Treatment Of Focal Hyperhidrosis Research Articles

A retrospective analysis of the use of tap water iontophoresis for focal hyperhidrosis at a district general hospital: the patients’ perspective

Objective: Tap water iontophoresis as a treatment for focal hyperhidrosis is given as an initial series of treatments in hospital, followed by home maintenance treatments. Our study assessed quality of life and perception of hyperhidrosis with the use of iontophoresis.Materials and methods: All patients treated with iontophoresis at our hospital from 2012 to 2017 were retrospectively assessed (n = 82, mean age 34 years; 60% female). Fifty of the 82 patients (mean age 34 years; 60% female) had a pre-treatment DLQI (mean 12.6). Twenty-three of these patients (mean age 33 years; 60% female) had a paired pre- and post-treatment DLQI recorded. The average DLQI pre-treatment was 14.1 and post-treatment was 2.2. Therefore, the average reduction (improvement) was 11.9 (p < .05).Results: Thirty-eight of the 82 patients (46%) completed a telephone interview (mean age 35 years; 65% female). Of this cohort, 24 had an improvement in HDSS following treatment, and the remaining 14 patients had no change. Nine patients (24%) bought their own iontophoresis machine. In these patients, there was a higher average improvement in HDSS (1.8), compared to the total interviewed cohort (1.0).Conclusion: In conclusion, tap water iontophoresis can result in a significant improvement in perceived severity of hyperhidrosis and quality of life.

Treatment of Focal Hyperhidrosis With Needleless Injections of Botulinum Toxin Into Sites Other Than the Axilla, Palm, and Sole.

Treatment of Focal Hyperhidrosis With Needleless Injections of Botulinum Toxin Into Sites Other Than the Axilla, Palm, and Sole.

Botulinumtoxin in der Dermatologie

Treatment with botulinum toxin (BTX) type A has become increasingly important in various clinical areas in dermatology. Particularly popular is the therapy with BTX for hyperkinetic lines associated with muscles of facial expression in aesthetic dermatology, which is the most frequent wrinkle treatment undertaken worldwide. Therapy with BTX also ranks high in curative dermatology. Injections with BTX are the most effective nonoperative therapy for hyperhidrosis. Common indications for the treatment of hyperkinetic lines with BTX are presented in this publication. Therapy of glabellar lines, which has received regulatory approval, is presented in detail. In the second part, treatment of focal hyperhidrosis with emphasis on axillary hyperhidrosis is addressed. In the hand of the experienced practitioner, treatment with BTX in a suitable area of indication is a very safe and effective procedure that leads to remarkable treatment results, associated with a very high patient satisfaction.

Thoracoscopic sympathectomy increases efferent cardiac vagal activity and baroreceptor sensitivity

Thoracoscopic sympathectomy at levels T2 or T2-T3 is a treatment for focal hyperhidrosis and facial blushing. These levels of the sympathetic trunk innervate the heart, and consequently, the procedure is reported to change the heart rate variability due to changes in efferent cardiac autonomic activity. Our objective was to investigate the effects of thoracoscopic sympathectomy on global autonomic control, including baroreceptor sensitivity. Eight patients (6 F, median age 28 years [range 20-58 years]) were exposed to the tilt-table test and cardiopulmonary exercise test before, and 3 months after, thoracoscopic sympathectomy. Eight healthy age-, gender- and BMI-matched controls were used as controls and underwent the same tests once. During tilt-table testing electrocardiogram, blood pressure, impedance cardiography and respiration were measured continuously, and efferent cardiac autonomic balance was estimated. The heart rate measured during orthostatic stress test was lowered after thoracoscopic sympathectomy (between-group; P = 0.01) due to a change in autonomic tone, with increased vagal (high-frequency power n.u.; P = 0.001), and reduced sympathetic efferent cardiac activity (low-frequency power n.u.; P < 0.001). Baroreceptor sensitivity measured during rest was increased (26 ± 13 vs 44 ± 19 ms/mmHg; P = 0.01), and diastolic blood pressure reduced after surgery (P = 0.01). The increases in systolic blood pressure and the sympathetic marker CCV-LF in response to orthostatic stress were higher before sympathectomy, with almost no increases post-surgically (condition × group interaction; P = 0.01 and P = 0.001, respectively). We found no change in post-procedure exercise capacity, although patients had a lower peak VO2 and maximal cardiac index than controls. Thoracoscopic sympathectomy changes the autonomic tone towards increased vagal activity; this is potentially cardioprotective. To our knowledge, this is the first study to show increased baroreceptor sensitivity after thoracoscopic sympathectomy.

