Hyperhidrosis Disease Severity Scale Research Articles

The comparative study of letibotulinum toxin A and onabotulinum toxin A in treatment of primary axillary hyperhidrosis.

Primary axillary hyperhidrosis (PAH) is a challenging condition characterized by excessive underarm sweating. The U.S. Food and Drug Administration has approved onabotulinum toxin A (OnaBTX-A, Botox®, Allergan Inc, USA) as the only botulinum toxin treatment for severe axillary hyperhidrosis, and it has demonstrated positive results. Recently, the off-label use of letibotulinum toxin A (LetiBTX-A, Hugel®, Hugel Inc, Korea) has risen significantly for cosmetic purposes due to its effectiveness. For the treatment of primary axillary hyperhidrosis, the authors proposed that LetiBTX-A is at least as effective as OnaBTX-A. To evaluate the efficacy and safety of letibotulinum toxin A (LetiBTX-A) in comparison to onabotulinum toxin A (OnaBTX-A) for treating primary axillary hyperhidrosis (PAH). All participants with a diagnosis of moderate to severe primary axillary hyperhidrosis (Hyperhidrosis Disease Severity Scale (HDSS) score ≥ 2) received random injections of 50 U of LetiBTX-A in one armpit and 50 U of OnaBTX-A in the other site. HDSS score and hyperhidrosis area were measured by using the Minor's iodine starch test. Participant satisfaction was evaluated at 1, 3, and 6 months following the injection. Onset of action and adverse events were also assessed. All 30 participants completed the study protocol, with the mean age was 34.44 ± 7.82 years and most of the participants were female. The mean age at onset was 20.47 ± 3.01 years and more than 50% of participants had a HDSS score of 3. There was no statistically significant difference observed in the reduction of HDSS scores, hyperhidrosis area, and participant satisfaction between the axillae treated with LetiBTX-A and those treated with OnaBTX-A at 1, 3 and 6 months after injections. The median onset of action of both LetiBTX-A and OnaBTX-A were 2 ± 1 day (p = 0.317). Procedure-related pain was comparable between 2 formulations (P = 0.876). No serious adverse event was observed. This study concluded that LetiBTX-A and OnaBTX-A demonstrate comparable efficacy and safety profiles in treating primary axillary hyperhidrosis (PAH).

A Comparison of 3 Minimally Invasive Surgeries for Treating Axillary Osmidrosis.

Axillary osmidrosis is a common cause of physical and social discomfort. Although many treatments are available, there is still room for improvement. For treatments of axillary osmidrosis 3 minimally invasive surgical methods of nasal endoscope-assisted suction cutting device, liposuction combined with subcutaneous curettage, and small incision trimming method are compared for the clinical efficacy, advantages and disadvantages. Two hundred fifty-one axillary osmidrosis patients treated respectively with nasal endoscope-assisted suction cutting device, Liposuction with curettage, or small incision trimming method are investigated and the surgical outcomes and complications are analyzed. The effective rate is higher in the endoscopic group compared to the trimming and liposuction with curettage group (P < 0.025). The postoperative Vancouver Scar Scale and total complication rate in the trimming group are significantly higher than those in the endoscopic and liposuction groups (P < 0.025). The Hyperhidrosis Disease Severity Scale and overall satisfaction rate was superior in the endoscopic group compared to both liposuction with curettage and trimming groups. Liposuction with curettage has fewer complications and is safer, but with a lower cure rate. The small incision trimming method provides a more thorough treatment but with a higher complication rate. Relatively, nasal endoscope-assisted suction cutting device ensures thorough removal with fewer complications, making it a more recommended method. Level III, Retrospective therapeutic study.

Long-term outcomes and predictors of compensatory sweating after bilateral endoscopic thoracic sympathectomy.

