Hyperhidrosis In Patients Research Articles

Risk Factors Affecting the Outcomes of CT-Guided Radiofrequency Thermocoagulation of the T3 Sympathetic Nerve in the Treatment of Craniofacial Hyperhidrosis.

Current studies mostly suggest that hyperhidrosis is caused by relative sympathetic hyperactivity. Sympathetic radiofrequency thermocoagulation is widely used in clinics. Previous studies have demonstrated that surgery at T3 is effective and safe compared with higher levels, so craniofacial hyperhidrosis in our hospital is selected to be treated at T3. However, some patients pursue repeat medical treatment due to an increase in hyperhidrosis at the original site after surgery. Previous studies have demonstrated the significance of Perfusion index (PI) value in the recurrence of palmar hyperhidrosis, but there is no relevant study on craniofacial hyperhidrosis. Clinical data from patients with craniofacial hyperhidrosis, who underwent T3 sympathetic radiofrequency thermocoagulation at Jiaxing First Hospital (Jiaxing, China) between January 1, 2018 and December 31, 2021, were analyzed. Recurrence in patients 1 year after surgery was recorded through a case search and telephone follow-up system that registered patient information. Clinical data were analyzed using binary logistic regression analysis to investigate risk factors associated with recurrence in patients with craniofacial hyperhidrosis 1 year after surgery. Of 83 patients included in the present study, 34 (40%) experienced increased craniofacial sweating 1 year after surgery. Results of univariate logistic regression analysis revealed that computed tomography (CT) scan count, increase in pulse index (PI) at the fingertips, and differences in forehead temperature were potential risk factors for postoperative recurrence in patients with craniofacial hyperhidrosis (p<0.2), and the results were consistent on both sides. Three potential risk factors were included in the multivariate logistic regression analysis and results revealed that the risk for recurrence was reduced by 48% (left side) and 67% (right side) for every 1 unit increase in PI value. A small increase in PI was an independent risk factor for recurrence of hyperhidrosis in patients with craniofacial hyperhidrosis after undergoing T3 sympathetic radiofrequency thermocoagulation.

[Translated article] Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review

Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

Efficacy of 5% sofpironium bromide gel in Duchenne muscular dystrophy with palmoplantar hyperhidrosis: A retrospective case study.

Duchenne muscular dystrophy (DMD) is a severe, progressive, muscle-wasting disease. Notably, several extramuscular manifestations and complications of advanced DMD, including skin disorders, are known. However, hyperhidrosis and its treatment have not been well-described in association with advanced DMD, therefore we aimed to confirm the efficacy of 5% sofpironium bromide gel in treating secondary hyperhidrosis in patients with advanced DMD. We retrospectively reviewed patients with advanced DMD who underwent treatment with 5% sofpironium bromide gel. All patients were evaluated using the hyperhidrosis disease severity scale (HDSS) score and by measuring the gravimetric weight of palmar and/or plantar sweat. Three patients with advanced DMD were treated and the patients were aged 28, 31, and 32 years, respectively. Their HDSS scores showed a decreasing tendency within 5 weeks after treatment. In addition, all patients had a decreased gravimetric weight of palmar and/or plantar sweat, and the mean decrease rate of palmar sweat at 7 weeks after treatment was 53.7%. One patient had skin dryness on both soles, but no serious adverse events were observed. Treatment using 5% sofpironium bromide gel showed beneficial efficacy against palmoplantar hyperhidrosis in patients with advanced DMD. These findings warrant further investigation in future studies.

Anticolinérgicos tópicos en el manejo de la hiperhidrosis focal en adultos y niños. Una revisión narrativa

Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

Relationship between hyperhidrosis and hypothalamic injury in patients with mild traumatic brain injury.

