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Eilertsen T, Kvammen BØ, Grimstad Ø. Botulinum Toxin A and B for Palmoplantar Hyperhidrosis. Dermatol Ther (Heidelb) 2024; 14:805-811. [PMID: 38424385 PMCID: PMC10965841 DOI: 10.1007/s13555-024-01113-3] [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: 12/08/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL. METHODS A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100-550) units BTX-A and a median dose (low to high) of 200 (200-500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475-1000) units BTX-B was injected. RESULTS At follow-up 2 weeks post-treatment, patients' Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001). CONCLUSION We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.
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Affiliation(s)
- Trond Eilertsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Bjørn Øivind Kvammen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Dermatology, University Hospital of North Norway, Tromsø, Norway
| | - Øystein Grimstad
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Dermatology, University Hospital of North Norway, Tromsø, Norway
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Oshima Y, Fujimoto T, Nomoto M, Fukui J, Ikoma A. Hyperhidrosis: A targeted literature review of the disease burden. J Dermatol 2023; 50:1227-1236. [PMID: 37519134 DOI: 10.1111/1346-8138.16908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
Hyperhidrosis is a chronic skin condition characterized by excessive sweating. It poses a burden on affected people, reducing their quality of life and productivity. We undertook a targeted literature review (TLR) to gather current evidence on the epidemiology as well as the human and economic burden posed on patients with hyperhidrosis. Searches were performed in Medline database (access via OVID interface) and ICHUSHI database. Articles published between January 2000 and September 2020 that analyzed at least 50 patients were included. Sixty-four publications were identified and 38 publications covering a unique domain were selected to inform this TLR. The incidence of hyperhidrosis ranged from 0.13% in the UK to 0.28% in the USA, with a higher rate in females. The prevalence of hyperhidrosis varied from 2.8%-4.8% in the US general population to 18.40% in Chinese inpatients, while the prevalence of axillary hyperhidrosis varied from 1.4% in the US general population to 5.75% in Japanese employees/students. Due to excessive sweating, hyperhidrosis was reported to be a moderate-to-extreme limitation at work for the US patients, with 33.5% feeling unhappy. Patients' satisfaction was high post-treatment. Considerable costs were related to the treatment with botulinum toxin and surgery. Hospital stays for surgery lasted from 10 h to 3 days. The percentage of patients who sought a medical consultation varied from 6.3% for Japanese patients with primary focal hyperhidrosis to 51% for the US general population with any type of hyperhidrosis. There is limited evidence of the hyperhidrosis burden, particularly among Japanese patients; however, the burden was high and limited patients' daily functioning. Future actions should include implementation of educational programs to raise awareness of the condition, conduct of larger studies, and generation of more evidence. Understanding the nature of hyperhidrosis and the burden it poses is of utmost importance.
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Affiliation(s)
- Yuichiro Oshima
- Department of Dermatology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Tomoko Fujimoto
- Ikebukuro Nishiguchi Fukurou Dermatology Clinic, Tokyo, Japan
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A Pilot Study of the Safety and Effectiveness of a Novel Device in Subjects With Axillary Hyperhidrosis. Dermatol Surg 2022; 48:1220-1225. [PMID: 36129240 DOI: 10.1097/dss.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND One-third of U.S. adults are bothered by excessive sweating and 5% suffer from hyperhidrosis, both of which negatively affect quality-of-life (QoL). A single-use disposable patch using the novel targeted alkali thermolysis (TAT) technology is being developed to address this condition. OBJECTIVE Assess the efficacy and safety of the TAT patch for the treatment of excessive sweating using a randomized, double-blind, sham-controlled study design. MATERIALS AND METHODS Adults with Hyperhidrosis Disease Severity Scale (HDSS) scores of 3 or 4 ( n = 16) were treated with an active or sham patch for up to 3 minutes (as established in a previous unpublished feasibility study) and evaluated weekly for 6 weeks post-treatment. The primary effectiveness measure was improved HDSS at Week-4. RESULTS The study met its objective. For the primary efficacy measure, 83% of TAT-treated subjects reported HDSS scores of 1 or 2 at Week-4 versus 0% of sham-treated subjects ( p = .0032). Furthermore, 67% of TAT-treated subjects had a 2-point improvement in HDSS scores versus 0% of sham-treated subjects ( p = .0123). Quality-of-life improvement correlated with HDSS. The TAT patch seemed to be well-tolerated; one transient moderate adverse event that resolved without sequelae was reported. CONCLUSION The TAT patch successfully demonstrated efficacy and was well-tolerated.
