of ETS on cardiovascular outcomes. We conducted a nationwide population-based cohort study using data acquired from the Korean Health Insurance Review and Assessment Service. Subjects newly diagnosed with hyperhidrosis in 2010 were identified and divided into two groups according to whether or not they underwent ETS. Propensity scores were calculated using a logistic regression model to match hyperhidrosis patients with control subjects. Combined cardiovascular events were defined as stroke and ischemic heart diseases. Subjects were followed up until the first cardiovascular event or 31 December 2017. The risk for cardiovascular events with hyperhidrosis and ETS was analyzed using Cox proportional hazards regression analysis. The risk for stroke was significantly higher in the hyperhidrosis group than in the control group (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.08-1.51); nonetheless, no significant difference in the risk for ischemic heart diseases was observed between the hyperhidrosis group and the control group (HR, 1.17; 95% CI, 0.99-1.31). Hyperhidrosis patients who did not undergo ETS were at significantly higher risk for cardiovascular events than the control group (HR, 1.28; 95% CI, 1.13-1.45). However, no significant difference in the risk for cardiovascular events was observed between hyperhidrosis patients who underwent ETS and the control group. Hyperhidrosis increases the risk for cardiovascular events. ETS could reduce this risk and needs to be considered for high-risk patients with cardiovascular diseases.
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14
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Rzany B, Bechara FG, Feise K, Heckmann M, Rapprich S, Wörle B. Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis. J Dtsch Dermatol Ges 2019; 16:945-952. [PMID: 29989362 DOI: 10.1111/ddg.13579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Focal hyperhidrosis can have a considerable impact on social and occupational activities and be associated with significant impairment in quality of life. Primary (idiopathic) hyperhidrosis is neither caused by systemic disorders nor by external factors. It usually occurs in areas characterized by a high density of sweat glands such as the axillae and hands. The diagnosis of focal hyperhidrosis is based on history and clinical findings. Supplementary diagnostic tests include gravimetry (measurement of the amount of sweat) and the iodine starch test (which shows the area of sweating). Treatment options consist of topical agents, botulinum toxin A injections, iontophoresis, treatment with radiofrequency, microwaves, or ultrasound as well as surgical procedures (axillary suction curettage, sympathectomy). Systemic agents such as anticholinergics may also be used. Selection of the most appropriate therapeutic approach depends on the site affected, prior treatment as well as the patient's requests.
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Affiliation(s)
- Berthold Rzany
- RZANY & HUND, Kurfürstendamm 183, 10707 Berlin, Deutschland
| | - Falk G Bechara
- Abteilung für Dermatochirurgie, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Konstantin Feise
- Praxis Dr. Feise, Belegarzt Sophienklinik, Sophienstraße 41, 70178 Stuttgart, Deutschland
| | - Marc Heckmann
- Praxisklinik für Dermatologie, Kreuzstraße 26, 82319 Starnberg, Deutschland
| | - Stefan Rapprich
- Hautmedizin Bad Soden, Kronberger Straße 2, 65812 Bad Soden, Deutschland
| | - Birgit Wörle
- Dermatologie und Laserzentrum, Hirslanden Klinik Meggen, Klinik St. Anna AG, Meggen, Schweiz
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15
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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: 79] [Impact Index Per Article: 15.8] [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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Madke B, Pradhan S, Sirka C. Review of oral anticholinergics in the treatment of palmoplantar hyperhidrosis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2019. [DOI: 10.4103/ijdd.ijdd_40_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Tsiogka A, Koller J. Langzeitergebnisse nach Schweißdrüsenresektion bei axillärer Hyperhidrose. J Dtsch Dermatol Ges 2018; 16:1286-1288. [DOI: 10.1111/ddg.13652_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aikaterini Tsiogka
