Hyperhidrosis Patients Research Articles

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.

Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study

ObjectiveThis study aims to evaluate the long-term outcomes of compensatory hyperhidrosis (CH) after thoracoscopic sympathectomy and explore the risk factors affecting postoperative CH in primary palmar hyperhidrosis(PPH) patients.MethodA retrospective analysis was conducted on patients who underwent thoracoscopic sympathectomy in the thoracic surgery department of our hospital from January 2015 to May 2022. Long-term follow-up surveys was conducted to collect data on post-operative satisfaction, PPH recurrence, and CH occurrence. Postoperative CH outcomes were assessed using the HDSS and satisfaction scores scale. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative CH.ResultA total of 152 patients was included in the final study, with 113 cases in the CH group and 39 cases in the nCH group. The incidence of postoperative CH was 74.3% (113/152), within which 33.6% (38/113) were severe CH. The median follow-up time was 3.1 years(2.5-5.5y) and the median interval of CH onset after surgery was 30 days (14-90d). Univariate analysis showed that body mass index(BMI), surgical time, and transected nerve level are correlated with CH, with statistically significant differences. Multivariate logistic regression analysis indicated a higher BMI (OR = 0.864, 95% CI 0.755–0.989, P < 0.05) is the independent risk factor for the occurrence of CH. There was no statistically significant difference in HDSS scores among CH patients at 1 month, 1 year, and 3 years after surgery.ConclusionA higher BMI is the independent risk factor for postoperative CH after thoracoscopic sympathectomy. The incidence and severity of postoperative CH kept stable during a long term follow up.

Primary Hyperhidrosis and Sensitive Skin: Exploring the Link with Predictive Machine Learning-Based Classification Models.

Primary hyperhidrosis (PHH) is a disorder of excessive sweating caused by aberrant cholinergic signaling. Sensitive skin (SS) is a condition of subjective cutaneous hyperreactivity to innocuous stimuli, impacting 40% to 70% of the population. SS is exacerbated by sweat, stress, and heat, suggesting that cholinergic stimulation may contribute to SS flares. To survey PHH sufferers to assess hyperhidrosis (HH) and SS symptom burden. An International Review Board (IRB)-exempt survey was disseminated by the International Hyperhidrosis Society. A predictive classification model for SS was built using random forest machine learning algorithms. Of the 637 respondents with PHH, 89% reported SS; and there was a significant association between HH and SS severity scores. Importantly, SS occurred on body sites affected and unaffected by HH. Predictive modeling designated Sensitive Scale-10&nbsp;(SS-10), a validated questionnaire to gauge SS severity, to be the most helpful in predicting SS in this cohort. Self-reported data. These data are the first to propose and support a relationship between SS and HH. SS occurred with greatest frequency at HH-afflicted body sites, but also occurred on unaffected sites, suggesting that sweat is not the sole causative link. Future work can explore cholinergic signaling as a potential link between these conditions. Screening HH patients for SS may be warranted. J Drugs Dermatol. 2024;23(10):882-888. doi:10.36849/JDD.8461.

Changes in electrodermal activity following sympathicotomy in hyperhidrosis patients.

The aim of this study was to assess the potential of electrodermal activity (EDA) as a diagnostic tool for preoperative evaluation in hyperhidrosis patients. EDA levels and patterns in different skin areas were investigated before and after endoscopic thoracic sympathicotomy (ETS) and was compared to healthy subjects. Thirty-seven patients underwent two days of measurements before and after the operation. Twenty-five (67.5%) of the patients also had a third measurement after six months. Non-invasive EDA measurements, involving skin conductance, were sampled from five different skin areas while patients were at rest in supine and sitting positions or when subjected to stimuli such as deep inspirations, mental challenge, and exposure to a sudden loud sound. Prior to the operation, hyperhidrosis patients showed higher spontaneous palm EDA variations at rest and stronger responses to stimuli compared to healthy subjects. Patients with facial blushing/hyperhidrosis or combined facial/palmar hyperhidrosis showed minimal spontaneous activity or responses, particularly during mental challenge and sound stimulus. Notably, palm EDA response was abolished shortly following sympathicotomy, although a minor response was observed after six months. Minimal EDA responses were also observed in the back and abdomen postoperatively. Hyperhidrosis patients showed stronger EDA response to stimuli compared to healthy subjects. Sympathicotomy resulted in the complete elimination of palm EDA responses, gradually returning to a limited extent after six months. These findings suggest that EDA recordings could be utilized in preoperative assessment of hyperhidrosis patients.