Antiperspirantien bei der Behandlung der fokalen Hyperhidrose

In Europe often no clear distinction is made between deodorant and antiperspirant. Particularly in Germany, the labeling "deo" is used for both. Only antiperspirants are capable of influencing the activity of eccrine sweat glands. In the treatment of focal hyperhidrosis, the use of aluminum chloride solutions represents the first choice. The efficacy is well documented in a variety of studies. Subjective side effects include pruritus and - less often - irritant dermatitis, which can be treated symptomatically and usually does not require discontinuation of the treatment. Rare variants of focal hyperhidrosis like auriculotemporal syndrome, Ross syndrome and nevus sudoriferus also are suitable for treatment with topical aluminum chloride hexahydrate solutions.

Treatment of Focal Hyperhidrosis

Focal hyperhidrosis is not rare, affecting over 2.5% of the population. This condition is often socially and professionally debilitating, leading to significant quality of life impairment. It most commonly involves the axillae, palms, soles, and face. To review hyperhidrosis and discuss and compare the treatment options currently available. Topical or systemic therapies may be helpful for patients with mild disease. Invasive surgical options, although often effective, are limited by complications. More recently, botulinum toxin injection has proven to be a safe and successful treatment for hyperhidrosis and results in high patient satisfaction. Botulinum toxin A (Botox, Allergan Inc., Irvine, CA) is currently approved in the United States, Canada, the United Kingdom, and many other countries for the treatment of axillary hyperhidrosis and is routinely used off-label for other anatomic sites.

Botulinum toxin type A by iontophoresis for primary palmar hyperhidrosis

Botulinum toxin type A by iontophoresis for primary palmar hyperhidrosis

Botulinum toxin in the treatment of focal hyperhidrosis

Focal hyperhidrosis is excessive sweating affecting approximately 2–3% of the population. The condition is mainly confined to axillary and palmoplantar regions and treatment is still a challenge. Conventional treatment options, such as topical antiperspirant agents, systemic anticholinergics or iontophoresis, do not usually provide satisfactory results. Although surgical techniques are effective, they are not always practical to perform and carry the risk of surgical complications. Botulinum toxin therapy, which acts by blocking acetylcholine release during nerve stimulation, has become one of the most favorable therapies for hyperhidrosis within recent years, with effective and safe results. This paper highlights the main issues regarding the use of botulinum toxin therapy in the treatment of hyperhidrosis by reviewing the literature and the authors’ own experiences.

The place of botulinum toxin type A in the treatment of focal hyperhidrosis: reply from authors

The place of botulinum toxin type A in the treatment of focal hyperhidrosis: reply from authors

The place of botulinum toxin type A in the treatment of focal hyperhidrosis

Conflicts of interest: none declared. Sir, I read with great interest the paper by Lowe et al.1 in which they discuss the place of botulinum toxin type A (BTX‐A) in the treatment of focal hyperhidrosis (HH) and propose, based on published data, an algorithm for axillary HH and a second for palmar HH. I agree with the authors that topical medications should be used as first‐line therapy where practical. In that sense I would like to indicate that treatment with supersaturated concentrations of aluminium chloride (AlCl3) ranging from 25% to 50% in a 4–6% salicylic acid (SA) gel should be considered, particularly on the palms and soles,2 alone or in combination with other therapeutic modalities such as iontophoresis and BTX‐A, before resorting to surgery. Even patients with axillary HH, who failed to respond to AlCl3 in alcohol or did not tolerate it, found AlCl3 in the gel formulation3 more effective and better tolerated. The details of this extemporaneous formulation have already been published.4

The place of botulinum toxin type A in the treatment of focal hyperhidrosis

Hyperhidrosis (primary or secondary) is excessive sweating beyond that required to return body temperature to normal. It can be localized or generalized, commonly affecting the axillae, palms, soles or face, and can have a substantial negative effect on a patient's quality of life. Objective evaluation comprising quantitative assessment (gravimetric and Minor's iodine starch test) and subjective evaluation (Dermatology Quality of Life Index and Hyperhidrosis Impact Questionnaire) allow accurate assessment of the impact of hyperhidrosis on patients. Botulinum toxin type A acts by inhibiting the release of acetylcholine at the presynaptic membrane of cholinergic neurones. It has proved useful in treating a number of diseases relating to muscular dystonia and is now proving beneficial in treating hyperhidrosis. Clinical trials investigating botulinum toxin type A use in axillary and palmar hyperhidrosis show significant benefits with few side-effects reported, with a favourable impact also being seen on patient quality of life. Botulinum toxin type A injections are generally well-tolerated with beneficial results lasting from 4 to 16 months. Botulinum toxin type A injections are an effective and well-tolerated treatment for hyperhidrosis. This paper proposes a positioning of this treatment along with current established treatments, and highlights the role of botulinum toxin type A as a valuable therapy for the treatment of hyperhidrosis.

Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin

Background: Botulinum toxin (Btx A) has recently been used in the treatment of focal hyperhidrosis. Hyperhidrosis is also an aggravating factor in nearly 40% of patients with dyshidrotic hand eczema. Objective: The objective of this study was to evaluate the effect of intradermal injections of Btx A on dermatitis in patients with vesicular hand dermatitis. Methods: Ten patients with vesicular dermatitis were treated on one hand with intradermal Btx A (mean, 162 U BOTOX, Allergan Pharmaceuticals, Irvine, Calif) with the untreated side as a control. Results: Self-assessment at follow-up 5 to 6 weeks after injection on a 5-point scale (none, slight, moderate, good, or very good effect) showed that 7 of 10 patients experienced good or very good effect. A decrease in itching was shown with a visual linear analogue scale (VAS) for itching, with mean 39% on the treated side compared with an increase by 52% on the untreated side. These findings were supported by the evaluation of clinical signs. Six of 7 patients who experienced good or very good effect also had aggravating hand sweating or worsening during the summer. Conclusion: Btx A can be a valuable alternative for patients with treatment-refractory hand eczema of the vesicular type, especially with hyperhidrosis or worsening during the summer. (J Am Acad Dermatol 2002;47:667-71.)

Long-term efficacy and quality of life in the treatment of focal hyperhidrosis with botulinum toxin A.

Botulinum toxin A has been used increasingly in the treatment of focal hyperhidrosis. To assess the long-term efficacy of botulinum toxin A in the treatment of hyperhidrosis and the changes in quality of life and patient satisfaction with treatment. A questionnaire was designed to assess the efficacy using visual analog scales and the quality of life both before and after treatment using a modified Dermatology Life Quality Index scale. There was a reduction in the hyperhidrosis and a statistically significant improvement in the quality of life scores for the axillae, palms, and forehead. Botulinum toxin A injections are safe and effective for the treatment of hyperhidrosis of the axillae, palms, and forehead, resulting in an improved quality of life for patients.

Long-Term Efficacy and Quality of Life in the Treatment of Focal Hyperhidrosis with Botulinum Toxin A

BACKGROUND Botulinum toxin A has been used increasingly in the treatment of focal hyperhidrosis. OBJECTIVE To assess the long-term efficacy of botulinum toxin A in the treatment of hyperhidrosis and the changes in quality of life and patient satisfaction with treatment. METHODS A questionnaire was designed to assess the efficacy using visual analog scales and the quality of life both before and after treatment using a modified Dermatology Life Quality Index scale. RESULTS There was a reduction in the hyperhidrosis and a statistically significant improvement in the quality of life scores for the axillae, palms, and forehead. CONCLUSION Botulinum toxin A injections are safe and effective for the treatment of hyperhidrosis of the axillae, palms, and forehead, resulting in an improved quality of life for patients.

Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients.

The blocking action of botulinum toxin type A (BTX-A) on cholinergically innervated sweat glands has been used successfully to treat patients with focal hyperhidrosis. To investigate the long-term efficacy and safety of intradermal injections of BTX-A. We performed an open-label study in 61 patients treated over a period of 3 years for axillary or palmar hyperhidrosis. A total dose of 400 mU BTX-A (Dysport) was injected into both axillae or 460 mU BTX-A (Dysport) into both palms. The injections were repeated after relapse. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. Four weeks after BTX-A treatment the median reduction in sweat production was 71% compared with baseline (P < 0.001) in the axillary group and 42% (P = 0.005) in the palmar group. Subjective assessment of sweat production by the patients using a visual analogue scale (0, no sweating; 100, the most severe sweating) showed a significant reduction in both the axillary (P < 0.001) and palmar groups (P < 0.001). Secondary disturbances due to focal hyperhidrosis interfering with daily activities were markedly improved in both groups. The median time interval between the sets of injections was 34 weeks for axillary hyperhidrosis and 25 weeks for palmar hyperhidrosis. The treatment of palmar hyperhidrosis was complicated by transient but not disabling weakness of the small hand muscles in nine of 21 patients. Repeated intradermal injections of BTX-A in patients with axillary and palmar hyperhidrosis are as effective as first treatments.

2-03-02 Treatment of focal hyperhidrosis with botulinum toxin

2-03-02 Treatment of focal hyperhidrosis with botulinum toxin