- Universitätsklinik für Dermatologie; Landeskrankenhaus Salzburg; Universitätsklinikum der Paracelcus Medizinischen Privatuniversität; Salzburg
| | - Josef Koller
- Universitätsklinik für Dermatologie; Landeskrankenhaus Salzburg; Universitätsklinikum der Paracelcus Medizinischen Privatuniversität; Salzburg
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Hyperhidrose – Ätiopathogenese, Diagnostik, Klinik und Therapie. Hautarzt 2018; 69:857-869. [DOI: 10.1007/s00105-018-4265-8] [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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20
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Tsiogka A, Koller J. Long-term outcomes following sweat gland excision for axillary hyperhidrosis. J Dtsch Dermatol Ges 2018; 16:1286-1288. [PMID: 30184339 DOI: 10.1111/ddg.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Aikaterini Tsiogka
- Department of Dermatology, Salzburg State Hospital, University Medical Center of Paracelsus Medical University, Salzburg, Austria
| | - Josef Koller
- Department of Dermatology, Salzburg State Hospital, University Medical Center of Paracelsus Medical University, Salzburg, Austria
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Rzany B, Bechara FG, Feise K, Heckmann M, Rapprich S, Wörle B. Aktualisierung der S1-Leitlinie zur Definition und Therapie der primären Hyperhidrose. J Dtsch Dermatol Ges 2018; 16:945-953. [DOI: 10.1111/ddg.13579_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Berthold Rzany
- RZANY & HUND; Kurfürstendamm 183; 10707 Berlin; Deutschland
| | - Falk G. Bechara
- Abteilung für Dermatochirurgie; Klinik für Dermatologie; Venerologie und Allergologie; Ruhr-Universität Bochum; Bochum Deutschland
| | - Konstantin Feise
- Praxis Dr. Feise; Belegarzt Sophienklinik; Sophienstraße 41; 70178 Stuttgart; Deutschland
| | - Marc Heckmann
- Praxisklinik für Dermatologie; Kreuzstraße 26; 82319 Starnberg; Deutschland
| | - Stefan Rapprich
- Hautmedizin Bad Soden; Kronberger Straße 2; 65812 Bad Soden; Deutschland
| | - Birgit Wörle
- Dermatologie und Laserzentrum; Hirslanden Klinik Meggen; Klinik St. Anna AG; Meggen Schweiz
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Ibrahim IM, Abdel Kareem IM, Alghobashy MA. Evaluation of topical liposome incorporated clove oil in the treatment of idiopathic palmar hyperhidrosis: Single-blinded placebo-controlled study. J Cosmet Dermatol 2017; 17:1084-1089. [PMID: 29285889 DOI: 10.1111/jocd.12471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Palmar hyperhidrosis is of great concern to patients because of its physical, occupational, and psychological impact on quality of life. Topical clove oil has been used in many conditions due to its major component Eugenol that exerts blocking effect on nerve transmission. AIM OF THE WORK To assess the efficacy of topical liposome incorporated clove oil in decreasing the rate of sweating among patients with idiopathic palmar hyperhidrosis. PATIENTS AND METHOD Forty patients with palmar hyperhidrosis were treated with clove oil 45% in liposome and another twenty patients were treated as a control group with 0.9% saline solution and evaluation was carried out before and after treatment through gravimetry testing and hyperhidrosis disease severity scale (HDSS). RESULT The gravimetry testing among clove oil-treated group showed that the mean sweating rate before treatment was 80.5 ± 41.85 (SD) mg/min which decreased significantly after treatment to 52.98 ± 37.94(SD) mg/min (P value < .001). On the other hand, the placebo-treated group,(control) the mean sweating rate before treatment was 77.40 ± 29.29(SD) which did not show significant improvement after placebo application 77.35 ± 28.29(SD; P value = .957). CONCLUSION The topical application of 45% clove oil in liposome twice daily for 2 weeks showing promising result evidenced by declining in the rate of palmar sweating among patients with idiopathic palmar hyperhidrosis.