Assessing Botulinum Toxin Effectiveness and Quality of Life in Axillary Hyperhidrosis: A One-Year Prospective Study.

This study hypothesized that botulinum toxin (Botox) therapy would sustainably reduce sweat production in axillary hyperhidrosis patients over one year and significantly improve various quality-of-life aspects, including psychological well-being, social interactions, and daily functioning. The objectives were to quantitatively measure changes in sweat production and qualitatively assess the evolving impact on patients' quality of life over one year. Conducted prospectively at the Pius Brinzeu Clinical Emergency Hospital in Timisoara, Romania, this study complied with ethical standards and included adults with primary axillary hyperhidrosis unresponsive to conventional treatments. Participants underwent Botox injections and were evaluated at baseline, six months, and one year, using the Hyperhidrosis Disease Severity Scale (HDSS), WHOQOL-BREF, and the Dermatology Life Quality Index (DLQI), among other tools. Involving 81 patients, the study showed significant improvements in sweat production and quality-of-life metrics. Sweat production decreased from 0.81 g to 0.23 g per 15 min over one year (p < 0.001). HDSS scores reduced from 3.4 to 1.5, indicating a decrease in symptom severity (p < 0.001). The DLQI total score, assessing life quality impact, notably dropped from 19.9 to 6.9 (p < 0.001). Quality-of-life domains also showed significant improvements, especially in the social (from 65.3 to 73.4, p < 0.001) and environmental aspects (from 68.0 to 72.1, p < 0.001). Higher HDSS and sweat production were significantly associated with a lower quality of life on the DLQI (B coefficients of -4.1 and -2.5, respectively). Botulinum toxin therapy proved effective in reducing sweat production and improving the quality of life in axillary hyperhidrosis patients over a one-year period. These improvements were statistically significant in both physical and psychosocial domains. The study highlights the potential long-term benefits of Botox therapy for hyperhidrosis.

The Impact of bilateral endoscopic thoracic sympathectomy on hyperhidrosis patients’ quality of life and its link to psychiatric disorders

Background and Aims: To measure the Quality of Life (QOL) of patients with hyperhidrosis after undergoing Bilateral en¬doscopic thoracic sympathectomy (BETS), and its association with psychiatric disorders, that were diagnosed using MINI psychiatric interview, and compensatory hyperhidrosis (CH). Methods: A retrospective cross-sectional study was carried out on patients with primary hyperhidrosis after undergoing BETS. 50 Patients were recruited from King Saud University Medical City database and contacted via phone calls. The interview contained a hyperhidrosis-specific QOL questionnaire, and a diagnostic psychiatric questionnaire MINI. The QOL results were classified into 5 categories and used to study QOL and its associated factors. Results: The reported QOL before the operation has 52% of the patients showing negative QOL. Alternately, the reported QOL after the operation improved with 96% patients showing positive QOL. Among this sample, 76% reported suffering from CH post procedure, 28% were diagnosed with one or more mood disorders, and 20% were diagnosed with one or more anxiety disorders. No statistical relationship was found linking the QOL of the sample to the occurrence of CH or the presence of any common psychiatric disorder. Conclusions: In conclusion, there was a significant improvement in the patients’ QOL after BETS. The improvement in QOL was unaffected by the surgeries most notable complication, compensatory hyperhidro¬sis, or the presence of any common psychiatric disorder that they were diagnosed with post-surgery. Further research is needed to explore factors that may affect the QOL of these patients.