Hyperhidrosis is clinical symptom of various diseases and is an important clinical feature of paroxysmal sympathetic hyperactivity (PSH). Traumatic brain injury (TBI) is known to be most common condition associated with PSH, and PSH has been mainly reported in moderate and severe TBI. However, very little has been reported on PSH or hyperhidrosis in mild TBI patients. In this study, we used diffusion tensor imaging (DTI) to investigate the relationship between hyperhidrosis and hypothalamic injury in patients with mild TBI. Seven patients with hyperhidrosis after mild TBI and 21 healthy control subjects were recruited for this study. The Hyperhidrosis Disease Severity Scale was used for evaluation of sweating at the time of DTI scanning. The fractional anisotropy and apparent diffusion coefficient DTI parameters were measured in the hypothalamus. In the patient group, the fractional anisotropy values for both sides of the hypothalamus were significantly lower than those of the control group (P < .05). By contrast, the apparent diffusion coefficient values for both sides of the hypothalamus were significantly higher in the patient group than in the control group (P < .05). In conclusion, we detected hypothalamic injuries in patients who showed hyperhidrosis after mild TBI. Based on the results, it appears that hyperhidrosis in patients with mild TBI is related to hypothalamic injury.

Hyperhidrosis in Parkinson's disease: a 3-year prospective cohort study.

Although hyperhidrosis is a common symptom in patients with Parkinson's disease (PD), no study has yet examined it longitudinally. We conducted a 3-year prospective cohort study to investigate the development, evolution and correlates of hyperhidrosis in patients with PD. A total of 224 patients with early-stage PD were enrolled at baseline and followed up annually for three consecutive years. Hyperhidrosis was assessed using hyperhidrosis question (item 30) of the Non-Motor Symptoms Scale (NMSS). The generalized estimating equations model was applied to investigate the correlates of both presence and severity of hyperhidrosis. The frequency of hyperhidrosis in PD had an overall increasing tendency from 24.1% at baseline to 34.4% after 3 years, although hyperhidrosis was not always persistent in all patients over the 3-year study period. The presence of hyperhidrosis was found to be associated with dyskinesia (OR 2.27 [1.02-5.04], P = 0.045), the sexual function domain subscore of the NMSS (OR 1.04 [1.01-1.07], P = 0.016), the Hamilton Anxiety Rating Scale (HARS) score (OR 1.08 [1.03-1.13], P = 0.001) and the Unified Parkinson's Disease Rating Scale part III score (OR 1.02 [1.00-1.04], P = 0.036). Only the HARS score was associated with the severity of hyperhidrosis (B 0.08 [0.03-0.12], P = 0.001). Hyperhidrosis is common in PD, and its frequency increases along with disease duration. Hyperhidrosis in PD is associated not only with motor severity and motor complication such as dyskinesia, but also with non-motor symptoms such as sexual dysfunction and anxiety.

26301 Pharmacokinetic analyses show limited systemic exposure with topical glycopyrronium tosylate

GT is a topical anticholinergic approved (US) for primary axillary hyperhidrosis in patients ≥9 years. In a Phase 1 study, GT was applied by study staff once-daily to axillae of primary axillary hyperhidrosis patients (5 days); oral glycopyrrolate was administered to healthy adults every 8h (15 days; 1.0 mg then increasing by 1.0 mg/5 days). In the Phase 2 studies (NCT02016885, NCT02129660), primary axillary hyperhidrosis patients were randomized to topical glycopyrronium (0.8-3.2%) or vehicle applied to axillae once-daily (4 weeks). Pharmacokinetic parameters were similar between GT-treated adult and pediatric patients, with no evidence of accumulation. Systemic absorption of glycopyrronium was lower with GT vs oral glycopyrrolate. No anticholinergic-related adverse events (AEs) occurred with GT in the Phase 1 study, while dry mouth and nasal dryness occurred with oral glycopyrrolate; anticholinergic AEs occurred in the Phase 2 studies. In the population pharmacokinetic analysis, frequency/severity of anticholinergic-related AEs increased with higher glycopyrronium concentration; however, the mean (0.0985 μg/L [SD 0.213]) and median (0.026 μg/L [min, max [0, 1.67]) Cmax values were low. Mild AEs tended to occur at low concentrations, while the probability of moderate/severe AEs did not become appreciable (over 20%) until Cmax values of approximately 0.2 μg/L; most patients had glycopyrronium Cmax values <0.2 μg/L. No relationship was observed between efficacy and pharmacokinetic measures. These studies indicate limited absorption and low risk of anticholinergic AEs with proper GT administration, which underscores the importance of following instructions for use (wipe each underarm once with same cloth, wash hands, avoid ocular contact).

