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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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Marani A, Gioacchini H, Paolinelli M, Bobyr I, Martina E, Radi G, Diotalallevi F, Campanati A. Pain Control during the Treatment of Primary Palmar Hyperhidrosis with Botulinum Toxin A by a Topical Application of Liposomal Lidocaine: Clinical Effectiveness. Toxins (Basel) 2024; 16:28. [PMID: 38251244 PMCID: PMC10818596 DOI: 10.3390/toxins16010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Primary palmar hyperhidrosis (PPH) constitutes a debilitating condition that profoundly impacts the social, functional, and occupational aspects of individuals. The intradermal administration of botulinum toxin type A (BoNT-A) stands as an established therapeutic approach for PPH, albeit one frequently accompanied by considerable pain, posing challenges for patient tolerance. Our study aimed to assess the efficacy of combining cryoanalgesia spray (CA) with topical anesthesia utilizing a cream containing liposomal lidocaine at a concentration of 40 mg/g, with the objective of mitigating the pain associated with intradermal BoNT-A injection for PPH treatment. Nineteen participants, aged ≥18 years and afflicted with severe PPH, were enrolled in a double-blind randomized vehicle-controlled trial. Patient-perceived pain during the procedure was quantified using the Numeric Rating Scale (NRS). Statistical analysis was applied to the collected data. The combination of CA and the topical application of liposomal lidocaine during BoNT-A treatment for PPH resulted in diminished pain compared to CA alone and the combination of CA with the application of a basic cream. Topical anesthesia through the application of a liposomal lidocaine-containing cream emerged as a facile, secure, and efficacious approach for alleviating the pain associated with intradermal BoNT-A injection in PPH treatment. Furthermore, it demonstrated compatibility with CA, thereby offering a comprehensive strategy for pain management during BoNT-A administration.
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Affiliation(s)
- Andrea Marani
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Helena Gioacchini
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Matteo Paolinelli
- Dermatology Unit, “Infermi” Hospital of Rimini, 47900 Rimini, Italy;
| | - Ivan Bobyr
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Emanuela Martina
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Giulia Radi
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Federico Diotalallevi
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
| | - Anna Campanati
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (A.M.); (H.G.); (I.B.); (E.M.); (G.R.); (F.D.)
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Muhaidat J, Al-Qarqaz F, Haje EAA, Al-Majali GN, Ahmed YB, Al-Bzour AN, Rawabdeh H, Alshiyab D. Compensatory Hyperhidrosis After Non-Surgical Treatment of Primary Focal Hyperhidrosis: Two-Year Single-Centered Prospective Study From Jordan. J Cutan Med Surg 2023; 27:584-588. [PMID: 37522712 DOI: 10.1177/12034754231191488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Primary focal hyperhidrosis (PH) can be managed by a wide range of medical and surgical modalities. Compensatory hyperhidrosis (CH) is a well-documented complication of surgical treatment. We aimed to investigate the occurrence of compensatory hyperhidrosis (CH) in PH patients after nonsurgical treatment with botulinum toxin A (BTX- A) or iontophoresis. METHODOLOGY We carried out a unicentric prospective study on PH patients from King Abdullah University Hospital (KAUH) in Jordan. PH patients were evaluated after 1-month of nonsurgical treatment. Patients who developed CH were re-assessed after 3-6 months through a telephone-based interview. RESULTS A total of 86 patients with PH who underwent nonsurgical treatment with iontophoresis or botulinum toxin were recruited. Twenty-four (27.9%) patients developed subjective CH. It was mild in (75%), moderate in (21%), and severe in (4%) of patients affected, it was self-limiting within a few months in all patients. Patients with CH did not differ significantly in demographic or clinical variables from patients who did not develop CH except at the site of PH (p value = .05). CONCLUSION The findings of this study indicate that more than quarter (27.9%) of patients with PH may develop minor compensatory sweating, however this didn't affect satisfaction with treatment.
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Affiliation(s)
- Jihan Muhaidat
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Al-Qarqaz
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | - Enas Abdullah Al Haje
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Yaman B Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayah N Al-Bzour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Haya Rawabdeh
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | - Diala Alshiyab
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
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Boyuk G, Dolu N, Aksoy B. Effect of Boron on Sympathetic Skin Response in Rats. Indian J Dermatol 2023; 68:723. [PMID: 38371583 PMCID: PMC10868984 DOI: 10.4103/ijd.ijd_7_22] [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] [Indexed: 02/20/2024] Open
Abstract
Background Boron effects on reproduction and growth have been extensively studied in animals. Electrodermal activity (EDA) reflects the activity of eccrine sweat glands stimulated by the release of acetylcholine from sympathetic nerves. Aim In the presen study, it was aimed to examine the effect of boron, which was turned into cream, on sweat glands. Methods A cream form mixed with thyme oil was prepared for EDA recording. Our groups were formed as EDA recording gel (Group 1), cream with thyme oil (Group 2), cream containing 10% boron (Group 3) and cream containing 30% boron (Group 4). In each group, 3 months old, 10 male rats were used, and creams were applied to the soles of the hind extremities of the rats, EDA was recorded from this region after half an hour, and skin conductivity levels (SCL) were recorded as tonic (at rest) and phasic (with auditory sound stimulation). Results EDA results recorded in the morning were analysed with tonic and phasic recordings. In the morning SCL measurements, tonic SCL value of Group 4 was higher than the other groups (P < 0.001). Although the phasic SCL value was measured, it was significantly higher in Group 4 than in all groups (P < 0.0s). Conclusion EDA measurements showed that boron increased sweat gland activity by increasing sympathetic nerve activity.
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Affiliation(s)
- Gulbahar Boyuk
- From the Department of Physiology, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
| | - Nazan Dolu
- Department of Physiology, Faculty of Medicine, İstanbul Nisantasi University, İstanbul, Turkey
| | - Busra Aksoy
- Department of Physiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Lee ACH, Ferguson MK. Knowledge of surgical management of hyperhidrosis among primary care physicians and the general public. Interact Cardiovasc Thorac Surg 2022; 34:791-798. [PMID: 35015865 PMCID: PMC9070533 DOI: 10.1093/icvts/ivab371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public. METHODS An online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public's perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey. RESULTS The majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery. CONCLUSIONS Neither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.
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Affiliation(s)
- Andy Chao Hsuan Lee
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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Heiskanen SL, Niskala J, Jokelainen J, Tasanen K, Huilaja L, Sinikumpu SP. Hyperhidrosis Comorbidities and Treatments: A Register-based Study among 511 Subjects. Acta Derm Venereol 2022; 102:adv00656. [PMID: 35088873 PMCID: PMC9558338 DOI: 10.2340/actadv.v102.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperhidrosis is a dermatological condition that causes psychosocial impairment and has a negative impact on patients’ quality of life. The epidemiology of hyperhidrosis is currently poorly understood. The aim of this study was to analyse comorbidities and treatments in 511 subjects with hyperhidrosis selected from the patient records of Oulu University Hospital. The mean age of patients with local hyperhidrosis was 27.9 years and the majority were female (62.7%). The most common anatomical site of symptoms in the youngest age group was the palms, whereas the axillae were a more common site in advanced age. Depression was a common comorbidity in both local (11.6%) and generalized hyperhidrosis (28.6%). Anxiety affected 12.7% of patients with generalized hyperhidrosis. In 36.8% of the patients with local hyperhidrosis there was a delay in diagnosis of more than 10 years. The most commonly used treatments included topical antiperspirants, iontophoresis and botulin toxin injections.