Enhancing Quality of Life: Pre- and Postoperative Assessment in Idiopathic Hyperhidrosis Patients.

This study aimed to characterize patients, describe surgical complications, and evaluate the pre- and postoperative quality of life (QOL) of individuals who underwent surgery for primary hyperhidrosis (PHH). A prospective, non-randomized, uncontrolled study was conducted, documenting cases of patients undergoing surgery for PHH at a reference center in La Habana, Cuba, from January 2016 to December 2022. A total of 49 cases were described, with a median age of 16 years; 59.1% were female. The most common presentation was palmar-plantar-axillary, observed in 53% of cases. The palmar presentation was more frequent in female patients (p<0.05). Within 24 hours post-procedure, 85.7% of patients showed dryness in the palmar and axillary areas, with surgical complications occurring in 14.3% of cases (intercostal neuritis, pneumothorax, and hemothorax). CHof some form was recorded in 89.8% of cases. At least 30 days after the surgery, 95.9% of the patients reported a significant improvement in their QOL. Thoracic sympathectomy is an efficient and safe method for treating hyperhidrosis in adolescents, leading to an enhanced QOL. However, this study reported a higher incidence of complications, particularly CH, compared to previous national and international studies.

T3-T5 Thoracoscopic sympathectomy versus sympathicotomy in the treatment of palmar–axillary–plantar hyperhidrosis

Background Compensatory hyperhidrosis is a common complication after thoracoscopic interruption of the sympathetic chain in hyperhidrosis patients. Nonetheless, no interruption technique has been defined to decrease the incidence of that dreadful complication. Herein, we compared T3-5 sympathectomy with sympathicotomy at the same levels with regard to postoperative outcomes. Methods Eighty patients diagnosed with primary palmar–axillary–plantar hyperhidrosis were randomized into two equal groups: the sympathectomy and sympathicotomy groups. They were followed up for 6 months after the procedure. The incidence and criteria of compensatory hyperhidrosis were compared between the two approaches. Results The sympathectomy group showed a significant prolongation of the operative time. However, postoperative pain, hospital stay, and the incidence of complications were statistically comparable between the two approaches. Both procedures were associated with a significant decline in the severity of sweating in the three regions, which was more prominent in the palmar and axillary regions compared with the foot. The incidence of compensatory hyperhidrosis was 65% in sympathectomy patients and 77.5% in sympathicotomy patients, with no significant difference between them (P=0.217). About two-thirds of these cases were temporary, and the majority of them had mild to moderate symptoms. Patient satisfaction did not differ between the two approaches, with poor satisfaction in patients with permanent compensatory hyperhidrosis. Conclusion Both sympathectomy and sympathicotomy had comparable outcomes in patients with palmar–axillary–plantar hyperhidrosis, manifested in comparable decreased sweating severity, incidence of compensatory hyperhidrosis, quality of life, and patient satisfaction.

YouTube is an important resource for hyperhidrosis patients

Background: YouTube is one of the most used information sources. Hyperhidrosis is a disease that needs treatment mostly due to social complaints.&#x0D; &#x0D; Methods: Search titles ‘Hand sweating, Excessive sweating, Armpit sweating, and Hyperhidrosis’ were searched for separately on YouTube. A total of 400 videos, consisting of 100 under each title, were evaluated. Data such as who uploaded the video, which treatment plan it contained, the upload date, country of upload, duration, number of times watched, and rating were recorded. The Video Power index (VPI) was used to evaluate the popularity of the videos in the study.&#x0D; &#x0D; Results: The number of views, number of likes, and VPI of the video group with a duration of 232 s or more were found to be significantly higher than the video group with a shorter duration (P =0.001, P =0.000, and P = 0.000). In commercial videos, the rate of videos featuring non-surgical treatment was found to be the highest at92.1%. It was found that the videos containing surgical treatment were older than the videos containing non-surgical treatment (P =0.028).&#x0D; &#x0D; Conclusion: The internet is an important source of information in diseases such as hyperhidrosis that cause social dysfunction in young patients and the treatment decision is determined entirely by the level of complaint the patient feels. On the YouTube platform, which is one of these sources of information, it was seen that video-assisted thoracoscopic surgery, which is the definitive and permanent treatment of hyperhidrosis, has started to lose its place to alternative methods in recent years.