Effects of lower thoracic sympathicotomy on plantar hyperhidrosis.

BackgroundThe purpose of this study was to investigate whether performing lower thoracic sympathicotomy (LTS) from T10 to T12 affects plantar hyperhidrosis in patients with palmo-plantar (PP) or palmo-axillary-plantar (PAP) hyperhidrosis.MethodsBetween January 2015 and January 2020, all consecutive patients with primary hyperhidrosis who underwent bilateral thoracoscopic sympathicotomy and met the inclusion criteria were included. Sympathicotomy was performed using one of the following two methods: the conventional upper thoracic vs. expanded thoracic sympathicotomy. In the expanded thoracic sympathicotomy, we expanded the level of sympathicotomy ranging from R5 to R12 in addition to the conventional upper thoracic sympathicotomy (R3 or R4). In cases of the expanded thoracic sympathicotomy, we defined the LTS as a sympathicotomy of the levels ranging from R10 to R12, which are related to plantar hyperhidrosis.ResultsA total of 103 subjects with PP (71 cases) or PAP (32 cases) hyperhidrosis were included. Palmar or axillary hyperhidrosis in all patients were alleviated after sympathicotomy. There was no difference in sweating decrease or CH according to the hyperhidrosis types or sympathicotomy techniques. In addition, no-LTS was performed in 77 cases and LTS was performed in 26 cases. In the no-LTS group, there were 65 and 12 cases of low and high degrees of CH, respectively. In the LTS group, there were 22 and four cases of low and high degrees of CH, respectively. There was no significant difference in CH between the no-LTS and LTS groups (P=0.981). Improvement in plantar hyperhidrosis in the no-LTS group was observed in 29 of 77 cases, while improvement in plantar hyperhidrosis in the LTS group was observed in 16 of 26 cases. The addition of LTS lead to significant improvement in plantar hyperhidrosis (P=0.034).ConclusionsPerforming LTS is a safe and feasible procedure that improved plantar sweating more so than it did in cases that did not undergo LTS. Therefore, we cautiously suggest that adding LTS helps in the treatment of plantar hyperhidrosis combined with palmar hyperhidrosis. Further studies on LTS are needed to validate these findings and will be helpful in establishing management guidelines.

Variables Affecting Delivery of Glycopyrronium Tosylate Through Human Skin In Vitro.

Hyperhidrosis is a condition characterized by excessive sweating beyond what is required for normal thermal regulation. It can involve multiple body areas including the axillae, palms, soles, or craniofacial regions. Glycopyrronium tosylate (GT) is a topical anticholinergic approved by the FDA (2018) for treatment of primary axillary hyperhidrosis in patients 9 years and older. Gain insight into variables (anatomical sites, occlusion, exposure time) affecting GT delivery into human skin. Human skin from different anatomical regions (palmar, plantar, axillary, and abdominal skin) was mounted into flow-through diffusion cells (MedFlux-HT&reg;). GT solution (2.4%) was applied at 10 mg/cm2 and the receiving fluid was collected every 2 hours, for 24 hours. GT penetration was determined using LC/MS/MS. The effect of occlusion was assessed by covering the skin with either parafilm or saran wrap, and the effect of exposure time was assessed by incubating the skin for 5, 15, or 60 minutes before washing off the GT from the surface. GT delivery through palmar and plantar skin was up to 40-fold lower compared to delivery through axillary or abdominal skin. Occlusion increased GT delivery up to 10-fold. Reducing exposure time from 24 hours to either 5, 15, or 60 minutes, decreased GT flux by 90%. However, occlusion during these varied exposure times was able to restore GT delivery to levels found in the 24-hour exposed, non-occluded control group. These in vitro skin penetration studies showed that skin thickness, exposure time, and occlusion substantially influenced GT delivery, potentially impacting clinical trial design. J Drugs Dermatol. 2020;19(11): doi:10.36849/JDD.2020.5062.