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Gupta AK, Venkataraman M, Joshi LT, Cooper EA. Potential use of microwave technology in dermatology. J DERMATOL TREAT 2022; 33:2899-2910. [PMID: 35699665 DOI: 10.1080/09546634.2022.2089333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Microwaves are used in medicine for diagnostics, and treatment of cancer. Recently, novel microwave devices (Swift®, Emblation Ltd, UK and miraDry®, Miramar Labs Inc., CA) have been cleared by the FDA and Health Canada for various dermatological conditions. OBJECTIVE AND METHODS To review the dermatological use of microwave-based treatments (plantar warts, corns, actinic keratosis, dermatophytosis, axillary hyperhidrosis, osmidrosis, and hidradenitis suppurativa). Clinical trials, case reports, or in vitro studies for each condition are summarized. RESULTS AND CONCLUSION Microwaves are a promising alternative therapy for cutaneous warts, actinic keratosis, axillary hyperhidrosis, and osmidrosis, with favorable safety profiles. However, patients with hidradenitis suppurativa have had negative clinical outcomes. Limited treatment of corns showed good pain reduction but did not resolve hyperkeratosis. A preliminary in vitro study indicated that microwave treatment inhibits the growth of T. rubrum. We present the first case of toenail onychomycosis successfully treated with microwaves. Despite the advancements in the use of microwaves, the mechanism of action in non-ablative treatment is not well understood; further research is needed. More high-quality randomized clinical trials with larger groups and long follow-up periods are also required to evaluate the clinical benefits and possible adverse effects of microwaves in treating dermatological conditions.
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Affiliation(s)
- A K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mediprobe Research Inc, London, Ontario, Canada
| | | | - L T Joshi
- School of Biomedical Science, University of Plymouth, Plymouth, UK
| | - E A Cooper
- Mediprobe Research Inc, London, Ontario, Canada
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Bloudek LM, Gillard KK, Nguyen VB, Klein SZ. Cost-effectiveness of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis. J Med Econ 2021; 24:29-37. [PMID: 33256494 DOI: 10.1080/13696998.2020.1855879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Primary axillary hyperhidrosis (PAHH) is a condition characterized by excessive sweating that negatively impacts health-related quality of life, with significant psychological and social impacts. Glycopyrronium tosylate (GT) is a topical anticholinergic approved in the United States for treatment of PAHH in patients 9 years of age and older. Our objective was to assess the cost-effectiveness of GT as first-line topical therapy compared to topical aluminum chloride from a United States commercial perspective. MATERIALS AND METHODS A Markov model was developed consisting of four health states based on the Hyperhidrosis Disease Severity Scale (HDSS) over a time horizon of 5 years with discount rates of 3% for both costs and outcomes. Transitions between health states were driven by HDSS response, defined as an improvement of ≥2 points. Non-responders and those who discontinue could switch to later line treatments or no treatment. Health utility scores were based on HDSS scores, supported by published literature. RESULTS Over 5 years, GT yielded 0.12 greater QALYs and 0.93 greater LYs with response compared to treatment with prescription aluminum chloride at an incremental cost of $10,584. Relative to prescription aluminum chloride, GT resulted in an incremental cost-effectiveness ratio (ICER) of $87,238 per QALY gained, $11,349 per LY with response. The ICER fell below $100,000 for 66% of probabilistic sensitivity analysis simulations and below $150,000 for 82% of simulations. LIMITATIONS This analysis represents a simplified scenario of a hypothetical PAHH patient. Due to sparse data, assumptions were required for treatment patterns, efficacy, and persistence. CONCLUSION Based on the analysis of incremental cost per QALY gained, GT may be cost-effective relative to prescription aluminum chloride at commonly accepted willingness to pay thresholds.
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Stuart ME, Strite SA, Gillard KK. A systematic evidence-based review of treatments for primary hyperhidrosis. J Drug Assess 2020; 10:35-50. [PMID: 33489435 PMCID: PMC7781989 DOI: 10.1080/21556660.2020.1857149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective Hyperhidrosis (excessive sweating) is associated with significant quality-of-life burden yet is often undertreated. With limited FDA-approved treatments, health care providers must determine optimal treatment among approved and off-label options. Key objectives of this review were to reassess, update, and expand a previous systematic review of commonly used treatment options for primary hyperhidrosis, including consideration of aluminum and zirconium compounds. Methods We performed a qualitative systematic review of efficacy, health-related quality of life, satisfaction, and safety of interventions, replicating and expanding the strategy outlined in a previous systematic review, with the addition of studies utilizing a within-patient design. We performed a critical appraisal of identified studies to determine risk of bias (RoB) and strength of evidence (SOE). Results A total of 32 studies were eligible for critical appraisal. Only three studies - two clinical trials of glycopyrronium cloth (2.4%) and one trial of botulinum toxin A injections in axillary hyperhidrosis were rated as "low" RoB; both had SOE ratings of "moderate" for use in axillary hyperhidrosis - the highest rating included in this review. Conclusions Optimal treatment choice depends on several factors, including understanding the quality of evidence regarding each treatment's efficacy and safety (considerations of convenience and cost are beyond the scope of this review). In hyperhidrosis, as in other clinical conditions, treatment decisions should be patient centered. At this time, because of the quality of evidence, only imprecise estimates of effect are possible for hyperhidrosis treatments included in this review, and statements about comparative effectiveness are not possible.