Robotic Sympathectomy for Hyperhidrosis.

In hyperhidrosis, the body's sweat glands overact. Excessive sweating results from this overactivity, and for many hyperhidrosis patients, managing symptoms can be difficult in day-to-day life. Both surgical and non-surgical types of treatment are available for hyperhidrosis. Surgical treatments include microwave sympathectomy (video-assisted thoracic surgery and robotic). Da Vinci Si and Xi robotic systems are used. This review summarizes the outcomes, complications, advantages, and disadvantages of robotic sympathectomy. We conducted a literature search using PubMed, Cochrane, and Scopus. After analyzing nine articles, we found that robotic sympathectomy decreased compensatory hyperhidrosis with similar outcomes to other procedures. Robotic sympathectomy also reduced complications of Horner syndrome and has changed minimally invasive surgery significantly due to the reduction in tremors by a surgeon's hands to three-dimensional magnified views. It can potentially address the limitations of human video-assisted sympathectomy. However, the higher cost of robotic surgery, longer perioperative time due to the setting up of the machine, and higher training requirements are some of the disadvantages. The advantages of robotic sympathectomy are a reduction in compensatory sweating, better dexterity, loss of tremors, better visualization, and better accuracy. Although the overall success rates seem to be similar between robotic and video-assisted approaches, more studies are needed.

Comparison of the Efficacy of Tap Water Iontophoresis Versus Aluminum Chloride Hexahydrate in the Treatment of Palmoplantar Hyperhidrosis.

To compare the efficacy of tap water iontophoresis (TWI) versus aluminum chloride (AC) hexahydrate in the treatment of palmoplantar hyperhidrosis. The study was a randomized control trial performed at the dermatology department of Pakistan Navy Station (PNS) Shifa Hospital, Karachi from March 2022 to September 2022. A total of 70 palmoplantar hyperhidrosis patients were included in the study after getting approval from the ethical committee. Patients were divided into two groups. Group A patients were treated with TWIthree times a week for four weeks. Group B patients were treated with a 20% ACtopical solution applied at night to the affected areas for four weeks. The Hyperhidrosis Disease Severity Scale (HDSS) score for both groups was calculated at baseline, one, two, three, and four weeks. The final response was labeled at four weeks by comparing mean HDSS reduction in both groups. SPSS version 28 (IBM Corp., Armonk, NY) was used for data analysis. Mean HDSS was compared for both groups at the end of the study, which showed a significant reduction in the mean score from 3.40 ± 0.65 to 1.48 ± 0.78 in group A, as compared to a decline in scores in group B from 3.28 ± 0.67 to 2.14 ± 0.94 (p = 0.002). In group A, zero, one, two, and three points HDSS improvement was 2.9%, 25.7%, 48.6%, and 22.9%, respectively. Whereas in group B, it was 34.3%, 22.9%, 34.3%, and 8.6%, respectively (p = 0.001). As compared to AC topical solution, TWI is an effective, safe, and inexpensive management option for palmoplantar hyperhidrosis. It causes more improvement in HDSS scores and has lesser side effects.

Laparoscopic Superselective Transperitoneal Lumbar Sympathectomy for Treating Plantar Hyperhidrosis

Background: Retroperitoneoscopic lumbar sympathectomyis the standard surgical treatment for plantar hyperhidrosis. However, it is rarely performed due to the technical complexity of the procedure. This study aimed to describe a modified video-assisted lumbar sympathectomy technique, the superselectivetransperitoneal lumbar sympathectomy. Methods: This is a retrospective study of 32 sympathectomies (16 patients) for plantar hyperhidrosis. The procedure is performed with the patient in the supine position and under general anesthesia. A video camera is introduced through the umbilical trocar, and the dissection forceps are introduced through trocars in the suprapubic area and right-and left-iliac fossa. The patient is placed in the Trendelenburg position at the level of the L3 vertebral body.