Bilateral endoscopic thoracic sympathectomy is an effective treatment for primary hyperhidrosis, yet the causes of its main side effect, compensatory sweating, remain unclear. This study aimed to identify risk factors for compensatory sweating in a long-term follow-up cohort. Patients who underwent bilateral endoscopic thoracic sympathectomy for primary hyperhidrosis between 2010 and 2023 (n = 98) were interviewed, and preoperative data were collected. Compensatory sweating was classified as mild, moderate, or severe according to the Society of Thoracic Surgeons guidelines. Quality of life (QOL) was assessed using the Hyperhidrosis Disease Severity Scale from the International Hyperhidrosis Society. Logistic and ordinal Bayesian regression models were applied to analyse associations between predictors, compensatory sweating outcomes, and QOL. The procedure achieved an overall effectiveness of 94.38%, with 34.69% of patients reporting compensatory sweating, predominantly mild (26.53%). Nearly all patients (97.95%) experienced a ≥ 50% reduction in sweating, and 94.89% achieved ≥80% reduction. Higher haemoglobin levels and marijuana protected against compensatory sweating incidence and severity. Conversely, smoking and hyperhidrosis involving both hands and axillae increased compensatory sweating risk. Better QOL outcomes were correlated with higher haemoglobin levels and female sex, while worse outcomes were associated with older age, higher body mass index, and axillary involvement. Long-term follow-up highlights key predictors for compensatory sweating, emphasizing the importance of tailored preoperative counseling. Identifying at-risk patients, such as smokers and those with low haemoglobin levels, is essential for improving outcomes and managing expectations in the treatment of primary hyperhidrosis.

Outcome of radiofrequency sympathectomy in palmar hyperhidrosis

BackgroundHyperhidrosis is a pathological condition characterized by excessive sweating, regardless of thermoregulatory needs, due to primary or secondary causes. Primary hyperhidrosis occurs in certain regions of the body, such as the palms, soles, face, and axillae, with a prevalence of up to 16.3% in Germany. The cause is still unknown but may be due to functional impairment in the sympathetic nervous system. Thoracic sympathectomy can be performed through surgical intervention, percutaneous sympathetic neurolysis, or radiofrequency ablation. Radiofrequency therapy is a minimally invasive modality that uses electromagnetic energy near the nerve tissue. In this experiment, we assessed the outcomes, complications, and recurrence of palmar hyperhidrosis in patients treated with radiofrequency sympathectomy.Methods All patients had their full medical histories evaluated, including family histories, and underwent general physical examinations. We operated on twenty-one cases of palmar hyperhidrosis. All patients received percutaneous thoracic sympathectomy of T3 as the treatment method. We used the Hyperhidrosis Disease Severity Scale (HDSS) to assess the severity of the condition before and after the treatment and to measure the occurrence of compensatory hyperhidrosis following the treatment.ResultsWe operated on twenty-one cases of palmar hyperhidrosis. The mean age was 17.3 years. Thirteen (62%) patients were treated in two sessions according to the patients’ demand to avoid the risk of bilateral pneumohemothorax. The other eight (38%) were treated in one session according to the patient’s consent. Nineteen (90%) patients were done under local anesthesia, and two (10%) were done under sedation together with local anesthesia. Only two (10%) patients had a complicated pneumothorax, which was treated conservatively. According to the Hyperhidrosis Disease Severity Scale (HDSS), pre- and post-operative improvement was observed in all patients. Compensatory hyperhidrosis was absent in eighteen (86%) patients, according to the HDSS. At the 6-month follow-up, there were no recurrences.Conclusion Thoracic percutaneous radiofrequency T3 can be used as a safe and effective option in the treatment of palmar hyperhidrosis. It is a minimally invasive procedure with acceptable results.