Long-term efficacy and safety of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Post hoc pediatric subgroup analysis from a 44-week open-label extension study.

Background/ObjectivesGlycopyrronium tosylate (GT) cloth, 2.4% is a topical anticholinergic approved in the United States for primary axillary hyperhidrosis in patients ≥9 years. This post hoc analysis evaluated long‐term response (efficacy and safety) in pediatric patients (≥9 to ≤16 years) to GT in the 44‐week, open‐label extension (NCT02553798) of two, phase 3, double‐blind, vehicle‐controlled, 4‐week trials (NCT02530281, NCT02530294).MethodsIn the double‐blind trials, patients ≥9 years with primary axillary hyperhidrosis were randomized 2:1 to once‐daily GT:vehicle. Those who completed the study could receive open‐label GT for up to an additional 44 weeks. Safety assessments included treatment‐emergent adverse events (TEAEs) and local skin reactions (LSRs). Descriptive efficacy assessments included gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale response (≥2‐grade improvement), and Children's Dermatology Life Quality Index.ResultsOf 43 pediatric patients completing either double‐blind trial, 38 (88.4%) entered the open‐label extension (age, years: 9 [n = 1], 12 [n = 2], 13 [n = 7], 14 and 15 [n = 9 each], 16 [n = 10]). The safety profile observed was similar to the double‐blind trials. Most TEAEs (>95%) were mild/moderate, related to anticholinergic activity, and infrequently led to discontinuation (n = 1/38 [2.6%]). No pediatric patients experienced a serious TEAE. Most anticholinergic TEAEs did not require a dose modification and resolved within 7 days. Approximately, one‐third of patients (n = 13/38 [34.2%]) had LSRs; most were mild/moderate in severity. Improvements in efficacy measures were maintained from the double‐blind trials.ConclusionsLong‐term, once‐daily GT for up to 48 weeks (4‐week double‐blind plus 44 week open label) provides a noninvasive, well‐tolerated treatment option for pediatric patients with primary axillary hyperhidrosis.

New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis.