Mydriasis and anisocoria in a pediatric hyperhidrosis patient with interesting findings in the family cat.

Here, we report a case of unilateral ocular mydriasis in a pediatric patient with longstanding hyperhidrosis, as well as similar findings in her cat. The patient had been undergoing treatment of her hyperhidrosis with topical glycopyrrolate. This case highlights the potential side effect profile of topical antimuscarinics and the importance of counseling patients on proper precautions.

A Review of Hyperhidrosis Treatment Methods

Context: Hyperhidrosis is known to cause numerous individual and social problems with sweating more than the body’s physiological needs. Researchers have discussed the causes of this disease so far; however, factors such as heredity, nervous system defects, infections, and drugs have been introduced as the causes. Evidence Acquisition: Firstly, 127 articles were identified from different databases. After categorizing and removing duplicate papers and reviewing the abstracts and full texts, we selected 50 articles to review and include in this study. Results: Hyperhidrosis is a burdening disorder leading to physical and social problems. Hyperhidrosis patients are not able to efficiently use specific tools such as metallic and electronic devices. Limitations of this disorder show great concern about the performance of military personnel, too. Therapeutic methods such as topical antiperspirants, anticholinergic drugs, surgery, and Botox injections are the therapeutic measures used to treat this disease; each of these treatments is prescribed at different stages of the disease, and the effect of each is observed. Topical treatment is at the forefront of treatment methods for this disease, followed by oral anticholinergic drugs. Iontophoresis is one of the methods considered in the treatment of hyperhidrosis. Besides surgery, Botox injection is one of the effective methods in treating this disease, especially in the palm. Conclusions: This review presents standard treatment methods used in treating hyperhidrosis with particular attention to iontophoresis as an engineering solution to solve health problems. Based on the severity of sweating and the region of hyperhidrosis incidents, there are different solutions to treat hyperhidrosis. Topical and anticholinergic therapies are the most common treatment options. However, there are other more effective treatment methods, such as iontophoresis and Botox delivery. Iontophoresis is effective and has a long-term effect on preventing sweating with fewer side effects. Suction curettage surgery is an invasive method to treat patients with hyperhidrosis.

Skin temperature response to thermal stimulus in patients with hyperhidrosis: A comparative study

Primary hyperhidrosis (HH), the excessive sweating exceeding physiological demand, has been associated to a complex dysfunction of the autonomic nervous system which may explain the disfunction in sweating but may also cause unrevealed alterations in skin blood flow regulation. In fact, HH patients present a sympathetic over-function with less reflex bradycardia in response to the Valsalva maneuver and higher sympathetic skin responses. We aimed to identify response patterns to room thermal stimulus in HH patients compared to a control group in order to investigate putative differences in blood flow assuming that skin temperature in glabrous (non-hairy) areas reflect the sympathetic tone in arteriovenous anastomoses (AVAs). Infrared thermography images were obtained from a cohort of patients diagnosed with HH, followed at a hospital pediatric surgical department and to a sex- and age-matched control group of patients admitted for other surgical procedures. With the participants in Fowler's position, a set of 3 images were captured simultaneously and 44 regions of interest were analyzed, distributed on the palms of the hands, soles of the feet, axilla, and inner canthus. After an acclimatization period at 20 °C, the room temperature was increased to 24, 28 and 32 °C to obtain similar sets of thermograms. A total of 37 patients with HH and 16 participants in the control group were included in the study. At baseline (20 °C), body core temperature (measured in the inner canthus) was significantly higher in the HH patients compared to the controls (p = 0.019 and p = 0.003 in right and left inner canthi, respectively), without any significant differences in the other thermograms. When room temperature was increased, differences in core temperature disappeared, while differences appeared in axilla and palms of the hands with HH patients presenting significantly lower temperature at the three thermal stimulus stages. Patients with HH presented a lower thermoregulatory response when submitted to room temperature increase, which may reflect a vasomotor sympathetic over-function in AVAs.