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Affiliation(s)
| | | | | | - Kaisa Tasanen
- Department of Dermatology and Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu, Oulu University Hospital, Oulu, Finland.
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Kuijpers M, van Zanden JE, Harms PW, Mungroop HE, Mariani MA, Klinkenberg TJ, Bouma W. Minimally Invasive Sympathicotomy for Palmar Hyperhidrosis and Facial Blushing: Current Status and the Hyperhidrosis Expert Center Approach. J Clin Med 2022; 11:jcm11030786. [PMID: 35160238 PMCID: PMC8836383 DOI: 10.3390/jcm11030786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/18/2022] Open
Abstract
Hyperhidrosis, the medical term for excessive sweating beyond physiological need, is a condition with serious emotional and social consequences for affected patients. Symptoms usually appear in focal areas such as the feet, hands, axillae and face. Non-surgical treatment options such as topical antiperspirants or systemic medications are usually offered as a first step of treatment, although these therapies are often ineffective, especially in severe and intolerable cases of hyperhidrosis. In the treatment algorithm for patients suffering from hyperhidrosis, surgical thoracoscopic sympathicotomy offers a permanent solution, which is particularly effective in the treatment of palmar hyperhidrosis and facial blushing. In this review, we describe the current status of thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing. In addition, we share the specific treatment approach, technique and results of our Hyperhidrosis Expert Center. Last, we share recommendations to ensure an effective, reproducible and safe application of single-port thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing, based on our extensive experience.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
- Correspondence:
| | - Judith E. van Zanden
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
| | - Petra W. Harms
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Hubert E. Mungroop
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Massimo A. Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Theo J. Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
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Puri HV, Asaf BB, Bishnoi S, Pulle MV, Sharma S, Kumar A. Thoracoscopic bilateral dorsal sympathectomy for primary palmo-axillary hyperhidrosis short- and mid-term results. J Minim Access Surg 2021; 17:532-536. [PMID: 33885020 PMCID: PMC8486074 DOI: 10.4103/jmas.jmas_174_20] [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] [Received: 08/13/2020] [Revised: 10/21/2020] [Accepted: 01/03/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Thoracoscopic bilateral dorsal sympathectomy is the standard of care for primary palmo-axillary hyperhidrosis. This study aims at studying the surgical outcomes with special emphasis on the incidence of compensatory hyperhidrosis (CH) after thoracoscopic dorsal sympathectomy. Post-procedural patient satisfaction as well as quality of life was measured and analysed. MATERIALS AND METHODS This is a retrospective analysis of sixty thoracoscopic dorsal sympathectomy surgeries in thirty patients in a tertiary level thoracic surgery centre over 2 years. Various peri-operative variables were recorded and assessed. Incidence of CH was noted and analysed in relation to patient satisfaction and record was made of quality of life at the time of discharge, at 3 months and 1-year follow-up following surgery. RESULTS We performed sixty video-assisted thoracoscopic sympathectomies in 30 patients. The mean operative time was 44.93 ± 10 min. The mean hospital stay was 1 day. There were no immediate post-procedural complications. All the patients had complete resolution of palmar and axillary hyperhidrosis. Fifty per cent of our patients (15/30) had some degree of CH after surgery. Quality-of-life measurement showed very good satisfaction by 100% at discharge, by 93.3% at 3 months and at 1 year. Those 6.66% of patients were partially satisfied/not satisfied because of the presence of moderate-to-severe CH. CONCLUSION A significant percentage of the patients with primary palmo-axillary hyperhidrosis will be very satisfied with the procedure at 1 year after surgery despite 50% of them developing CH. Detailed counselling regarding CH in the pre-operative period would minimise the dissatisfaction rate after surgery.
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Affiliation(s)
| | - Belal Bin Asaf
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Shikha Sharma
- Department of Anesthesia, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Farrell J, Stewart T, Singh B, Singh G, Rosen R. Retrospective analysis of the efficacy and duration of botulinum toxin A injections in 30 patients with palmar hyperhidrosis. Intern Med J 2021; 51:1517-1521. [PMID: 34541778 DOI: 10.1111/imj.15489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
Palmar hyperhidrosis is a common disorder characterised by excessive sweating due to hyperfunction of the sweat glands. It can be classified as primary disease, or secondary to other causes. It has a high morbidity, and a range of treatment options. Botulinum toxin injections inhibit the release of acetylcholine from the presynaptic receptors. It is an effective treatment; however, it is infrequently selected as only axillary hyperhidrosis currently attracts a Medicare subsidy. We conducted a retrospective review of 30 patients at a Sydney dermatology clinic who received botulinum toxin injections for palmar hyperhidrosis within the past 5 years. This study has the largest patient cohort with this condition in Australia. There was evidence for a median reduction in the Hyperhidrosis Disease Severity Scale, a qualitative self-reported score, as well as an increasing duration of efficacy with repeated injections. There were minimal side-effects of weakness and numbness. There is also an association between treatment of palmar disease and improvement in plantar disease, which suggests that treatment of palmar hyperhidrosis should be considered earlier and more frequently.