BackgroundPrimary hyperhidrosis (PH) is characterized by excessive and uncontrollable secretion in the eccrine sweat glands of the craniofacial region, armpits, hands, and feet. Sympathicotomy is the most effective treatment for severe PH; however, compensatory hyperhidrosis (CH) remains the most devastating postoperative complication. The purpose of the present study was to suggest a new sympathicotomy method for PH to prevent severe CH.MethodsFrom March 2014 to December 2018, a total of 212 patients were included in the study. R2 (53 cases) sympathicotomy for craniofacial hyperhidrosis and R3 (79 cases) or R4 (80 cases) sympathicotomy for palmar hyperhidrosis using the thoracoscopic technique were performed, respectively. Sympathicotomy was performed using two different methods (conventional 145 cases and new 67 cases). Expanded sympathicotomy was performed as the new method (67 cases), which was divided into two groups (partial- and full-expanded sympathicotomy). Operative effectiveness was evaluated by a reduction in percentage of post-operative sweating compared with pre-operative sweating and groups were divided into complete and incomplete sweat reduction characteristics. Complete sweat reduction was defined as sweat reduction ≥80% compared with preoperative sweating. The degrees of CH were classified as negligible, mild bothering (tolerable), and severe bothering (intolerable). Data on preoperative subject characteristics, disease status, operative technique, and postoperative outcomes were gathered using medical records and telephone surveys.ResultsAccording to sympathicotomy techniques, the conventional procedure (non-expanded sympathicotomy) was performed in 145 cases and the new expanded sympathicotomy procedure was performed in 67 cases (partial-expanded sympathicotomy 28 cases; full-expanded sympathicotomy 39 cases). Craniofacial hyperhidrosis was significantly more prevalent in the older group and in female patients (P<0.001 and P=0.007, respectively). Sympathicotomy was significantly more effective in palmar hyperhidrosis than craniofacial hyperhidrosis (P<0.001). CH was significantly more severe in craniofacial hyperhidrosis than palmar hyperhidrosis after sympathicotomy (P<0.001). In craniofacial hyperhidrosis, there was no significant difference in sweat reduction and CH between conventional and the expanded sympathicotomy techniques (P=0.177 and P=0.474, respectively). In palmar hyperhidrosis, there was no significant difference in sweat reduction between the conventional and the expanded sympathicotomy (P=0.178), however, degree of CH in the conventional technique was significantly more severe than in the expanded technique (P=0.001). Regarding comparison between partial- and full-expanded sympathicotomy, there was no significant difference in sweat reduction between partial-, and full-expanded sympathicotomy; however, CH was significantly more severe in partial-expanded sympathicotomy (craniofacial hyperhidrosis P=0.006; palmar hyperhidrosis P<0.001). Irrespective of hyperhidrosis types, there was no significant difference in sweat reduction between full-expanded and the others (non-expanded and partial-expanded sympathicotomy), however, full-expanded sympathicotomy showed a significantly less degree of CH than non-expanded and partial-expanded sympathicotomy (craniofacial, P=0.002; palmar, P<0.001).ConclusionsFull-expanded sympathicotomy is a safe and feasible treatment that shows a significant decrease in the degree of CH with the same effect in sweat reduction in both craniofacial and palmar hyperhidrosis. Importantly, no severe CH developed after a full-expanded sympathicotomy without any major postoperative complications.

Analysis of the Results of Videotoracoscopic Sympathectomy in the Treatment of Hyperhidrosis in Patients 40 Years or Older

Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (video-assisted thoracoscopic sympathectomy [VATS]) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40years or older compared with those of young adult patients (19-40years). We retrospectively analyzed 2,431 HH patients who underwent bilateral VATS and divided the patients into the following groups: a group younger than 40years old (1,760 patients) and a group 40years and older (142 patients). Variables included quality of life before surgery, improvement in quality of life after surgery, clinical improvement in sweating, the presence of severe compensatory hyperhidrosis (CH), and general satisfaction at 1 month after surgery. We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the 2 groups of patients. More than 90% of the patients in this series had great clinical improvement in the main HH site, with no significant difference between the 2 groups. Severe CH occurred in 23.8% of the patients in this series, with no significant difference between the 2 groups. Patients 40years of age or older benefit just as much as younger patients from VATS performed to treat primary HH, presenting excellent significant surgical results.

Variables Affecting Delivery of Glycopyrronium Tosylate Through Human Skin In Vitro

Abstract not available. Disclosures: Study sponsored by Dermira.

Epidemiologic analysis of prevalence of the hyperhidrosis.

BackgroundThe present paper aims to study the prevalence of the various manifestations of hyperhidrosis in patients who sought treatment in a specialized ambulatory in the state of São Paulo.ObjectivesOpposite to previous studies, this paper studies the different combinations of sweating sites, not being restricted to the main complaint site of the patients, but taking into consideration secondary complaints patients may present.MethodsThis was a retrospective approach of a database containing more than 1200 patients in which were mapped: combination of sweating sites, age of onset, age spectrum, mean age, body mass index and gender of patients. Patients were categorized into four groups based on their main sweating site - palmar, plantar, axillary and facial.ResultsWe concluded that hyperhidrosis appears frequently in more than one site, being the main complaint that affects the most patients palmar hyperhidrosis, which appears early in the patients during adolescence. When there are two sites of sweating, the most frequent combination is palmar + plantar, and when there are three sites of sweating the most frequent combinations are palmar + plantar + axillary and axillary + palmar + plantar.Study limitationsThis research has casuistics limited to a single care service for patients with hyperhidrosis.ConclusionIt is necessary to keep in mind that the disease manifests itself mainly in more than one location, with different intensities in each of the patients, generating a significant impairment of their quality of life.