The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study

Background: We aimed to investigate the impact of the COVID-19 pandemic on the degree of depression among hyperhidrosis patients and their quality of life. Methods: 222 patients were contacted through an online questionnaire. Patients reported quality of life (QoL), including treatment and changes in symptoms during the pandemic, and also responded to the Patient Health Questionnaire-9 (PHQ-9) to evaluate the severity of depression. Those were compared with the result from the general population. Spearman correlation and multiple linear regression were performed to identify the factors related to the PHQ-9 score. Results: Half of the patients were female. The mean PHQ-9 score (5.25) of hyperhidrosis patients was higher than the general population, and female patients displayed significantly higher PHQ-9 scores than males (p = 0.002). QoL was impaired more in females. About 10% of patients experienced worsening symptoms, and 30% had difficulties getting appropriate management. Significant negative correlations were found between the PHQ-9 and age or disease duration. Predictive factors for the PHQ-9 were female (p = 0.006) and facial hyperhidrosis (p = 0.024). Conclusions: The level of depression among hyperhidrosis patients was higher than the general population during the COVID-19 pandemic; female and facial hyperhidrosis patients need much more psychiatric attention. Though hyperhidrosis is classified as benign and often neglected by clinicians, we need to give more awareness to the mental burden imposed by the COVID-19 pandemic.

Repeated Single Level Lumbar Sympathetic Neurolysis using Alcohol in a Plantar Hyperhidrosis Patient: A 5-year Follow-up Case Report

Background: Plantar hyperhidrosis causes discomfort in daily life. However, there are few reports on sympathetic neurolysis in plantar hyperhidrosis. Case: A 19-year-old woman complained of excessive sweating of both hands and feet. Using video-assisted thoracic surgery, the patient underwent bilateral T3 sympathectomy in the department of chest surgery. One year later, she visited pain clinic with with plantar hyperhidrosis and wanted to undergo sympathetic block. Lumbar sympathetic neurolysis was performed using 2.5 ml of pure anhydrous alcohol at the L4 vertebral level. The symptoms improved after the procedure, and there were no side effects. The patient again underwent sympathetic neurolysis as the symptoms recur. Conclusions: Repeated lumbar sympathetic neurolysis was performed in a patient with plantar hyperhidrosis, and its success was confirmed during 5 years of follow-up.

Can thiol-disulfide balance be an indicator of oxidative stress for hyperhidrosis?

Hyperhidrosis is responsible for various causes. The increased reactive oxygen radical production with insufficient antioxidant mechanism capacity may play a role in the etiopathogenesis of hyperhidrosis. It is probable to gather data about oxidative stress by detecting plasma thiol/disulfide ratio. The aim of this study was to determine whether thiol-disulfide balance changes in patients with hyperhidrosis. The files of patients who were diagnosed with hyperhidrosis in the dermatology outpatient clinic between 2015 and 2018 and whose native thiol, total thiol, and disulfide values were examined for any reason were examined. Seventy-three patients were included in the study. 33 of the patients with hyperhidrosis were primary. Mean age; for primary hyperhidrosis patients (PHH)=26.36±7.61, primary hyperhidrosis (PHH) control group=27.16±7.94; secondary hyperhidrosis (SHH) patients=47.88±12.29, SHH control (45.40±12.02). The native thiol values of PHH (469.93±56.82μmol/L) were higher than SHH (440.64±62.72) (p=0.024). However, as a result of thiol-disulfide comparison between hyperhidrosis patients (PHH and SHH) and control groups, disulfide levels increased (p=0.04). In the PHH group, total thiol was measured as 512±54.84μmol/L, and SHH was measured as 484.11±58.9μmol/L, (p=0.074). Serum thiol levels in SHH increased more than PHH. As a result of thiol-disulfide comparison between hyperhidrosis patients and control groups, the balance shifted in favor of disulfide and oxidative side.