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Affiliation(s)
- Ibrahim M Ibrahim
- Department of Dermatology and Venerology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim M Abdel Kareem
- Department of Dermatology and Venerology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed A Alghobashy
- Department of Dermatology and Venerology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Albadrani A. Clonidine is effective for the treatment of primary idiopathic hyperhidrosis and hot flushes: a case report. J Med Case Rep 2017; 11:16. [PMID: 28093070 PMCID: PMC5240237 DOI: 10.1186/s13256-016-1174-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While primary hyperhidrosis can be seen in men, accompanying hot flushes is rarely seen in men. Primary hyperhidrosis is thought to be related to overactivity of the sympathetic nervous system while hot flushes are believed to be related to altered peripheral vascular reactivity and a narrowed thermoregulatory zone. CASE PRESENTATION I report the case of a 29-year-old man of Arab origin who presented to a dermatology clinic with a complaint of generalized sweating, with heavier involvement of his inguinal region, axilla, and lower back. His complaint was associated with a transient hot sensation and erythema over the affected areas. He did not respond to topical antiperspirants containing aluminum chloride, topical aluminum chloride, or to botulinum toxin A injected in both inguinal areas. He was then referred to an endocrinology clinic to rule out secondary causes of hyperhidrosis and hot flushes; a primary diagnosis was confirmed. He did not respond to oral glycopyrrolate and additionally was complaining of its anticholinergic side effects. The glycopyrrolate was then replaced with oral clonidine 0.15 mg twice a day. Clonidine was well tolerated without remarkable side effects and he quickly started to feel marked improvement which was maintained for 2 years. CONCLUSIONS I report an atypical presentation of primary hyperhidrosis and hot flushes that was effectively controlled by clonidine without remarkable side effects. Further research on a large number of patients may be required before recommending clonidine in similar conditions.
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Affiliation(s)
- Ahmed Albadrani
- Internal Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, P.O. Box 173, Al-Kharj, 11942, Saudi Arabia.
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25
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Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects. An Bras Dermatol 2016; 91:716-725. [PMID: 28099590 PMCID: PMC5193180 DOI: 10.1590/abd1806-4841.20165358] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/16/2015] [Indexed: 11/22/2022] Open
Abstract
Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.
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Affiliation(s)
- Flávio Ramalho Romero
- Universidade Estadual Paulista "Júlio de
Mesquita Filho"BotucatuSPBrazilUniversidade Estadual Paulista "Júlio de
Mesquita Filho" (Unesp) – Botucatu (SP), BrazilUniversidade Estadual
Paulista
| | - Gabriela Roncada Haddad
- Universidade Estadual Paulista "Júlio de
Mesquita Filho"BotucatuSPBrazilUniversidade Estadual Paulista "Júlio de
Mesquita Filho" (Unesp) – Botucatu (SP), BrazilUniversidade Estadual
Paulista
| | - Hélio Amante Miot
- Universidade Estadual Paulista "Júlio de
Mesquita Filho"BotucatuSPBrazilUniversidade Estadual Paulista "Júlio de
Mesquita Filho" (Unesp) – Botucatu (SP), BrazilUniversidade Estadual
Paulista
| | - Daniele Cristina Cataneo
- Universidade Estadual Paulista "Júlio de
Mesquita Filho"BotucatuSPBrazilUniversidade Estadual Paulista "Júlio de
Mesquita Filho" (Unesp) – Botucatu (SP), BrazilUniversidade Estadual
Paulista
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Residual Limb Hyperhidrosis and RimabotulinumtoxinB: A Randomized Placebo-Controlled Study. Arch Phys Med Rehabil 2016; 97:659-664.e2. [DOI: 10.1016/j.apmr.2015.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022]
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Koren K, Pišot R, Šimunič B. Active workstation allows office workers to work efficiently while sitting and exercising moderately. APPLIED ERGONOMICS 2016; 54:83-89. [PMID: 26851467 DOI: 10.1016/j.apergo.2015.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/27/2015] [Accepted: 11/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the effects of a moderate-intensity active workstation on time and error during simulated office work. METHODS The aim of the study was to analyse simultaneous work and exercise for non-sedentary office workers. We monitored oxygen uptake, heart rate, sweating stains area, self-perceived effort, typing test time with typing error count and cognitive performance during 30 min of exercise with no cycling or cycling at 40 and 80 W. RESULTS Compared baseline, we found increased physiological responses at 40 and 80 W, which corresponds to moderate physical activity (PA). Typing time significantly increased by 7.3% (p = 0.002) in C40W and also by 8.9% (p = 0.011) in C80W. Typing error count and cognitive performance were unchanged. CONCLUSIONS Although moderate intensity exercise performed on cycling workstation during simulated office tasks increases working task execution time with, it has moderate effect size; however, it does not increase the error rate. Participants confirmed that such a working design is suitable for achieving the minimum standards for daily PA during work hours.