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Affiliation(s)
- Joshua Farrell
- Department of Dermatology, Southern Suburbs, Sydney, New South Wales, Australia
| | - Thomas Stewart
- Department of Dermatology, Southern Suburbs, Sydney, New South Wales, Australia
| | - Bhavneet Singh
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gurkirat Singh
- Department of Vascular Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Robert Rosen
- Department of Dermatology, Southern Suburbs, Sydney, New South Wales, Australia
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Jung JM, Na HM, Kim JH, Yoon J, Yang HJ, Lee WJ, Chang SE, Lee MW, Won CH. The efficacy and safety of a fractional microneedle radiofrequency device for the treatment of axillary hyperhidrosis: clinical prospective pilot study. Lasers Med Sci 2021; 37:1559-1566. [PMID: 34453655 DOI: 10.1007/s10103-021-03404-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/18/2021] [Indexed: 12/14/2022]
Abstract
We aimed to evaluate the efficacy and safety of a fractional microneedle radiofrequency device (FMRD) for the treatment of primary axillary hyperhidrosis (PAH). The FMRD adopted insulated microneedles, which could be located at a depth of up to 4.5 mm and deliver a radiofrequency current in a fractional manner. Also, the device could automatically regulate the amount of the delivered energy. Sixteen Korean patients with PAH received two FMRD treatment sessions at a 3-week interval and were followed-up until week 15. The primary outcome was Patient Satisfaction Scale (PSS) score at each visit. Hyperhidrosis Disease Severity Scale (HDSS) and Global Aesthetic Improvement Scale (GAIS) were also assessed. The area and amount of sweat produced were evaluated by specific tests. Mean PSS score significantly improved from 1.6 at week 3 to 2.5 at week 15 by 56%. More than a 50% improvement in sweating assessed by the PSS score was seen in 63% and 50% of patients at weeks 11 and 15, respectively. Mean HDSS score significantly decreased by week 3 and further decreased by week 7. Mean GAIS scores improved from the first follow-up visit at week 3 and improved again at week 7. The mean hyperhidrosis area assessed by starch-iodine test significantly decreased by 36% at week 15 compared with baseline. Mean transepidermal water loss level significantly decreased by 42% at week 15 compared with baseline. No patients experienced any serious adverse events. FMRD can be an effective and safe treatment modality for PAH.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hyoung Min Na
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jung Ho Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jihae Yoon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Joo Yang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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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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Park JH, Kim R, Na SH, Kwon SY. Effect of botulinum toxin in stellate ganglion for craniofacial hyperhidrosis: a case report. J Int Med Res 2021; 49:3000605211004213. [PMID: 33788638 PMCID: PMC8020114 DOI: 10.1177/03000605211004213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Craniofacial hyperhidrosis causes sweating of the face and scalp due to excessive action of the sweat glands and manifests when patients become tense/nervous or develop an elevated body temperature. If noninvasive treatments are ineffective, invasive treatments such as a sympathetic block and resection are considered. A 32-year-old woman with no specific medical history was referred for uncontrolled craniofacial hyperhidrosis that included excessive sweating and hot flushing. Physical examination showed profuse sweating, and infrared thermography showed higher temperature in the neck and face than in the trunk. The patient underwent several stellate ganglion blocks, and her symptoms improved; however, the treatment effect was temporary. Botulinum toxin was then injected into the stellate ganglion. At the time of this writing, her sweating had been reduced for about 6 months and she was continuing to undergo follow-up. Craniofacial hyperhidrosis is a clinical condition in which patients experience excessive sweating of their faces and heads. It is less common than palmar and plantar hyperhidrosis. Botulinum toxin injection into the stellate ganglion is simple and safe and produces longer-lasting effects than other treatments, such as endoscopic sympathectomy and a single nerve block.
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Affiliation(s)
- Jung Hyun Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Rip Kim
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Sang Hoon Na
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - So Young Kwon
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Liu M, Ni H, Tao J, Xie K. Lumbar Sympathetic Nerve Modulation Using Absolute Ethanol for the Treatment of Primary Lower-Extremity Hyperhidrosis: A Dose-Effect Pilot Study. Med Sci Monit 2021; 27:e928209. [PMID: 33434188 PMCID: PMC7812694 DOI: 10.12659/msm.928209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Primary lower-extremity hyperhidrosis (PLEH) can be treated by CT-guided lumbar sympathetic nerve modulation using absolute ethanol. However, doses of ethanol that are too high can cause nerve injury, and doses that are too low have suboptimal results. The present study aimed to investigate the dose-effect relationship of CT-guided lumbar sympathetic nerve modulation with absolute ethanol for PLEH. MATERIAL AND METHODS The study was conducted at the First Affiliated Hospital of Jiaxing University between 07/2014 and 02/2017. Twenty participants were enrolled in each group. The doses of absolute ethanol were 2.0 ml in the R₁ group, 2.5 ml in the R₂ group, 3.0 ml in the R₃ group, 3.5 ml in the R₄ group, and 4.0 ml in the R₅ group. Treatment effectiveness was assessed according to the time to complete hyperhidrosis relief: <10 min, effective; ≥10 min, non-effective. RESULTS The patient characteristics among the 5 groups were not statistically different (P>0.05). The onset time and time to complete hyperhidrosis relief decreased significantly with increasing dose of absolute ethanol (P<0.05). The effective rates in the 5 groups were 15.0%, 35.0%, 60.0%, 90.0%, and 100.0%, respectively. The ED₅₀ and ED₉₅ were 2.306 ml (95% CI: 2.003-2.512 ml) and 3.343 ml (95% CI: 3.051-3.962 ml), respectively. CONCLUSIONS This was the first dose-effect pilot study of consecutive PLEH patients treated by CT-guided lumbar sympathetic nerve modulation. CT-guided lumbar sympathetic nerve modulation with 2.306 ml (ED₅₀) and 3.343 ml (ED₉₅) of absolute ethanol showed treatment efficacy for PLEH. No complications were seen.
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Affiliation(s)
- Mingjuan Liu
- Department of Anesthesiology and Pain Medicine, First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
| | - Huadong Ni
- Department of Anesthesiology and Pain Medicine, First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
| | - Jiachun Tao
- Department of Anesthesiology and Pain Medicine, First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
| | - Keyue Xie
- Department of Anesthesiology and Pain Medicine, First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
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Abstract
PURPOSE OF REVIEW This article reviews disorders of sweating, including hyperhidrosis and anhidrosis due to central or peripheral autonomic nervous system causes. RECENT FINDINGS Disorders of thermoregulation and sweating may manifest with hyperhidrosis or hypohidrosis/anhidrosis. Primary disorders of hyperhidrosis may significantly impact quality of life yet tend to be benign. Many sweating disorders present with compensatory hyperhidrosis due to areas of anhidrosis. Anhidrosis may occur due to either central or peripheral damage to the autonomic nervous system. The thermoregulatory control of sweating involves central pathways from the hypothalamus to the brainstem and then spinal cord as well as projections to peripheral structures, including the sympathetic chain ganglia, peripheral nerves, and eccrine sweat glands. Disruption at any point of this pathway may lead to impaired sweating. Characterization of sweating dysfunction helps localize different autonomic disorders to guide diagnosis and may allow for evaluation of treatment effect. SUMMARY Sweating dysfunction manifests in myriad ways, including essential hyperhidrosis, complete anhidrosis with heat intolerance, and compensatory hyperhidrosis due to anhidrosis, and often indicates involvement of underlying central or peripheral autonomic dysfunction.
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Abstract
Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.
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Mantelakis A, Spencer H, Duval JL, Joshi A. Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00304-8] [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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Reduction of focal sweating by lipid nanoparticle-delivered myricetin. Sci Rep 2020; 10:13132. [PMID: 32753614 PMCID: PMC7403431 DOI: 10.1038/s41598-020-69985-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
Myricetin—a flavonoid capable of inhibiting the SNARE complex formation in neurons—reduces focal sweating after skin-application when delivers as encapsulated in lipid nanoparticles (M-LNPs). The stability of M-LNP enables efficient delivery of myricetin to sudomotor nerves located underneath sweat glands through transappendageal pathways while free myricetin just remained on the skin. Furthermore, release of myricetin from M-LNP is accelerated through lipase-/esterase-induced lipolysis in the skin-appendages, enabling uptake of myricetin by the surrounding cells. The amount of sweat is reduced by 55% after application of M-LNP (0.8 mg kg−1) on the mouse footpad. This is comparable to that of subcutaneously injected anticholinergic agents [0.25 mg kg−1 glycopyrrolate; 0.8 U kg−1 botulinum neurotoxin-A-type (BoNT/A)]. M-LNP neither shows a distal effect after skin-application nor induced cellular/ocular toxicity. In conclusion, M-LNP is an efficient skin-applicable antiperspirant. SNARE-inhibitory small molecules with suitable delivery systems have the potential to replace many BoNT/A interventions for which self-applications are preferred.