Clinical Efficacy of Sofpironium Bromide in Reducing Odor Intensity in Axillary Osmidrosis Complicated by Primary Axillary Hyperhidrosis: A Cohort Study

Objective: The efficacy of sofpironium bromide in managing axillary hyperhidrosis is well documented. However, limited information is available regarding its application in patients with axillary osmidrosis complicated by primary axillary hyperhidrosis. This study aimed to retrospectively examine the clinical efficacy of sofpironium bromide for odor reduction in patients with axillary osmidrosis complicated by primary axillary hyperhidrosis. Methods: We retrospectively reviewed the medical records of patients with axillary osmidrosis and primary axillary hyperhidrosis, from May 2022 to May 2023 in Nippon Medical School Musashi Kosugi Hospital, and data from those who had Hyperhidrosis Disease Severity Scale (HDSS) scores of 2 to 4 and were topiocally treated with sofpironium bromide once a day for 4 weeks were collected. Odor severity was assessed using both a 4-point physician scale and an 11-point patient subjective scale. Paired t-test was used to compare odor severity assessment and HDSS scores before and after applying sofpironium bromide. Linear multiple regression analysis was conducted to identify factors influencing odor reduction. Results: Data from a total of 87 patients were analyzed. Sofpironium bromide application significantly reduced axillary odor, with physician’s subjective odor scores improving from (2.39±0.74) to (1.78±0.78) (t=7.258, P &lt;0.001) and patient’s subjective scores from (7.37±1.84) to (4.91±2.68) (t=8.456, P &lt;0.001). Multivariate analysis revealed that a decrease in HDSS score, which was improved by sofpironium bromide application, was significantly associated with odor reduction (β= 1.983, SE = 0.291, 95% CI: 1.398 -2.568, P &lt;0.001) . Conclusion: Sofpironium bromide effectively reduces odor in patients with axillary osmidrosis complicated by primary axillary hyperhidrosis, providing a potential new non-invasive and economically feasible therapeutic option for this condition.

Impact of primary hyperhidrosis on patients' quality of life in Damietta governorates.

Primary hyperhidrosis (PH) is the presence of increased sweating in the absence of a physiological trigger or underlying identifiable pathological cause. The aim of this study was to assess the impact of primary hyperhidrosis on patients' quality of life in Damietta; one of Egypt's governorates. This cross sectional study included 302 patients aged between 8 and 35 years and fulfilling diagnostic criteria of primary hyperhidrosis. Data were collected using a hyperhidrosis quality of life index (HidroQoL) questionnaire and to assess the severity of hyperhidrosis (HH), we used the hyperhidrosis Disease Severity Scale (HDSS). The majority of the participants had experienced some emotional sequelae as a result of the hyperhidrosis, and these were the most prevalent psychosocial domains of hyperhidrosis quality of life index. Patients were often very much embarrassed (57.6%) and were often nervous (51%) about sweat breaking out at any moment and very much frustrated (46.7%). Hyperhidrosis has a profound psycho-social impact on patients. Results demonstrated a significantly impactful and distressing illness that warrants equal attention as other more well-known skin conditions. Further multicenter large-scale and adequately powered randomized controlled trials are needed to provide an integrated approach for tackling the psychosocial impairment associated with hyperhidrosis.

Systemic effect of sympathectomy in the treatment of localized hyperhidrosis

Abstract Hyperhidrosis is thought to result from excessive stimulation of sweat glands due to increased sympathetic activity; however, data on systemic responses following bilateral thoracic sympathectomy as the definitive treatment have not yet been sufficiently evaluated. This study, designed as a prospective cohort investigation, included 24 patients who underwent sympathectomy for palmar and axillary hyperhidrosis at our center in 2023, along with an age-matched control group of equal size. In the sympathectomy group, pupillometry measurements were performed 1 day before surgery and on the 7th postoperative day, while the control group underwent measurements at corresponding intervals. Data from the sympathectomy group were analyzed both preoperatively and postoperatively and compared with the control group. According to the Hyperhidrosis Disease Severity Scale, all patients had severe hyperhidrosis. Sympathectomy was performed at the T3 level in 9 patients and at both T3 and T4 levels in 15 patients. The postoperative satisfaction rate was recorded as 95.8%. No statistically significant differences were observed between preoperative pupillometry measurements of the sympathectomy group and those of the control group. However, when comparing preoperative and postoperative data within the sympathectomy group, significant differences favoring increased parasympathetic activity were noted in the latency of contractions and photopic low values (p = 0.016 and p = 0.038, respectively). Our study is one of the pioneering works to objectively demonstrate, through a quantitative method, that sympathectomy for hyperhidrosis enhances the parasympathetic system response in the ocular region.