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Affiliation(s)
- Katja Koren
- University of Primorska, Science and Research Centre of Koper, Institute for Kinesiology Research, Garibaldijeva 1, SI-6000, Koper, Slovenia.
| | - Rado Pišot
- University of Primorska, Science and Research Centre of Koper, Institute for Kinesiology Research, Garibaldijeva 1, SI-6000, Koper, Slovenia.
| | - Boštjan Šimunič
- University of Primorska, Science and Research Centre of Koper, Institute for Kinesiology Research, Garibaldijeva 1, SI-6000, Koper, Slovenia.
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Brehmer F, Lockmann A, Grönemeyer LL, Kretschmer L, Schön MP, Thoms KM. Wiederholte Injektionen von Botulinumtoxin Typ A steigern kontinuierlich die Wirkdauer bei primärer axillärer Hyperhidrose: Eine retrospektive Analyse von 101 Patienten. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.50_12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Franziska Brehmer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Anike Lockmann
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Lisa-Lena Grönemeyer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Lutz Kretschmer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Michael P. Schön
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
| | - Kai-Martin Thoms
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsmedizin Göttingen; Göttingen Deutschland
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Brehmer F, Lockmann A, Grönemeyer LL, Kretschmer L, Schön MP, Thoms KM. Repetitive injections of botulinum toxin A continuously increase the duration of efficacy in primary axillary hyperhidrosis: a retrospective analysis in 101 patients. J Dtsch Dermatol Ges 2015; 13:799-805. [PMID: 26176740 DOI: 10.1111/ddg.12623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Botulinum toxin type A is an effective, well-tolerated, albeit temporary treatment for primary axillary hyperhidrosis. However, little is known about the influence of repetitive injections on the duration of efficacy. PATIENTS AND METHODS 139 patients with primary axillary hyperhidrosis were injected with 50 units of botulinum toxin per axilla. In 101 patients, who received at least three treatments, the duration of efficacy after the first, second, and last treatment was evaluated. RESULTS The median duration of efficacy was 4.0 months, 4.5 months, and 5.0 months after the first, second, and last injection, respectively. Overall, the duration of efficacy was significantly longer after the last injection compared to the duration of efficacy after the first injection (p = 0.0055, Wilcoxon matched-pairs signed-rank test). Likewise, the difference between the first and second injection (p = 0.0302) as well as the difference between the second and the last injection (p = 0.0381) were significant. In 25.7 % of patients, the duration of efficacy remained unchanged over the entire treatment period. CONCLUSIONS Repetitive botulinum toxin treatments led to a significantly increased duration of efficacy in axillary hyperhidrosis. While the average duration of efficacy continued to increase with each treatment, there were considerable interindividual differences.