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Divisi D, Zaccagna G, Imbriglio G, Di Francescantonio W, De Vico A, Barone M, Crisci R. Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis. J Cardiothorac Surg 2020; 15:133. [PMID: 32522214 PMCID: PMC7285583 DOI: 10.1186/s13019-020-01176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022] Open
Abstract
Purposes We compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients. Methods From January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor. Results We noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques. Conclusion Modified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy.
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Giovanna Imbriglio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - William Di Francescantonio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
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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: 1] [Impact Index Per Article: 0.3] [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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Kim HM, Lee MJ, Lee MH, Lee H. Pressure‐and dose‐controlled, needle‐free, transcutaneous pneumatic injection of botulinum neurotoxin‐A for the treatment of primary axillary and palmoplantar hyperhidrosis. Skin Res Technol 2020; 26:577-583. [DOI: 10.1111/srt.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Min Ji Lee
- Yonsei E1 Plastic Surgery Clinic Anyang Korea
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Wadhawa S, Agrawal S, Chaudhary M, Sharma S. Hyperhidrosis Prevalence: A Disease Underreported by Patients and Underdiagnosed by Physicians. Indian Dermatol Online J 2019; 10:676-681. [PMID: 31807447 PMCID: PMC6859754 DOI: 10.4103/idoj.idoj_55_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hyperhidrosis (HH) is a disorder characterized by excessive sweating beyond required for normal thermoregulation, as a result of the excessive functioning of the sudomotor sweat control system. HH is broadly classified into 2 categories: primary HH and secondary. Our aim was to study the prevalence of HH in patients attending dermatological outpatients. METHODS Randomly selected 832 attendees of dermatology outpatient department were requested to fill out a questionnaire for their presenting concerns to attend, the demography information (age, gender, and occupation), and presence of excessive visible sweating symptoms after the informed, written, and understood consent. This questionnaire was then evaluated by the researchers. And those who had a history of excessive sweating were evaluated in detail about HH by another questionnaire. RESULTS The overall prevalence of HH was 17.9% (149/832), whereas only self-reported prevalence was 10.2% (85/832) in the dermatology outpatients. Of 149 patients, 110 (73.8%) were of primary HH followed by 39 (26.2%) of secondary HH. CONCLUSION This study showed a higher prevalence of HH in the attendees of dermatology outpatients of a tertiary care center but estimates that this disease affects a much larger proportion of individuals in the Nepalese population.
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Affiliation(s)
- Surajsingh Wadhawa
- Department of Dermatology, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Sudha Agrawal
- Department of Dermatology, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Manoj Chaudhary
- Department of Dermatology, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Sanjib Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences Ghopa, Dharan, Nepal
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review. J Am Acad Dermatol 2019; 81:657-666. [DOI: 10.1016/j.jaad.2018.12.071] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
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Abstract
Autonomic complaints are frequently encountered in clinical practice. They can be due to primary autonomic disorders or secondary to other medical conditions. Primary autonomic disorders can be categorized as orthostatic intolerance syndromes and small fiber neuropathies; the latter are associated with autonomic failure, pain, or their combinations. The review outlines orthostatic intolerance syndromes (neurally mediated syncope, orthostatic hypotension, postural tachycardia syndrome, inappropriate sinus tachycardia, orthostatic cerebral hypoperfusion syndrome, and hypocapnic cerebral hypoperfusion) and small fiber neuropathies (sensory/autonomic/mixed, acute/subacute/chronic, idiopathic/secondary, inflammatory and noninflammatory). Several specific autonomic syndromes (diabetic neuropathy, primary hyperhidrosis, paroxysmal sympathetic hyperactivity, autonomic dysreflexia), neurogenic bladder, and gastrointestinal motility disorders are discussed as well.
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. J Am Acad Dermatol 2019; 81:669-680. [PMID: 30710603 DOI: 10.1016/j.jaad.2018.11.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
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Smets E, De Raedt W, Van Hoof C. Into the Wild: The Challenges of Physiological Stress Detection in Laboratory and Ambulatory Settings. IEEE J Biomed Health Inform 2018; 23:463-473. [PMID: 30507517 DOI: 10.1109/jbhi.2018.2883751] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stress and mental health have become major concerns worldwide. Research has already extensively investigated physiological signals as quantitative and continuous markers of stress. In recent years, the focus of the field has shifted from the laboratory to the ambulatory environment. We provide an overview of physiological stress detection in laboratory settings with a focus on identifying physiological sensing priorities, including electrocardiogram, skin conductance, and electromyogram, and the most suitable machine learning techniques, of which the choice depends on the context of the application. Additionally, an overview is given of new challenges ahead to move toward the ambulant environment, including the influence of physical activity, lower signal quality due to motion artifacts, the lack of a stress reference, and the subject-dependent nature of the physiological stress response. Finally, several recommendations for future research are listed, focusing on large-scale, longitudinal trials across different population groups and just-in-time interventions to move toward disease prevention and interception.
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Miotto A, Honda PAA, Bachichi TG, Holanda CS, Evangelista Neto E, Perfeito JAJ, Leão LEV, Costa ADS. Comparative study of transepidermal water loss in patients with and without hyperhidrosis by closed-chamber measurer in an air-conditioned environment. EINSTEIN-SAO PAULO 2018; 16:eAO4312. [PMID: 30427484 PMCID: PMC6223951 DOI: 10.31744/einstein_journal/2018ao4312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/30/2018] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the difference in transepidermal water loss in patients diagnosed with hyperhidrosis and healthy subjects, in an air-conditioned environment. Methods Twenty patients diagnosed with hyperhidrosis and 20 healthy subjects were subjected to quantitative assessment using a closed-chamber device, in six previously established sites. Results The measurements showed different transepidermal water loss values for healthy subjects and patients with hyperhidrosis, especially in the hands and feet. In the Control Group, the median for the hands was 46.4g/m2/hour (p25: 36.0; p75: 57.6), while in the Hyperhidrosis Group, the median was 123.5g/m2/hour (p25: 54.3; p75: 161.2) – p<0.001. For the feet, the Control Group had a median of 41.5g/m2/hour (p25: 31.3; p75: 63.5) and the Hyperhidrosis Group, 61.2g/m2/hour (p25: 32.3; p75: 117) – p<0.02. Measurements of the axillas also showed differences. In the Control Group, the median was 14.8g/m2/hour (p25: 11.8; p75: 19.0) and, in the Hyperhidrosis Group, 83.5g/m2/hour (p25: 29.5; p75: 161.7) – p<0.001. Conclusion Measuring transepidermal water loss is sufficient for diagnosis and follow-up of patients with hyperhidrosis.