Arabic Translation, Cultural Adaptation, and Validation of the Hyperhidrosis Disease Severity Scale (Ar-HDSS).

Background: Hyperhidrosis (HH) is characterized by excessive sweating, which affects quality of life. The Hyperhidrosis Disease Severity Scale (HDSS) is a four-point scale used to evaluate HH severity by measuring how much excessive sweating disrupts daily activities. This study aimed to translate, validate, and adapt the HDSS tool into Arabic. Methods: A quantitative, analytical, cross-sectional study was carried out from May to June 2024 on patients clinically diagnosed with HH. The process of translating the HDSS into Arabic involved three independent forward translations, followed by a preliminary version created by a reviewer. Three additional independent translators conducted backward translations. All of the versions were then revised and merged to produce the final version. Reliability was evaluated through a test-retest reliability approach to ensure the reproducibility of the results. For validity, we used construct validity to compare the HDSS with the HidroQoL index. Results: A total of 167 patients were included, with a mean age of 29 ± 9.02 years, and over half of the patients were male (61%). The interrater agreement between the HDSS test and the retest results was substantial, with a kappa coefficient of 0.732. Significant positive correlations were observed between the HDSS score and daily life (r = 0.413, p < 0.001), the psychological domain (r = 0.374, p < 0.001), and HidroQOL (r = 0.425, p < 0.001). Conclusions: Our findings demonstrate that the Arabic HDSS has excellent psychometric properties, including construct validity and reproducibility. Proper use of the Arabic HDSS will allow the effective assessment of HH severity.

Comparative study between fractional laser assisted drug delivery of botulinum toxin versus botulinum toxin injection in primary palmar and axillary hyperhidrosis.

Palmar hyperhidrosis is common condition that is challenging to treat. Nonsurgical treatments include topical antiperspirants, iontophoresis, anticholinergic drugs and botulinum toxin injections. To evaluate the safety and efficacy of ablative fractional laser therapy, combined with topically applied botulinum toxin versus its injection for the treatment of hyperhidrosis. This study included 40 patients with pimary hyperhydrosis divided into two groups. Group A (n = 20) diagnosed with primary axillary hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right axilla and botulinum toxin injection in left axilla. Group B (n = 20) diagnosed with primary palmer hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right palm and botulinum toxin injection in left palm. There was a statistically significant decrease in the hyperhidrosis disease severity scale (HDSS) in all subgroups after treatment as compared to before treatment. Following 3 months of treatment, the amount of sweat as detected by transepidermal water loss (TEWL) was statistically significantly lower in the injection subgroup in both the axillary group (p = 0.075) and the palmer group (p < 0.001). The use of both botulinum toxin injection and laser assisted botulinum toxin drug delivery were associated with significant improvement in the manifestation, disease severity and quality of life in the cases with both axillary and palmer hyperhidrosis. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A.

Evaluation of Efficacy and Safety of miraDry® Procedure in the Treatment of Primary Axillary Hyperhidrosis.

Primary axillary hyperhidrosis significantly impacts the quality of life of affected individuals. miraDry®, a non-invasive local precisely controlled thermal energy procedure, represents a promising treatment option. This retrospective analysis aimed to evaluate the treatment success and patient safety following miraDry® procedure in the treatment of primary axillary hyperhidrosis. A total of 139 patients receiving miraDry® procedure from 2019 to 2023 with miraDry® fresh protocol for treatment of excessive axillary hyperhidrosis were analyzed. Subjective assessment was performed before and after treatment using hyperhidrosis disease severity scale (HDSS). Minor test (iodine starch test) was done before treatmentand 6 months after treatment to objectively quantify sweat severity. Patients with subjective or objective unsatisfied results after first procedure were scheduled for a second treatment. The majority of treated patients (84%) could effectively be treated with one single treatment, while only 16% (n = 22) required a secondary intervention. HDSS after treatment completion (single and double treatment) showed a significant improvement (p < 0.001) in subjective evaluation of the treatment success. Minor tests demonstrated a significant reduction in sweat severity (p < 0.001), with 95% of patients experiencing no or minimal sweating after treatment completion. The miraDry® procedure demonstrated a favorable safety profile with typical and transient treatment reactions that mostly resolved within 6 months (94.2%) CONCLUSION: Our data demonstrate that miraDry® procedure is an effective and safe treatment option for primary axillary hyperhidrosis, which results in an immense improvement in quality of life and high satisfaction of affected individuals. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of using dermapen device assisted delivery of Botulinum Toxin a versus its intradermal injection in the treatment of palmar hyperhidrosis