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Affiliation(s)
- Franziska Brehmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Anike Lockmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Lisa-Lena Grönemeyer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Lutz Kretschmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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Singh S, Davis H, Wilson P. Axillary hyperhidrosis: A review of the extent of the problem and treatment modalities. Surgeon 2015; 13:279-85. [PMID: 25921800 DOI: 10.1016/j.surge.2015.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 10/24/2014] [Accepted: 03/24/2015] [Indexed: 12/09/2022]
Abstract
BACKGROUND The purpose of this review is to summarize the extent of the problem of axillary hyperhidrosis and treatment modalities available. The benefits and disadvantages of various treatments are reflected on with the hope of providing a starting point to investigate new ways of treating hyperhidrosis. MATERIAL & METHODS A literature search was conducted using various databases and search criteria. RESULTS Current treatments include aluminium chloride antiperspirants, iontophoresis, botox injections and endoscopic thoracic sympathectomy. Botox therapy is usually the most effective treatment, without surgery or unpleasant side effects. However it has to be administered by a skilled clinician and involves around 20 injections to treat axillary hyperhidrosis. Other ways of giving Botox are being developed, the most promising one being the use of microneedles which are able to penetrate the skin and deliver drugs to the target area of the dermis without causing pain. In comparison to the temporary effects of microneedles, laser and microwave therapies are also assessed as they offer the hope of permanent relief from hyperhidrosis. CONCLUSION There is a considerable dearth in the literature on the management of axillary hyperhidrosis. Further study in larger populations with longer follow up times is critical to access the long term effects of treatment. Microneedles could be the future treatment of choice with the potential to deliver drugs in a safe and pain free way.
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Affiliation(s)
- Sanjay Singh
- Department of Vascular Surgery, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
| | - Harriet Davis
- Department of Vascular Surgery, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK
| | - Paul Wilson
- Department of Vascular Surgery, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK
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The development and validation of a disease-specific quality of life measure in hyperhidrosis: the Hyperhidrosis Quality of Life Index (HidroQOL©). Qual Life Res 2014; 24:1017-27. [PMID: 25367139 PMCID: PMC4366556 DOI: 10.1007/s11136-014-0825-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/03/2022]
Abstract
Purpose
To develop and validate a new disease-specific quality of life measure in hyperhidrosis for use in both routine clinical practice and clinical research. Methods
Interviews and focus group discussions with hyperhidrosis patients, reported elsewhere, provided the content for the measure validated in this study (n = 71). A panel of dermatologists (n = 5) and patients (n = 7) carried out content validation. Further, item reduction and the initial construct validation were carried out in a cross-sectional study (n = 595), using the unidimensional Rasch analysis and exploratory factor analysis. Subsequently, the construct validity, reliability and responsiveness of the revised measure were assessed in a longitudinal study (n = 260). Data collection for the item reduction and the final validation phases was entirely carried out online. Results The expert panels judged the HidroQoL as content valid. Rasch analysis supported the revision of response options from five to three. Following removal of misfitting items, a set of 15 items showed optimal fit to the model (chi-squared statistic = 159.64, p = 0.07). Three additional items were retained on consideration of their importance to patients, resulting in an 18-item instrument. The items were grouped into two subscales, daily life activities and psychosocial life domains, based on results of the factor analysis. In subsequent construct validation, the HidroQoL correlated with the DLQI (rs = 0.6, p < 0.01). Reliability was high (internal consistency, Cronbach’s alpha: overall scale = 0.9; test–retest reliability, Intra-class correlation = 0.9). The HidroQoL scores were sensitive to change in patients’ disease severity (score change from baseline to follow-up after 15–35 days, Cohen’s ES = 0.47). Conclusion This study has provided the initial evidence supporting measurement properties and the use of the HidroQoL instrument in both routine clinical practice and in research, for assessing quality of life impacts in hyperhidrosis. Electronic supplementary material The online version of this article (doi:10.1007/s11136-014-0825-2) contains supplementary material, which is available to authorized users.