Topical glycopyrronium tosylate in Japanese patients with primary axillary hyperhidrosis: A randomized, double-blind, vehicle-controlled study.

Glycopyrronium tosylate cloth, an anticholinergic drug, has been approved for the topical treatment of primary axillary hyperhidrosis in the USA, but its effects in Japanese patients have not been previously investigated. This 4‐week, randomized, double‐blind, vehicle‐controlled, multicenter study was conducted to evaluate the efficacy and safety of glycopyrronium tosylate cloth for primary axillary hyperhidrosis patients in Japan. Eligible patients, who were ≥9 years of age and had primary axillary hyperhidrosis ≥6 months, with gravimetrically‐measured sweat production ≥50 mg/5 min, and Hyperhidrosis Disease Severity Scale ≥3 (moderate) were randomized 1:1:1 to once daily topical glycopyrronium tosylate 3.75%, 2.5%, or vehicle. Overall, 497 patients (163 in the glycopyrronium tosylate 3.75% group, 168 in the glycopyrronium tosylate 2.5% group, and 166 in the vehicle group, hereinafter in this order) were randomized. Statistically higher proportions of patients in the glycopyrronium tosylate groups achieved ≥2‐point improvement in Hyperhidrosis Disease Severity Scale and ≥50% reduction in sweat production from baseline versus vehicle at week 4 (51.6%, 41.1%, and 16.4%, respectively; p < 0.001 in both cases). Higher responder rates in the glycopyrronium tosylate groups compared with the vehicle group occurred as early as week 1. The most common treatment‐emergent adverse events in patients treated with glycopyrronium tosylate were photophobia, mydriasis, thirst, and dysuria. Most treatment‐emergent adverse events were mild as determined by the investigators. The incidence of treatment‐emergent adverse events leading to treatment modification was low in the three groups. The 4‐week use of topical glycopyrronium tosylate improved the patient‐reported outcome measure Hyperhidrosis Disease Severity Scale and objectively‐evaluated sweat production with a favorable benefit/risk profile.

Selective T3\u2013T4 sympathicotomy versus gray ramicotomy on outcome and quality of life in hyperhidrosis patients: a randomized clinical trial

Compensatory hyperhidrosis is the leading cause of patients' dissatisfaction after thoracic sympathicotomy. The study aimed to reduce compensatory hyperhidrosis to increase patients’ satisfaction. A prospective randomized study on palmar hyperhidrosis, May 2016–September 2019. Twenty-one patients T3–T4 sympathicotomy and 21 T3–T4 gray ramicotomy. Data prospectively collected. Analysis at study's end. Focus on the sweating, temperature, quality of life baseline and postoperatively, compensatory hyperhidrosis, hand dryness, patients' satisfaction, and if they would undergo the procedure again and recommend it. No baseline differences between groups. Hyperhidrosis was controlled postoperatively in all patients. No mortality, serious complications, or recurrences. Sympathicotomy worse postoperative quality of life (49.05 (SD: 15.66, IR: 35.50–63.00) versus ramicotomy 24.30 (SD: 6.02, IR: 19.75–27.25). After ramicotomy, some residual sweating on the face, hands, and axillae. Compensatory sweating worse with sympathicotomy. Satisfaction higher with ramicotomy. Better results with ramicotomy than sympathicotomy regarding hand dryness, how many times a day the patients had to shower or change clothes, intention to undergo the procedure again or recommend it to somebody else, and how bothersome compensatory hyperhidrosis was. T3–T4 gray ramicotomy had better results than T3–T4 sympathicotomy, with less compensatory sweating and higher patients' satisfaction.