Background Hyperhidrosis (HH) is a condition characterized by excessive sweating caused by overstimulation of cholinergic receptors on eccrine glands. Primary hyperhidrosis (PH) is idiopathic, bilaterally symmetric, and affects various parts of the body. Botulinum neurotoxin-A (BTX-A) has a role in the nonsurgical management of HH. Dermapen was introduced for transdermal drug delivery. Objective To evaluate the clinical efficacy of Dermapen assisted delivery of BTX-A versus its intradermal injection in the treatment of primary palmar HH. Patients and methods A prospective intrapatient comparative study, conducted on 20 patients with bilateral palmar HH categorized into two groups, group A: left palm was treated by intradermal injection of BTX-A, group B: right palm was treated by Dermapen combined with topically applied BTX-A. Results Both groups had significant improvement after treatment. However, group A showed significantly better grades regarding hyperhidrosis disease severity scale, dermatology life quality index, and patient satisfaction. Conclusion Both methods were effective and tolerable. Intradermal injection intervention was better regarding hyperhidrosis disease severity scale, dermatology life quality index, patients satisfaction, and long-term follow-up.

Safety and efficacy of glycopyrronium tosylate in patients with primary axillary hyperhidrosis: a systematic review and meta-analysis

Hyperhidrosis affects approximately 4.8% of the US population, impairing quality of life with excessive sweating. Glycopyrronium tosylate (GT), a topical anticholinergic, treats primary axillary hyperhidrosis in adults and pediatric patients. Despite its use, comprehensive evaluation of GT’s long-term safety and efficacy has been lacking. This systematic review and meta-analysis aimed to assess GT’s effectiveness and safety profiles. Following Cochrane and PRISMA guidelines, we conducted a thorough search of electronic databases for clinical trials on GT. Studies underwent quality assessment and data extraction based on predefined criteria. Primary outcomes included changes in the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and Axillary Sweating Daily Diary (ASDD) or its change score (ASDD-C). Secondary outcomes evaluated safety concerns like mydriasis, dry mouth, urinary hesitation, and treatment-emergent adverse events. Our analysis, integrating data from three randomized controlled trials, highlights GT’s efficacy in improving quality of life and reducing sweating severity. Although minor adverse effects were reported, no significant increase in serious adverse events was observed. These findings suggest GT as a promising treatment for primary axillary hyperhidrosis, with benefits outweighing minimal side effects.

A Pivotal Study on the Safety and Effectiveness of a Targeted Alkali Thermolysis Patch for Treatment of Primary Axillary Hyperhidrosis or Excessive Axillary Sweating.

One-third of US adults are bothered by excessive sweating, approximately 5% are diagnosed with hyperhidrosis. A topical patch using targeted alkali thermolysis (TAT) was developed for treatment of this condition. This study was intended to assess the efficacy and safety of the TAT-Patch for axillary sweat reduction. A randomized, multicenter, double-blind, sham-controlled, pivotal trial enrolled 120 subjects to a bilateral axillary treatment with a TAT patch (63 subjects) or sham patch (57 subjects). The primary end point was achieved; 64% of TAT-treated versus 44% of sham-treated subjects ( p = .0332) improved from Hyperhidrosis Disease Severity Scale (HDSS) 3/4 to HDDS 1/2 at 4 weeks. Targeted alkali thermolysis treatment also showed a statistically significant improvement over sham treatment for all secondary end points, including gravimetric sweat production and subject-reported quality-of-life (QoL) assessments. The duration of effect is approximately 3 months, determined by the time to return to baseline HDSS. Mild-to-moderate treatment-site adverse events (AEs) were reported in 22% of TAT patch subjects. No serious or severe AEs were reported. HDSS, GSP, and QoL findings confirm clinically meaningful sweat reduction and a significant improvement in quality of life following a single TAT patch treatment. This device has potential to offer a new, noninvasive treatment option that is well tolerated with minimal downtime.