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Ertongur-Fauth T, Hochheimer A, Buescher JM, Rapprich S, Krohn M. A novel TMEM16A splice variant lacking the dimerization domain contributes to calcium-activated chloride secretion in human sweat gland epithelial cells. Exp Dermatol 2014; 23:825-31. [PMID: 25220078 DOI: 10.1111/exd.12543] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 12/13/2022]
Abstract
Sweating is an important physiological process to regulate body temperature in humans, and various disorders are associated with dysregulated sweat formation. Primary sweat secretion in human eccrine sweat glands involves Ca(2+) -activated Cl(-) channels (CaCC). Recently, members of the TMEM16 family were identified as CaCCs in various secretory epithelia; however, their molecular identity in sweat glands remained elusive. Here, we investigated the function of TMEM16A in sweat glands. Gene expression analysis revealed that TMEM16A is expressed in human NCL-SG3 sweat gland cells as well as in isolated human eccrine sweat gland biopsy samples. Sweat gland cells express several previously described TMEM16A splice variants, as well as one novel splice variant, TMEM16A(acΔe3) lacking the TMEM16A-dimerization domain. Chloride flux assays using halide-sensitive YFP revealed that TMEM16A is functionally involved in Ca(2+) -dependent Cl(-) secretion in NCL-SG3 cells. Recombinant expression in NCL-SG3 cells showed that TMEM16A(acΔe3) is forming a functional CaCC, with basal and Ca(2+) -activated Cl(-) permeability distinct from canonical TMEM16A(ac). Our results suggest that various TMEM16A isoforms contribute to sweat gland-specific Cl(-) secretion providing opportunities to develop sweat gland-specific therapeutics for treatment of sweating disorders.
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Hessam S, Bechara FG. [Hyperhidrosis]. MMW Fortschr Med 2014; 156:46. [PMID: 24930231 DOI: 10.1007/s15006-014-3076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Morphometric analysis of thoracic ganglion neurons in subjects with and without primary palmar hyperhidrosis. Ann Vasc Surg 2013; 28:1023-9. [PMID: 24342829 DOI: 10.1016/j.avsg.2013.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hyperhidrosis (HH) is a disease whose physiopathology remains poorly understood and that adversely affects quality of life. There is no morphologic study that includes an adequate control group that allows for comparison of the ganglion of HH to those of normal individuals. The purpose of study was to analyze morphologic and morphometric characteristics of the ganglion from patients with HH and normal individuals (organ donators). METHODS This was a transversal study. The sympathetic thoracic ganglia were obtained from 2 groups of patients. Group PH (palmar hyperhidrosis), 40 patients with palmar HH submitted to surgery by video-assisted thoracoscopy, and group C (control group), 14 deceased individuals (control group of organ donators) without any history of HH. The third left sympathetic thoracic ganglion was resected in all patients. RESULTS We observed higher number of cells in the PH group than in the control group (14.25 + 3.81 vs. 10.65 + 4.93) with P = 0.007; the mean percentage of ganglion cells stained by caspases-3 in the PH group was significantly greater than that of the C group (2.37 + 0.79 vs. 0.77 + 0.28) with P < 0.001; the mean value of area of collagen in the PH group was 0.80 IQ (0.08-1.87), and in the control group it was 2.36 IQ (0.49-5.98) with P = 0.061. CONCLUSIONS Subjects with primary palmar HH have a higher number of ganglion cells within the ganglion and a higher number of cells in apoptosis. Also, the subjects of PH group have less collagen in the sympathetic ganglion when compared with the control group, but not statistically significant.
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Abstract
Among the various forms of focal hyperhidrosis, axillary hyperhidrosis is treatable by dermatologic surgery. The historical development of the methods is presented and reflects the desire to achieve maximum effect with minimum tissue defects. The current status and the indications of the individual methods are demonstrated in study data.
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Affiliation(s)
- S Rapprich
- Hautklinik, Klinikum Darmstadt GmbH, Heidelberger Landstr. 379, 64297 Darmstadt, Deutschland.