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Affiliation(s)
- Andre Miotto
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Thiago Gangi Bachichi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Caio Santos Holanda
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Altair da Silva Costa
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Celleno L, Mastropietro F, Tolaini MV, Pigatto PD. Clinical evaluation of an antiperspirant for hyperhidrosis. GIORN ITAL DERMAT V 2018; 154:338-341. [PMID: 30249082 DOI: 10.23736/s0392-0488.18.05986-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperhidrosis is a fairly common condition characterized by excessive sweating, usually in axillary areas. Although not leading to major health problems, it causes significant psychological distress and bears a negative impact on sociality and quality of life in general. The first line of defense used to address this problem are antiperspirants, usually containing aluminum salts, capable of blocking the excessive sweating. METHODS We made a clinical trial to test the deodorant effectiveness and anti-bacterial activity of an antiperspirant product, based on agaricine, aluminum hydrochloride, and silver citrate, in a cohort of 20 subjects following a single laboratory application under controlled conditions. Later, the same product has been tested for skin compatibility, effectiveness and cosmetic quality after repeated home applications under normal conditions of use for 14 consecutive days. RESULTS After 6 and 24 hours from the application, the microbial load observed in treated axilla was inferior in a statistically significant way compared to the untreated axilla. Pathogenic bacteria have not been found on any of the two armpits. The tested product has shown an excellent anti-bacterial activity. CONCLUSIONS Overall, the product has been highly appreciated by the volunteers for its effectiveness and its cosmetic qualities, particularly because it has a good deodorant activity, which persist throughout the day, it does not stain clothes, and it has a practical package.
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Affiliation(s)
- Leonardo Celleno
- Biotechnology and Cosmetics Research Center, Sacred Heart Catholic University, Rome, Italy -
| | | | | | - Paolo D Pigatto
- Department of Medical Biosciences for Surgery and Orthopedics, Galeazzi Hospital and Scientific Institute for Research and Care, University of Milan, Milan, Italy
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Zaid IIA, Hussein MA, Mousa GS, Mohamed AR, Badr NM, Hamid AA. Acetylcholine iontophoresis in diabetic patients with and without peripheral neuropathy: a potential therapeutic tool. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_51_17] [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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Romero FR, Cataneo DC, Cataneo AJM. Outcome of Percutaneous Radiofrequency Thoracic Sympathectomy for Palmar Hyperhidrosis. Semin Thorac Cardiovasc Surg 2018; 30:362-366. [PMID: 30006204 DOI: 10.1053/j.semtcvs.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 11/11/2022]
Abstract
The impact of upper thoracic percutaneous sympathectomy with radiofrequency on the quality of life (QOL) of patients with palmar hyperhidrosis was evaluated. Thirty-six patients with palmar hyperhidrosis were selected for a prospective observational study. Treatment consisted of percutaneous radiofrequency thoracic sympathectomy of T3 and T4 ganglions in all cases. QOL questionnaires were applied preoperatively, on the 1st postoperative (PO) day, and on the 30th, 90th, 180th, and 360th PO days. Furthermore, compensatory hyperhidrosis (HDSSc) scale measures were used simultaneously, in order to evaluate the rate and frequency of this side effect. The QOL questionnaire evaluation showed preoperative values of 83.94 ± 4.74 (meaning poor quality of life), decreasing to 24.61 ± 2.86 on the 1st PO day, 25.14 ± 3.12 on the 30th PO day, 31.28 ± 4.42 on the 90th PO day, 32.97 ± 4.54 on the 180th PO day, and 33.94 ± 4.6 on the 360th PO day (all postoperative results with values below 35 were considered optimal). Compensatory hyperhidrosis (HDSSc) scale values were 1.14 ± 0.35 on the 1st PO day, 1.42 ± 0.55 on the 30th PO day, 1.83 ± 0.85 on the 90th PO day, 1.92 ± 0.91 on the 180th PO day, and 1.92 ± 0.91 on the 360th PO day (meaning that hyperhidrosis was mainly unnoticed). Patients' subjective satisfaction was considered very good and the majority of patients would recommend the treatment procedure. Percutaneous radiofrequency thoracic sympathectomy had a positive impact on the quality of life of patients with palmar hyperhidrosis, compared to the surgical treatment, with a low rate and intensity of HDSSc and without other complications.
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Affiliation(s)
| | - Daniele Cristina Cataneo
- Division of Thoracic Surgery. Botucatu School of Medicine, São Paulo State University - UNESP, Brazil..
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Endo C, Johnson TA, Morino R, Nakazono K, Kamitsuji S, Akita M, Kawajiri M, Yamasaki T, Kami A, Hoshi Y, Tada A, Ishikawa K, Hine M, Kobayashi M, Kurume N, Tsunemi Y, Kamatani N, Kawashima M. Genome-wide association study in Japanese females identifies fifteen novel skin-related trait associations. Sci Rep 2018; 8:8974. [PMID: 29895819 PMCID: PMC5997657 DOI: 10.1038/s41598-018-27145-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 05/25/2018] [Indexed: 12/27/2022] Open
Abstract
Skin trait variation impacts quality-of-life, especially for females from the viewpoint of beauty. To investigate genetic variation related to these traits, we conducted a GWAS of various skin phenotypes in 11,311 Japanese women and identified associations for age-spots, freckles, double eyelids, straight/curly hair, eyebrow thickness, hairiness, and sweating. In silico annotation with RoadMap Epigenomics epigenetic state maps and colocalization analysis of GWAS and GTEx Project eQTL signals provided information about tissue specificity, candidate causal variants, and functional target genes. Novel signals for skin-spot traits neighboured AKAP1/MSI2 (rs17833789; P = 2.2 × 10-9), BNC2 (rs10810635; P = 2.1 × 10-22), HSPA12A (rs12259842; P = 7.1 × 10-11), PPARGC1B (rs251468; P = 1.3 × 10-21), and RAB11FIP2 (rs10444039; P = 5.6 × 10-21). HSPA12A SNPs were the only protein-coding gene eQTLs identified across skin-spot loci. Double edged eyelid analysis identified that a signal around EMX2 (rs12570134; P = 8.2 × 10-15) was also associated with expression of EMX2 and the antisense-RNA gene EMX2OS in brain putamen basal ganglia tissue. A known hair morphology signal in EDAR was associated with both eyebrow thickness (rs3827760; P = 1.7 × 10-9) and straight/curly hair (rs260643; P = 1.6 × 10-103). Excessive hairiness signals' top SNPs were also eQTLs for TBX15 (rs984225; P = 1.6 × 10-8), BCL2 (rs7226979; P = 7.3 × 10-11), and GCC2 and LIMS1 (rs6542772; P = 2.2 × 10-9). For excessive sweating, top variants in two signals in chr2:28.82-29.05 Mb (rs56089836; P = 1.7 × 10-11) were eQTLs for either PPP1CB or PLB1, while a top chr16:48.26-48.45 Mb locus SNP was a known ABCC11 missense variant (rs6500380; P = 6.8 × 10-10). In total, we identified twelve loci containing sixteen association signals, of which fifteen were novel. These findings will help dermatologic researchers better understand the genetic underpinnings of skin-related phenotypic variation in human populations.