Effect of T4 thoracoscopic sympathectomy on plantar hyperhidrosis in patients with primary palmoplantar hyperhidrosis

To evaluate the effect of video-assisted thoracoscopic sympathectomy at the T4 level on plantar hyperhidrosis in the treatment of palmoplantar hyperhidrosis. The clinical data of 28 patients with primary palmoplantar hyperhidrosis, who were admited in our hospital from June 2009 to May 2014, was analyzed. All patients were qualified to bilateral thoracoscopic transaction of the sympathetic chain at the thoracic level T4. Patients completed a self-administered hyperhidrosis questionnaire and scoring before and after procedure. Follow-up data were obtained at 1 and 6 months after the surgery. Endoscopic thoracic sympathectomy at the thoracic level T4 was performed successfully for all cases. Palmar hyperhidrosis was completely alleviated after the operation and no recurrence was observed during follow-up. The ratio for initial improvement of plantar hyperhidrosis was 28.6% (8/28) at 1 month after the surgery followed by a recurrence of plantar hyperhidrosis. No case continued to show the improvement of palmoplantar hyperhidrosis at 6 months after the sympathectomy. Twenty-seven patients (96.4%) were very satisfied with the outcome of the operation, 1 patient (3.6%) satisfied and no patient regretted the surgical procedure. T4 thoracoscopic sympathectomy could initialliy alleviate plantar hyperhidrosis in some patients with palmoplantar hyperhidrosis, but the improvement was not sustained over a long period. It could not be used to treat plantar hyperhidrosis.

Thoracoscopic Sympathicotomy for Treatment of Hyperhidrosis

Background: Approximately, 3% of the world’s population have hyperhidrosis, a situation in which excessive sweating occurs in response to the need to regulate body temperature. Endoscopic devices have been used for treatment of this disease through sympathicotomy. Objectives: The aim of this study was to assess the effectiveness and adverse effects of endoscopic sympathicotomy in treatment of hyperhidrosis. Patients and Methods: We enrolled 41 patients in the study. Ganglion disconnection was performed at T2 - T3 level for patients with palmar hyperhidrosis and at T3 - T4 level for patients with axillary hyperhidrosis. Patients were evaluated for successful response to surgical treatment, occurrence of reflex hyperhidrosis following surgery, and location of reflex hyperhidrosis at one week and at six months of surgery. Results: After surgical treatment, 75.6% of patients reported complete response to treatment while 82.9% reported reflex hyperhidrosis after surgery. The frequency for moderate and severe sweating was 8.8% and 26.5%, respectively. Conclusions: Sympathicotomy technique can be used in the treatment of primary hyperhidrosis in patients who did not respond to nonsurgical treatments; however, the incidence of reflex hyperhidrosis is of concern following surgical treatment.

Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation.

To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years.

ABSTRACTObjective:Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years.Methods:Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation.Results:In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement.Conclusion:Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis.

Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for patients with primary palmar hyperhidrosis

To evaluate the efficiency of video-assisted thoracoscopic surgery for primary palm hyperhidrosis by T4 sympathicotomy plus bypass fiber resection, and to describe our experience regarding the prevention of related postoperative complications. Clinical data for 32 cases of primary palmar hyperhidrosis in patients who underwent bilateral video-assisted thoracoscopic sympathictomy plus bypass fiber resection from October 2008 to June 2011 were analyzed retrospectively. The operation was performed successfully on all patients, and their palmar hyperhidrosis was completely alleviated after operation. No severe, surgery-related, postoperative complications occurred. Video-assisted thoracoscopic sympathictomy is an effective, safe and minimally invasive procedure for primary palmar hyperhidrosis.