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Müller C, Augustin M. Willingness-to-pay and patient-defined benefits in the treatment of hyperhidrosis: results from the first German health services research study in hyperhidrosis. Br J Dermatol 2013; 168:448-50. [DOI: 10.1111/j.1365-2133.2012.11150.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Augustin M, Radtke M, Herberger K, Kornek T, Heigel H, Schaefer I. Prevalence and Disease Burden of Hyperhidrosis in the Adult Population. Dermatology 2013; 227:10-3. [DOI: 10.1159/000351292] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
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Abstract
In Europe often no clear distinction is made between deodorant and antiperspirant. Particularly in Germany, the labeling "deo" is used for both. Only antiperspirants are capable of influencing the activity of eccrine sweat glands. In the treatment of focal hyperhidrosis, the use of aluminum chloride solutions represents the first choice. The efficacy is well documented in a variety of studies. Subjective side effects include pruritus and - less often - irritant dermatitis, which can be treated symptomatically and usually does not require discontinuation of the treatment. Rare variants of focal hyperhidrosis like auriculotemporal syndrome, Ross syndrome and nevus sudoriferus also are suitable for treatment with topical aluminum chloride hexahydrate solutions.
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Müller C, Berensmeier A, Hamm H, Dirschka T, Reich K, Fischer T, Rzany B. Efficacy and safety of methantheline bromide (Vagantin(®) ) in axillary and palmar hyperhidrosis: results from a multicenter, randomized, placebo-controlled trial. J Eur Acad Dermatol Venereol 2012; 27:1278-84. [PMID: 23004926 DOI: 10.1111/j.1468-3083.2012.04708.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Focal hyperhidrosis can severely affect quality of life. So far, knowledge on the effect of systemic therapy of focal hyperhidrosis is limited. OBJECTIVE To assess the efficacy and safety of methantheline bromide (MB) in the treatment of axillary and palmar-axillary hyperhidrosis. METHODS A multicenter controlled randomized double-blind clinical trial was conducted in patients with axillary or palmar-axillary hyperhidrosis defined by a sweat production >50 mg/5 min. Patients received 3 × 50 mg MB daily or placebo over a period of 28 ± 1 days. Main outcome criterion was the reduction of sweat as measured by gravimetry on day 28 ± 1. Quality of life was assessed by Dermatology Life Quality Index (DLQI) and Hyperhidrosis Disease Severity Score (HDSS). RESULTS A total of 339 patients were randomly assigned to receive MB or placebo. On day 28 ± 1, the mean axillary sweat production was 99 mg for MB and 130 mg for placebo compared with 168 mg and 161 mg respectively at baseline (P = 0.004). Patient's HDSS score decreased in the MB group from 3.2 to 2.4 compared with 3.2 to 2.7 for placebo (P = 0.002). Similar results could be obtained for the DLQI with 9.7 for MB and 12.2 for placebo, which decreased from 16.4 or 17 respectively (P = 0.003). Tolerability was good for both groups. The most frequent adverse event was dry mouth. CONCLUSION Fifty milligrams methantheline bromide three times a day is an effective and safe treatment of axillary hyperhidrosis.
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Affiliation(s)
- C Müller
- Department of Medical Science and Operations, RIEMSER Arzneimittel AG, Greifswald, Germany Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany Private Dermatological Practice Centre, Wuppertal, Germany SCIderm Research Institute and Dermatologikum Hamburg, Hamburg, Germany Skin and Laser Center Potsdam, Potsdam, Germany Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Abstract
Hyperhidrosis is characterized by localized or general excessive sweating which is severe enough to be perceived as pathological. Since excessive sweating often starts in childhood and adolescence, usually in children between 6 and 16 years of age, hyperhidrosis is an important disorder for children and juveniles. This condition causes considerable disruption of both social life and educational career, leading to severe deterioration in the patient's quality of life. In addition, therapy is often challenging since many treatment modalities are not approved for children. Nonetheless, there are still effective therapeutic options for children with hyperhidrosis.