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Affiliation(s)
- Chihiro Endo
- Department of Dermatology, School of Medicine, Tokyo Women's Medical University, Shinjuku, Tokyo, 162-8666, Japan
| | | | - Ryoko Morino
- EverGene Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | | | | | | | | | - Tatsuya Yamasaki
- Life Science Group, Healthcare Division, Department of Healthcare Business, MTI Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Azusa Kami
- EverGene Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Yuria Hoshi
- Life Science Group, Healthcare Division, Department of Healthcare Business, MTI Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Asami Tada
- EverGene Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | | | - Maaya Hine
- LunaLuna Division, Department of Healthcare Business, MTI Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Miki Kobayashi
- LunaLuna Division, Department of Healthcare Business, MTI Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Nami Kurume
- LunaLuna Division, Department of Healthcare Business, MTI Ltd., Shinjuku-ku, Tokyo, 163-1435, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, School of Medicine, Tokyo Women's Medical University, Shinjuku, Tokyo, 162-8666, Japan
| | | | - Makoto Kawashima
- Department of Dermatology, School of Medicine, Tokyo Women's Medical University, Shinjuku, Tokyo, 162-8666, Japan
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Impact of Thoracoscopic T2 Sympathectomy on Patients With Primary Palmar and Axillary Hyperhidrosis. Ann Thorac Surg 2018; 106:1032-1037. [PMID: 29885980 DOI: 10.1016/j.athoracsur.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/30/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are different techniques for thoracoscopic sympathectomy for management of primary hyperhidrosis. Each technique has the advantage of giving good surgical results, but may cause complications, which depend on the level of sympathectomy used in each technique. METHODS From October 2012 to August 2016, a total number of 120 patients (of primary palmar and axillary hyperhidrosis) were enrolled in this prospective randomized study. Patients were randomized preoperatively and divided into 2 groups: group A (underwent T2, T3, and T4 sympathectomy) and group B (underwent T3 and T4 sympathectomy) with 1 year of follow-up. Improvement of palm sweating, development of complications, patient satisfaction, and quality of life were evaluated. RESULTS Family history was positive in 33 patients (55%) in group A and in 31 patients (52%) in group B. All patients had improvement of hand sweating. Overdry hands were significant in group A (p = 0.032). Compensatory sweating was significant in group A after the first month (p = 0.016), after 6 months (p = 0.022), and after 12 months (p = 0.025). In group B, very satisfied patients were significant after 6 and 12 months (p = 0.002 and 0.000, respectively). CONCLUSIONS Limited sympathectomy to the level of T3 and T4 has the same therapeutic effect obtained by T2, T3, and T4 sympathectomy with less complications, greater patient satisfaction, and better quality of life. It should be the technique of choice for treatment of primary palmar and axillary hyperhidrosis.
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Cho SB, Park J, Zheng Z, Yoo KH, Kim H. Split-axilla comparison study of 0.5-MHz, invasive, bipolar radiofrequency treatment using insulated microneedle electrodes for primary axillary hyperhidrosis. Skin Res Technol 2018; 25:30-39. [PMID: 29790612 DOI: 10.1111/srt.12591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Energy-delivering devices can be used to induce thermal coagulation of the eccrine sweat glands for treating primary axillary hyperhidrosis (PAH). OBJECTIVE The objective of this study was to compare the efficacy and safety of invasive, bipolar radiofrequency (RF) treatment for PAH. METHODS A split-axilla study was performed to compare the clinical outcomes of 0.5 MHz, invasive, bipolar RF treatment with treatment settings of a longer conduction time and lower power (LC/LP) vs a shorter conduction time and higher power (SC/HP) for treating PAH. RESULTS The in vivo study revealed median hyperhidrosis disease severity scale scores of 1.5 (interquartile range [IQR], 1-2) at 1 month and 1 (IQR, 1-2) at 3 months after treatment with the LC/LP setting, compared to baseline. Meanwhile, the other side of the axillae treated with the SC/HP setting showed scores of 2 (IQR, 2-2) at 1 month and 2 (IQR, 1.25-2) at 3 months. Analysis via a linear mixed model revealed a significant interaction (group, P = .011; time, P < .001; and group × time, P = .048) between treatment group and time. CONCLUSION PAH can be effectively and safely treated with invasive, multilayered, multiple-pass, 0.5-MHz, bipolar RF treatment, particularly with LC/LP.
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Affiliation(s)
- S B Cho
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.,Kangskin Dermatology Clinic, Seoul, Korea
| | - J Park
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Z Zheng
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.,Department of Dermatology, Yanbian University Hospital, Yanji, China
| | - K H Yoo
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - H Kim
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
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Wang HY, Zhu YJ, Liu J, Li LW, Liu YH. The relationship between preoperative psychological evaluation and compensatory sweating. J Cardiothorac Surg 2018; 13:42. [PMID: 29776420 PMCID: PMC5960156 DOI: 10.1186/s13019-018-0728-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study analyzes the relationship between preoperative psychological states of primary palmar hyperhidrosis patients and postoperative compensatory sweating. METHODS We evaluated the psychological states of patients with primary palmar hyperhidrosis who received sympathectomy in our hospital from 2016 to 2017. The relationship between preoperative psychological states and postoperative compensatory sweating were assessed using Spearman's rank-order correlation. RESULTS Fifty-five patients who received R4 + R3 bypass transection accepted the preoperative questionnaire survey; 35 were males and 20 were females. The average age was 24.0 ± 6.3 years (range, 14-44 years). Depression symptoms were present in 21.9% (12/55) of the patients; the incidence of anxiety was almost similar, at 23.7% (13/55). Compensatory sweating occurred in 67.3% (37/55) of the patients; of these, 56.4% (31/55) was mild and 10.9% (6/55) was moderate. None of the patients had severe compensatory sweating. There was no significant relationship between the scores of SDS, SAS, and the incidence of postoperative compensatory sweating (P>0.05). However, the psychoticism scale displayed a strong impact on the degree of compensatory sweating (P<0.05). The higher the degree of psychoticism scale, the more serious the degree of compensatory sweating. CONCLUSIONS The results of this study showed that patients with primary palmar hyperhidrosis are more likely to have mild or moderate mental disorders, and that postoperative compensatory sweating may impact the satisfaction of surgery. In addition, the personality characteristics of patients are related to compensatory sweating.