Longitudinal validity of the Hyperhidrosis Quality of Life Index (HidroQoL©) in a phase IIIb clinical trial population with hyperhidrosis: responsiveness and meaningful change.

The Hyperhidrosis Quality of Life Index (HidroQoL©) is a well-developed patient-reported outcome measure assessing the quality of life impacts in hyperhidrosis (HH), which has proven very good measurement properties, such as structural validity and internal consistency. We aimed to investigate responsiveness over time and estimate values for meaningful within-person change (MWPC) towards symptom improvement for different measurement timepoints (4 and 12 weeks), extending the existing validity evidence in patients with primary axillary HH. Data (from a phase IIIb clinical trial) were collected at baseline, and at weeks 4, 8, 12, 28, 52 and 72. For the assessment of responsiveness, HidroQoL change scores were correlated with corresponding change scores of the Hyperhidrosis Disease Severity Scale (HDSS), the Dermatology Life Quality Index (DLQI) and gravimetric sweat production based on a priori formulated hypotheses. Furthermore, we tested whether the different HDSS change score groups differed significantly from each other over time and whether the HidroQoL was sensitive towards these group differences over time. This was extended by the calculation of matched-pair tests and effect sizes to test significance for each change group separately. For the estimation of MWPC thresholds towards symptom improvement, different anchor-based and integrated approaches were used. In total, the sample comprised 357 patients with primary axillary HH. For the assessment of responsiveness, five out of 14 a priori hypotheses regarding the correlation of the change scores could be confirmed, whereas the rejected hypotheses differed only marginally from the expected values. Furthermore, regarding responsiveness, the HidroQoL showed sensitivity towards symptom improvement at each measurement timepoint. Effect sizes were large as expected (d ≥ 0.806). MWPC thresholds towards symptom improvement were proposed for two measurement timepoints: 5 (week 4) and 6 (week 12). Increasing MWPC values over time were observed. This study extends the evidence for the longitudinal validity of the HidroQoL© up to 72 weeks and proposed MWPC thresholds for different time intervals (4 and 12 weeks) after baseline, aiding interpretability. Results concur with findings from previous validation studies.

Efficacy and safety of topical glycopyrronium bromide in treating axillary hyperhidrosis: systematic review and meta-analysis

BackgroundHyperhidrosis (HH), characterized by excessive sweating, poses a significant challenge to patients’ quality of life. This meta-analysis evaluates the safety and efficacy of topical glycopyrronium bromide (GBP) in treating primary hyperhidrosis, a chronic condition affecting various body regions. Despite its prevalence, primary axillary hyperhidrosis is often undertreated due to a lack of awareness and social stigma.MethodsFollowing PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing GBP to a placebo in primary hyperhidrosis patients. Eligibility criteria included outcomes related to perspiration suppression and symptom improvement.ResultsFour RCTs involving 1401 patients were included. GBP significantly increased Hyperhidrosis Disease Severity Scale (HDSS) responders (RR = 2.33, 95% CI [1.99 to 2.74], p < 0.00001) and Axillary Sweating Daily Diary (ASDD/ASDD-C) responders (MD = 3.07, 95% CI [2.32 to 4.06], p < 0.002) without significantly causing adverse events. Dermatology life quality index was also significantly improved in the GBP group (MD = -2.32, 95% CI [-3.09, -1.55], P < 0.00001).ConclusionGBP demonstrated effectiveness in reducing sweat production while improving HDSS and DLQI scores. Adverse events included dry mouth and anticholinergic effects. Dry eye and local skin reactions were not significant, which makes GBP promising in managing primary hyperhidrosis, offering improvements in symptoms and quality of life. While adverse events should be considered, further research with larger sample sizes and long-term follow-up is warranted for comprehensive clinical integration.