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Streker M, Reuther T, Hagen L, Kerscher M. Hyperhidrosis plantaris - a randomized, half-side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride. J Dtsch Dermatol Ges 2011; 10:115-9. [PMID: 21848980 DOI: 10.1111/j.1610-0387.2011.07750.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary focal hyperhidrosis plantaris can cause impairment in social, physical, leisure and occupational activities. Topical treatment with aluminium chloride is the first-line treatment. The aim of this trial was to evaluate efficacy and safety of two different concentrations of aluminium chloride hexa-hydrate (12.5%, 30%) for 6 weeks. PATIENTS AND METHODS 20 volunteers with hyperhidrosis plantaris were included. Efficacy was evaluated using a clinical rating scale of the hyperhidrosis level and qualitative assessments including Minor's (iodine-starch) test and a standardized sniff test. Furthermore a patient questionnaire and measurements of skin surface pH were done to evaluate the subjective assessments and side effects. RESULTS The hyperhidrosis level significantly decreased in both concentrations. There were no differences in tolerability regarding the skin surface pH and the patient questionnaires. In addition the hidrotic areas decreased after application of both products and the sniff test improved. CONCLUSION Topical application of an antiperspirant containing aluminium chloride reduced sweat production in plantar hyperhidrosis significantly. As both 12.5% and 30% were efficacious and safe, we would recommend 12.5% for outpatient treatment.
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Affiliation(s)
- Meike Streker
- Cosmetic Science (FB 13), University of Hamburg, Germany
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Hyperhidrosis axillaris – Effektivität und Verträglichkeit eines aluminiumchloridhaltigen Antiperspirants. Hautarzt 2009; 61:139-44. [DOI: 10.1007/s00105-009-1841-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schlereth T. Hyperhidrosis—Causes and Treatment of Enhanced Sweating: In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009. [DOI: 10.3238/arztebl.2009.0448b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schlereth T, Dieterich M, Birklein F. Hyperhidrosis--causes and treatment of enhanced sweating. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:32-7. [PMID: 19564960 DOI: 10.3238/arztebl.2009.0032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/03/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Basically two types of sweating exist: thermoregulatory and emotional sweating. They are controlled by different centers: thermo regulatory sweating is regulated predominantly by the hypothalamus, emotional sweating predominantly by the limbic system. Enhanced sweating, called hyperhidrosis, can be generalized or focal. Primary focal hyperhidrosis is the most common type and affects the axillae, hands, feet, and face--areas principally involved in emotional sweating. Secondary hyperhidrosis develops due to dysfunction of the central or peripheral nervous system. METHODS Review based on a selective search of the literature via Medline and on the guidelines of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften [AWMF]). RESULTS Various conservative and surgical treatments exist for hyperhidrosis. Conservative treatment options are the local application of aluminum chloride, tap water iontophoresis, and the intracutaneous injection of botulinum toxin. Surgical approaches include endoscopic sympathectomy and axillary tumescent curettage and liposuction, removing the sweat glands. Systemic drugs (e.g. anticholinergic substances) can be used in the treatment of generalized hyperhidrosis. CONCLUSION A step-by-step approach is recommended for the treatment of hyperhidrosis. Local treatment options with few and minor side effects should be tried first.
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Affiliation(s)
- Tanja Schlereth
- Klinik für Neurologie, Johannes Gutenberg-Universität Mainz, Germany.
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Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series. Arch Phys Med Rehabil 2008; 89:1407-9. [PMID: 18586144 DOI: 10.1016/j.apmr.2007.11.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/11/2007] [Accepted: 11/14/2007] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation. DESIGN Consecutive case series. SETTING Outpatient physical medicine and rehabilitation clinic. PARTICIPANTS Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation. INTERVENTION BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid. MAIN OUTCOME MEASURE A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections. RESULTS Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment. CONCLUSIONS BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.
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Affiliation(s)
- Alexandra Charrow
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Kim DW, Kim C, Han KR, Park JH, Cho SM. MMPI Analysis of Patients with Essential Hyperhisrosis. Korean J Pain 2008. [DOI: 10.3344/kjp.2008.21.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Do Wan Kim
- Department Anesthesiology and Pain Medicine, Neuropain Clinic, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Chan Kim
- Department Anesthesiology and Pain Medicine, Neuropain Clinic, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Kyung Ream Han
- Department Anesthesiology and Pain Medicine, Neuropain Clinic, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Jae Hong Park
- Department Anesthesiology and Pain Medicine, Neuropain Clinic, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Sun Mi Cho
- Department Psychiatry, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
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