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Affiliation(s)
- Huai-Yu Wang
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China.
| | - Yan-Jun Zhu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
| | - Jie Liu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
| | - Li-Wei Li
- Nuclear Medicine Department of General Hospital of Air-Force PLA, No.30 Fucheng Road,Haidian District, Beijing, 100142, China
| | - Ying-Hui Liu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
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Betzalel N, Ben Ishai P, Feldman Y. The human skin as a sub-THz receiver - Does 5G pose a danger to it or not? ENVIRONMENTAL RESEARCH 2018; 163:208-216. [PMID: 29459303 DOI: 10.1016/j.envres.2018.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
In the interaction of microwave radiation and human beings, the skin is traditionally considered as just an absorbing sponge stratum filled with water. In previous works, we showed that this view is flawed when we demonstrated that the coiled portion of the sweat duct in upper skin layer is regarded as a helical antenna in the sub-THz band. Experimentally we showed that the reflectance of the human skin in the sub-THz region depends on the intensity of perspiration, i.e. sweat duct's conductivity, and correlates with levels of human stress (physical, mental and emotional). Later on, we detected circular dichroism in the reflectance from the skin, a signature of the axial mode of a helical antenna. The full ramifications of what these findings represent in the human condition are still unclear. We also revealed correlation of electrocardiography (ECG) parameters to the sub-THz reflection coefficient of human skin. In a recent work, we developed a unique simulation tool of human skin, taking into account the skin multi-layer structure together with the helical segment of the sweat duct embedded in it. The presence of the sweat duct led to a high specific absorption rate (SAR) of the skin in extremely high frequency band. In this paper, we summarize the physical evidence for this phenomenon and consider its implication for the future exploitation of the electromagnetic spectrum by wireless communication. Starting from July 2016 the US Federal Communications Commission (FCC) has adopted new rules for wireless broadband operations above 24 GHz (5 G). This trend of exploitation is predicted to expand to higher frequencies in the sub-THz region. One must consider the implications of human immersion in the electromagnetic noise, caused by devices working at the very same frequencies as those, to which the sweat duct (as a helical antenna) is most attuned. We are raising a warning flag against the unrestricted use of sub-THz technologies for communication, before the possible consequences for public health are explored.
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Affiliation(s)
- Noa Betzalel
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 91904, Israel
| | - Paul Ben Ishai
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 91904, Israel; Department of Physics, Ariel University, Ariel 40700, Israel
| | - Yuri Feldman
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 91904, Israel.
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Maguire SC, Fleming CA, O'Brien G, McGreal G. Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis affecting the lower extremities-a single-centre experience. Ir J Med Sci 2018. [PMID: 29516399 DOI: 10.1007/s11845-018-1775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted. METHODS A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive). Symptomatology, surgical indications and patient outcomes were reported. RESULTS Twenty-seven cases were performed in total (21 unilateral, 3 bilateral). Underlying diagnoses were as follows: PAD [59.3% (n = 16)], hyperhidrosis [18.5% (n = 5)] and equal numbers of complex regional pain syndrome, diabetic neuropathy and vasculitis [7.4% (n = 2) each]. Overall, 85.2% (n = 23) had improvement or resolution of symptoms at 1 month and 70.3% (n = 19) had persistent improvement of symptoms at 1 year. Non-PAD patients had superior outcomes with 90.9% (n = 10) reporting improved symptomatology at 1 month and nearly three quarters [72.8% (n = 8)] maintaining this improvement at 1 year. Only four patients required subsequent major amputation, all in the severe PAD group. CONCLUSION Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis. Non-PAD patients have the greatest benefit.
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Affiliation(s)
- Sean C Maguire
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland.
| | | | - Gavin O'Brien
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
| | - Gerald McGreal
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
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Ricchetti-Masterson K, Symons JM, Aldridge M, Patel A, Maskell J, Logie J, Yamaguchi Y, Cook SF. Epidemiology of hyperhidrosis in 2 population-based health care databases. J Am Acad Dermatol 2018; 78:358-362. [DOI: 10.1016/j.jaad.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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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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Nasir A, Bissonnette R, Maari C, DuBois J, Pene Dumitrescu T, Haddad J, Yamaguchi Y, Dalessandro M. A phase 2a randomized controlled study to evaluate the pharmacokinetic, safety, tolerability and clinical effect of topically applied Umeclidinium in subjects with primary axillary hyperhidrosis. J Eur Acad Dermatol Venereol 2017; 32:145-151. [DOI: 10.1111/jdv.14651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Nasir
- Wake Research Institute; Raleigh NC USA
| | | | - C. Maari
- Innovaderm Research Inc.; Montreal QC Canada
| | | | - T. Pene Dumitrescu
- Clinical Pharmacology Modeling and Simulation; GlaxoSmithKline Upper Merion PA USA
| | - J. Haddad
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
| | - Y. Yamaguchi
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
| | - M. Dalessandro
- Dermatology Therapeutic Area Unit; GlaxoSmithKline; Collegeville PA USA
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Hong B, Yao L, Ni L, Wang L, Hu X. Antinociceptive effect of botulinum toxin A involves alterations in AMPA receptor expression and glutamate release in spinal dorsal horn neurons. Neuroscience 2017; 357:197-207. [DOI: 10.1016/j.neuroscience.2017.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/29/2022]
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Tap water iontophoresis in the treatment of pediatric hyperhidrosis. J Pediatr Surg 2017; 52:309-312. [PMID: 27912978 DOI: 10.1016/j.jpedsurg.2016.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
Abstract
AIM OF THE STUDY The treatment options for localized hyperhidrosis include antiperspirants, anticholinergics, iontophoresis, botulinum toxin and surgery. Tap water iontophoresis (TWI) involves immersing the affected area in tap water and passing a small electrical current through the area. Our aim was to assess the success of this therapy in a pediatric cohort. METHODS Retrospective case note review of all patients younger than 18years who underwent TWI between 2002 and 2015. Demographic data, number of treatment sessions, side effects and overall success were analyzed. Individuals undergo 7 treatments over 4weeks. A positive outcome was determined as an improvement in symptoms. Pre- and posttreatment hyperhidrosis disease severity scale (HDSS) was measured. Data are presented as mean (range). Statistical analysis was by paired t-test. A P value of <0.05 was regarded as significant. RESULTS There were 43 patients (30 females) with a mean age of 15 (8-17) years. Palmar and/or plantar hyperhidrosis (PPH) was present in 39/43 (91%) patients. Axillary hyperhidrosis (AH) was present in 19/43 (44%) patients. All patients (with the exception of one) underwent 7 sessions (5-7). Side effects included paresthesia (88%), pruritus (26%), pain (26%), erythema (14%), dryness (12%) as well as vesicle formation and abrasions in one patient (2%). A positive outcome was found in 84% (36/43) of patients. There was a significant reduction in mean HDSS (pre 3.5 vs. post 2; P=0.0001). CONCLUSION TWI is a safe and effective modality of treatment for both PPH and AH in the pediatric population, with minimal side effects. Pediatric surgeons should offer this treatment option before considering more invasive surgical procedures. LEVEL OF EVIDENCE IV: Retrospective study.