Iontophoresis Improves the Impact on the Quality of Life of Children with Primary Hyperhidrosis-A Prospective Study and a Short Review.

Primary hyperhidrosis (PH) is a somatic and idiopathic pediatric skin disease. The eccrine glands are tiny and very numerous, with approximately 3 million distributed throughout the skin. There is no commonly accepted amount of sweating to define hyperhidrosis, but people with this disease suffer real limitations integrating into society, which can be quantified through quality of life measurement scales. We want to draw attention to this disease and its impact on children's quality of life because it is significant and there are no studies conducted on groups consisting solely of children. There are various quality of life evaluation questionnaires for hyperhidrosis. We studied 103 children with hyperhidrosis by monitoring their sweat severity and its impact on quality of life, using the Hyperhidrosis Disease Severity Scale. We compared the scale results before and after 10 days of iontophoresis. This study includes only children under 18 years old, treated with iontophoresis. The average age of the group is 11.84 ± 2.89 years. Treatment success is recorded in 68 (66.02%) children, but a change in the score is recorded in 74 (71.84%) children. The average HDSS score at T0 is 2.95 ± 0.70, compared to the HDSS score at T1 of 1.92 ± 0.86. Hyperhidrosis has a negative impact on daily life, especially self-esteem, occupational productivity, emotional well-being, and interpersonal relationships. Iontophoresis is a safe and effective treatment method that reduces the severity of hyperhidrosis and increases the quality of life.

Fractional CO2 Laser-Assisted Delivery of Botulinum Toxin-A Versus Aluminum Chloride in Treatment of Primary Palmar Hyperhidrosis.

Primary palmar hyperhidrosis (PPH) constitutes a distressing dermatologic condition that greatly affects patients' quality of life. Its management still needs to be addressed to find a suitable therapeutic modality that is readily available, cost effective, and gives patients a quite long disease-free period. To assess the efficacy of fractional CO2 laser as a delivery method for botulinum toxin-A (BTX-A) and aluminum chloride in treating PPH. Twenty-four subjects with PPH were treated on both hands with fractional CO2 laser followed on the right hand with topical BTX-A and on the left hand with topical aluminum chloride. Minor's starch-iodine test and Hyperhidrosis Disease Severity Scale (HDSS) were used for evaluation of treatment response and for follow-up. There was a significant improvement in HDSS in both groups, but there was no statistically significant difference in the therapeutic response for both modalities. There was a statistically significant longer disease-free period in the BTX-A-treated hands. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A and aluminum chloride, the two most widely used agents for treating PPH, with a comparable anhidrotic response.

Treatment of Primary Axillary Hyperhidrosis with Two Doses of Botulinum Toxin A-Observational Study.

Hyperhidrosis (HH) is defined as the production of more sweat than is necessary for its thermoregulatory function, negatively affecting patients' quality of life and interfering with their social, work and family life. In this context, the aim of thisstudy was to evaluate the efficacy of two different doses of botulinum toxin type A (50 or 100 units) in each axilla in severe primary axillary hyperhidrosis. A descriptive, observational, cross-sectional and post-authorisation study was conducted onpatients referred to our department.Thirty-one patients with severe primary axillary hyperhidrosis were included, some of whom received more than one infiltration during the follow-up period, performing a total of 82 procedures. They were assigned by simple random sampling to two types of treatment: infiltration of 50 or 100 units (U) of botulinum toxin A per axilla.Hyperhidrosis severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Onabotulinum toxin A infiltration reduced the severity of hyperhidrosis and improved the quality of life of the treated patients, with no significant differences between the two groups.