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Campanati A, Gregoriou S, Consales V, Rizzetto G, Bobyr I, Diotallevi F, Martina E, Kontochristopoulos G, Platsidaki E, Offidani A. Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: Results of a clinical, multicenter, prospective study. Dermatol Ther 2020; 33:e14039. [DOI: 10.1111/dth.14039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - Stamatios Gregoriou
- Faculty of Medicine, First Department of Dermatology Andreas Syggros Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Veronica Consales
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - Ivan Bobyr
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - Federico Diotallevi
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - Emanuela Martina
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
| | - George Kontochristopoulos
- Faculty of Medicine, First Department of Dermatology Andreas Syggros Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Eftychia Platsidaki
- Faculty of Medicine, First Department of Dermatology Andreas Syggros Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences Polytechnic University of the Marche Region Ancona Italy
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Li Y, Huang Z, Ran L, Wang W, Yu X, Wang R. A retrospective study on comparing the surgery and microneedles radiofrequency and microwaves treatment in axillary osmidrosis. J DERMATOL TREAT 2020; 33:420-426. [PMID: 32343164 DOI: 10.1080/09546634.2020.1762837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare the traditional treatment of minimally invasion surgery with the evolving treatments of microneedles radiofrequency and microwaves, this study mainly focused on the clinical efficacy and the incidence rate (IR) of complications among three treatments.Methods: From August 2017 to August 2018, a total of 76 patients with bilateral axillary osmidrosis were enrolled respectively underwent minimally invasion surgery, microneedles radiofrequency and microwaves treatment. All these subjects were evaluated the clinical outcomes and collected the complications by themselves or physicians. The difference of objective recovery or effective rate, subjective effective rate, the intense of sweat secretion or armpits hair, IR of complications among these three groups were studied.Results: The baseline characteristics of 33 patients in surgery group, 24 patients in microneedles group and 19 patients in microwaves group were similar. Firstly, the objective clinical efficacy was similar, but the subjective effective rate in surgery group was the soundest. In addition, the reduction of sweat secretion was homologous in three group, but the intense of armpits hair reduction in microneedles group was the minimum in three groups. Moreover, surgery treatment caused the highest IR of complications and the broadest types of complications, especially for the IR of 87.9% in postoperative scar formation. Meanwhile, the microwaves treatment had the best safety profile. At last, the recurrence rate on 6 months postoperatively was also identical with no significant difference.Conclusions: For the advantages and disadvantages of these three treatments, axillary osmidrosis patients should choose the proper therapy with comprehensive considerations.
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Affiliation(s)
- Yuanchao Li
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Zhenggen Huang
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Lei Ran
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wei Wang
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xiaoqin Yu
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Rupeng Wang
- Department of Dermatology and Rheumatology Immunology, Xinqiao Hospital of Army Medical University, Chongqing, China
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Wade R, Jones-Diette J, Wright K, Layton AM, Woolacott N. Hyperhidrosis quality of life measures: review and patient perspective. J DERMATOL TREAT 2018; 30:303-308. [PMID: 30051732 DOI: 10.1080/09546634.2018.1506080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To identify the tools that have been used to measure quality of life in hyperhidrosis research and obtain patient insight on commonly used tools. METHODS Twelve databases were searched to identify studies that reported measuring quality of life or described a quality of life tool in the context of hyperhidrosis. Data on the use of the tools were tabulated and hyperhidrosis-specific and dermatology-specific measures were summarized. A workshop was held to obtain the patients' perspective on the most commonly used tools and the newly developed HidroQoL tool. RESULTS One hundred and eighty-two studies were included in the review. Twenty-two quality of life tools were identified; two or more tools were often used in combination. The most commonly used tools were the Hyperhidrosis Disease Severity Scale, the Dermatology Quality of Life Index and the Hyperhidrosis Quality-of-Life Questionnaire. Patient advisors preferred the new HidroQoL tool, which was considered to be easy to complete and most relevant to hyperhidrosis patients. CONCLUSIONS There are several tools available for assessing quality of life in hyperhidrosis patients; disease specific measures are widely used and appear suitable. It is unclear which tool is the most reliable, although the HidroQoL tool was preferred by a small group of patient advisors.
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Affiliation(s)
- Ros Wade
- a Centre for Reviews and Dissemination , University of York , York , United Kingdom
| | - Julie Jones-Diette
- a Centre for Reviews and Dissemination , University of York , York , United Kingdom
| | - Kath Wright
- a Centre for Reviews and Dissemination , University of York , York , United Kingdom
| | - Alison M Layton
- b Harrogate and District NHS Foundation Trust , Harrogate , United Kingdom
| | - Nerys Woolacott
- a Centre for Reviews and Dissemination , University of York , York , United Kingdom
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Durack A. Interventional management of hyperhidrosis in secondary care: where do we go from here? Br J Dermatol 2018; 179:555-556. [DOI: 10.1111/bjd.16940] [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)
- A. Durack
- Department of Dermatology; Addenbrooke's Hospital; Hills Road Cambridge CB2 0QQ U.K
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