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Bahar R, Zhou P, Liu Y, Huang Y, Phillips A, Lee TK, Su M, Yang S, Kalia S, Zhang X, Zhou Y. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH). J Am Acad Dermatol 2016; 75:1126-1133. [DOI: 10.1016/j.jaad.2016.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
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Abstract
Objective: To report a case of palmar–plantar hyperhidrosis (PPH) In which paroxetine was found to be helpful. Case Summary: A 32-year-old man with a history of excessive sweating of the palms and soles since childhood was diagnosed with PPH and was prescribed paroxetine 10 mg/day, which was increased to 20 mg/day. After one month, he experienced a marked reduction in sweating and improvement in socio-occupational functioning, which were sustained during follow-up at 6 months without any emergent adverse effects. Discussion: Paroxetine's anticholinergic action may be responsible for its beneficial effect in PPH, as it may override the adrenergic mechanism, which has a minor effect on sweating from eccrine glands. Alternatively, paroxetine's beneficial effect in PPH may be secondary to its antianxiety effect, through central mechanisms. Conclusions: Paroxetine may be a useful option in the treatment of PPH.
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Clinical outcomes of Botox injections for chronic temporomandibular disorders: do we understand how Botox works on muscle, pain, and the brain? Int J Oral Maxillofac Surg 2016; 46:322-327. [PMID: 27908491 DOI: 10.1016/j.ijom.2016.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 11/04/2016] [Indexed: 11/21/2022]
Abstract
The main objective of this retrospective review was to analyze the clinical outcomes following the use of botulinum toxin (onabotulinumtoxinA, Botox) injections to relieve the symptoms of chronic temporomandibular disorders (TMD). Seventy-one patients with a diagnosis of TMD (according to the RDC/TMD international consortium) associated with or without bruxism and refractory to conventional treatment (e.g. oral appliances, physiotherapy, etc.) received Botox injections into the temporalis and masseter muscles. Subjective responses to Botox were categorized as 'beneficial' or 'not beneficial', as patient-reported outcomes based on the subjective reduction in pain and/or improvement in function. Fifty-five of the 71 subjects (77%) reported beneficial effects with Botox. Subjects with a concomitant bruxism diagnosis reported significant improvement over subjects without bruxism (87% vs. 67%; P=0.042). Subjects with stress-related psychiatric comorbidities and bruxism had a significantly higher benefit than those with stress-related psychiatric comorbidities alone (P=0.027). Patients reported less improvement if the time between the initial Botox injection and follow-up was less than an average of 5 weeks, compared to an average follow-up of 5-10 weeks (P=0.009). The subgroup TMD diagnosis and time interval post-injection are important predictors of patient-reported beneficial outcomes.
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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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Abstract
Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis.
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Affiliation(s)
- Roman Rieger
- Department of Surgery, Salzkammergut-Klinikum Gmunden, Miller von Aichholzstrasse 49, Gmunden 4810, Austria.
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Muthusamy A, Gajendran R, Ponnan S, Thangavel D, Rangan V. A Study on the Impact of Hyperhidrosis on the Quality of Life among College Students. J Clin Diagn Res 2016; 10:CC08-10. [PMID: 27504282 DOI: 10.7860/jcdr/2016/19495.8061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/30/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hyperhidrosis (HH) is a condition characterized by excessive sweating or perspiration. General population, especially in developing countries like India are seldom aware of this condition and sparsely seek medical attention. The tropical climate and the environment also influence this condition to a greater extent. This can be a hindrance in their professional and social life. Though, it is a widely explored topic, studies on hyperhidrosis from India are rare. AIM The current study was aimed at estimating the prevalence of hyperhidrosis among college students subjectively and to assess the quality of life using Dermatology Life Quality Index (DLQI). MATERIALS AND METHODS Five hundred students with age ranging from 17 to 21 years of both genders were included in this study using convenient sampling method. After explaining the study and getting written consent, the students were requested to respond to two questionnaires, one for the subjective diagnosis of hyperhidrosis using a standardized questionnaire developed by North Jersey Thoracic Surgical Associates and the other to assess the quality of life using DLQI. Based on the subjective prevalence scores, the students were divided into 3 groups as "Not bothersome" group, "Somewhat bothersome group" and "Extremely bothersome" group. The DLQI scores of these three groups were compared by ANOVA using SPSS 21.0. RESULTS The study revealed that overall, 38% of the students were suffering from somewhat bothersome to extremely bothersome hyperhidrosis. Gender analysis showed that male students were affected more (58%), especially with palmar hyperhidrosis and were significantly requiring treatment when compared to female students. Analysis of DLQI scores using ANOVA revealed the fact that overall quality of life was significantly affected in almost 35% of students to the extent that they require appropriate treatment and care. CONCLUSION This study brings into light the higher prevalence of hyperhidrosis and also its impact on the quality of life among college students in this tropical region.
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Affiliation(s)
- Anbarasi Muthusamy
- Associate Professor, Department of Physiology, Dhanalakshmi Srinivasan Medical College and Hospital , Siruvachur, Perambalur, Tamil Nadu, India
| | - Rajkumar Gajendran
- Associate Professor, Department of Paediatrics, Dhanalakshmi Srinivasan Medical College and Hospital , Siruvachur, Perambalur, Tamil Nadu, India
| | - Sathasivam Ponnan
- Student, Chennai Medical College Hospital and Research Center , Trichy, India
| | - Dinesh Thangavel
- Assistant Professor, Department of Physiology, Dhanalakshmi Srinivasan Medical College and Hospital , Siruvachur, Perambalur, Tamil Nadu, India
| | - Venkatesan Rangan
- Assistant Professor, Department of Physiology, Dhanalakshmi Srinivasan Medical College and Hospital , Siruvachur, Perambalur, Tamil Nadu, India
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Kang N, Lin F, Zhao W, Lombardi JP, Almihdhar M, Liu K, Yan S, Kim J, Luo J, Hsiao BS, Poliks M, Zhong CJ. Nanoparticle–Nanofibrous Membranes as Scaffolds for Flexible Sweat Sensors. ACS Sens 2016. [DOI: 10.1021/acssensors.6b00414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | | | | | | | - Mihdhar Almihdhar
- Department
of Chemistry, Stony Brook University, Stony Brook, New York 11794, United States
| | - Kai Liu
- Department
of Chemistry, Stony Brook University, Stony Brook, New York 11794, United States
| | | | | | | | - Benjamin S. Hsiao
- Department
of Chemistry, Stony Brook University, Stony Brook, New York 11794, United States
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Baker D. Topical glycopyrrolate reduces axillary hyperhidrosis. J Eur Acad Dermatol Venereol 2016; 30:2131-2136. [DOI: 10.1111/jdv.13745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D.M. Baker
- Department of Surgery; Royal Free Hospital; London UK
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