The reliability and validity of a developed anxiety scale specific to primary focal hyperhidrosis symptoms

BackgroundPatients with primary focal hyperhidrosis (hyperhidrosis) are known to have higher levels of anxiety induced by sweating than those who do not. However, in hyperhidrosis, no scale has been developed to measure anxiety specific to hyperhidrosis symptoms. Therefore, this study aimed to develop an anxiety scale specific to hyperhidrosis symptoms (ASSHS) and to verify its reliability and validity.MethodsBased on previous studies on hyperhidrosis and a preliminary survey conducted with 26 university students who met the diagnostic criteria for hyperhidrosis, 40 items that adequately reflected anxiety specific to hyperhidrosis symptoms were obtained. A survey was done to examine the internal consistency and validity of the our developed ASSHS. In total, 1,207 participants (680 male and 527 female; mean age ± standard deviation 18.7 ± 0.9 years) were included. A second survey (re-survey) was conducted three weeks later to verify the reliability. It included 201 participants (85 male and 116 female; mean age ± standard deviation 18.6 ± 0.7 years). The survey items included (1) the diagnostic criteria for hyperhidrosis, (2) our anxiety scale developed for primary focal hyperhidrosis symptoms (ASSHS), (3) Hyperhidrosis Disease Severity Scale (HDSS), (4) State-Trait Anxiety Inventory (STAI), (5) Hospital Anxiety and Depression Scale (HADS), (6) Dermatology Life Quality Index (DLQI), and (7) presence of anxiety induced by sweating.ResultsThe results of the factor analysis revealed 10 items with one factor, “anxiety specific to hyperhidrosis symptoms.” The alpha coefficient of the ASSHS was α = 0.94. The correlation coefficient between the scores at re-test was r = 0.75. A moderate positive correlation was found between the ASSHS, HDSS (r = 0.53), and anxiety induced by sweating (r = 0.47) (all p < 0.001). Additionally, participants with hyperhidrosis symptoms had significantly higher ASSHS scores than did those without hyperhidrosis symptoms (p < 0.001). Those with mild/moderate hyperhidrosis and those with severe hyperhidrosis had significantly higher the ASSHS scores than did those without hyperhidrosis (p < 0.001).ConclusionsThis scale has sufficient reliability and validity as an instrument to measure anxiety specific to hyperhidrosis symptoms.

Long-term safety and efficacy of Glycopyrronium tosylate in patients with primary axillary hyperhidrosis: a systematic review and meta-analysis

Background: Hyperhidrosis, a condition characterized by excessive sweating, affects ≈ 4.8% of the US population. (1) Glycopyrronium tosylate (GT) is a topical anticholinergic drug approved for primary axillary hyperhidrosis (PAH) treatment. (2) However, no meta-analysis exists on GT’s long-term safety and efficacy. Aim: To evaluate the long-term safety and efficacy of GT as a treatment for PAH. Methods: We systematically searched PubMed, Scopus, and ClinicalTrials.gov. Study selection, quality assessment, and data extraction followed the eligibility criteria. The primary endpoints were changes in the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and Axillary Sweating Daily Diary (ASDD) or Axillary Sweating Daily Diary – Change (ASDD-C). Safety endpoints included mydriasis, dry mouth, urinary hesitation, and treatment-emergent adverse events (TEAEs). Statistical analysis was conducted using RevMan 5.1. Results: Our meta-analysis demonstrated that topical GT is clinically effective in treating PAH. GT significantly improves the quality of life of patients, as measured by the DLQI (MD = -2.81, 95% CI = [-4.04, -1.59],P = 0.001), HDSS (OR = 3.72, 95% CI = [2.92, 4.74], P = 0.001), and ASDD/ASDD-C (OR = 4.91, 95%CI = [3.75, 6.44], P = 0.001). Adverse effects such as mydriasis, dry mouth, and urinary hesitation were observed; however, no difference was found between GT and control groups in serious TEAEs, deaths, and severe TEAEs. Conclusion: Topical GT is effective with minimal side effects, providing a valuable option for patients unresponsive to or experiencing significant side effects from other treatments.