Treatment Of Hyperhidrosis Research Articles

Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients.

Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

Minimally Invasive Sympathicotomy for Palmar Hyperhidrosis and Facial Blushing: Current Status and the Hyperhidrosis Expert Center Approach.

Hyperhidrosis, the medical term for excessive sweating beyond physiological need, is a condition with serious emotional and social consequences for affected patients. Symptoms usually appear in focal areas such as the feet, hands, axillae and face. Non-surgical treatment options such as topical antiperspirants or systemic medications are usually offered as a first step of treatment, although these therapies are often ineffective, especially in severe and intolerable cases of hyperhidrosis. In the treatment algorithm for patients suffering from hyperhidrosis, surgical thoracoscopic sympathicotomy offers a permanent solution, which is particularly effective in the treatment of palmar hyperhidrosis and facial blushing. In this review, we describe the current status of thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing. In addition, we share the specific treatment approach, technique and results of our Hyperhidrosis Expert Center. Last, we share recommendations to ensure an effective, reproducible and safe application of single-port thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing, based on our extensive experience.

Segmental anhidrosis and heat intolerance

A 62 year-old woman with no previous medical history presented to the Dermatology department with sweating disorders for several years. She described segmental hyperhidrosis and hyperemia while running. This excessive sweating occurred in the left hemiface, the left half of the trunk, the left upper limb and the right lower limb (Fig. 1A). This was associated with heat intolerance and previous faintness during sport. She did not describe any chest pain before faintness and the cardiac auscultation was normal. The neurological examination revealed a diffuse areflexia in the absence of any sensory or motor disorders. By illuminating the right eye, we observed a delay in ipsilateral pupillary contraction, whereas we observed an absence of the consensual photomotor reflex of the right eye by illuminating the left eye (Adie's tonic pupil, Fig. 1B and C, and Supplementary file 1). However, she did not complain of reduced visual acuity. Ross syndrome is a rare autonomic disorder caused by a selective degenerative process of the postganglionic cholinergic sudomotor neurons [[1]Sommer C. Lindenlaub T. Zillikens D. Toyka K.V. Naumann M. Selective loss of cholinergic sudomotor fibers causes anhidrosis in Ross syndrome.Ann Neurol. 2002; 52: 247-250Google Scholar]. Ross syndrome is diagnosed by the presence of a triad of symptoms associating segmental anhidrosis (with compensatory hyperhidrosis), Adie's tonic pupil and areflexia [[2]Mishra A.K. Kharkongor M. Kuriakose C.K. George A.A. Peter D. Carey R.A.B. et al.Is ross syndrome an autoimmune entity? A case series of 11 patients.Can J Neurol Sci. 2017; 44: 318-321Google Scholar]. The main complaint of patients is generally the segmental compensatory hyperhidrosis, the anhidrosis in contrast is not even noticed. The two other signs must be specifically examined for to make the diagnosis. The deep tendon hyporeflexia or areflexia affects the four limbs, whereas the tonic pupil is observed on the pathological and anhidrotic side of the face. It has been proposed to treat hyperhidrosis with botulinum toxin [[3]Bergmann I. Dauphin M. Naumann M. Flachenecker P. Müllges W. Koltzenburg M. et al.Selective degeneration of sudomotor fibers in Ross syndrome and successful treatment of compensatory hyperhidrosis with botulinum toxin.Muscle Nerve. 1998; 21: 1790-1793Google Scholar], but this treatment may theoretically increase the heat intolerance and the risk of faintness during sport. Even if the disorder is benign, the objective is to avoid any faintness. Clinicians should advise patients with Ross syndrome to wear light clothing for sports and to avoid excessive heat exposure.

Knowledge of surgical management of hyperhidrosis among primary care physicians and the general public.

OBJECTIVESOur study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public.METHODSAn online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public’s perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey.RESULTSThe majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery.CONCLUSIONSNeither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.

Comparison of 10 versus 20 sessions tap water iontophoresis efficacy in the treatment of palmoplantar hyperhidrosis.

Tap water iontophoresis (TWI) is an effective treatment option for palmoplantar hyperhidrosis (HH). However, the optimal number and frequency of TWI sessions to control profuse sweating are unclear. To compare the efficacy of 10 and 20sessions of TWI in patients with palmoplantar HH and determine the adequate number of sessions to achieve a favorable clinical response. Eighty patients treated with TWI for palmoplantar HH were included. The alteration in sweating intensity considering the mean value of gravimetric measurement and mean visual analog scale (VAS) scores after the 10th and 20th session of TWI were calculated. The difference between performing 10 and 20sessions of TWI in providing improvement of HH was analyzed. We also conducted a telephone-based inquiry to determine the patients' outcome. The reduction in sweating intensity was significant both after the 10th (p<0.001) and 20th (p<0.001) sessions when compared with the basal level considering gravimetry and VAS. When the mean sweating intensity after the 10th and 20th sessions were compared, no difference was observed gravimetrically (p=0.03); the difference between the mean score of VAS after the 10th and 20th sessions (p<0.001) was significant. Eleven and nine patients not considering a maintenance or an alternative treatment had lower and same sweating intensity as compared with the baseline, respectively. Ten TWI sessions within two weeks for managing palmoplantar HH are adequate to achieve a clinical response. However, the patients are more satisfied when they receive 20sessions instead of 10sessions of TWI.

Sofpironium bromide: an investigational agent for the treatment of axillary hyperhidrosis

ABSTRACT Introduction In recent years, increased knowledge about pathophysiology of primary hyperhidrosis has led to novel therapeutic advances. Topical and systemic anticholinergic agents have been proven beneficial in reducing sweat production in primary axillary hyperhidrosis (PAH), although their use is limited by the increased likelihood of systemic anticholinergic drug reactions, particularly regarding systemic agents. Areas covered This paper provides an overview of pharmaceutical characteristics, efficacy and safety data from phase II and III clinical trials on sofpironium bromide (SB), a topical anticholinergic agent that has been employed for the treatment of PAH and has already received its first approval in Japan for the treatment of PAH in the form of 5% gel formulation. Expert opinion The retrometabolic drug design of topical SB presents distinct advantages, by limiting systemic absorption and therefore development of anticholinergic adverse events. This along with the popularity of the non-greasy gel formulation is expected to increase compliance. However, this therapy still offers a temporary control of PAH, compared to sympathectomy or device-based treatments, such as microwave thermolysis. Hence, physicians should balance the effectiveness against adverse events of each therapeutic modality and use a personalized approach based on patient’s needs.

A Survey on Clinical Effectiveness and Patients’Satisfaction of Sofpironium Bromide in the Treatment of Primary Axillary Hyperhidrosis

A Survey on Clinical Effectiveness and Patients’Satisfaction of Sofpironium Bromide in the Treatment of Primary Axillary Hyperhidrosis

Diode Laser 1470 nm versus Diode Laser 980 nm for Treatment of Primary Axillary Hyperhidrosis

Diode Laser 1470 nm versus Diode Laser 980 nm for Treatment of Primary Axillary Hyperhidrosis

Efficacy, Safety and Quality of Life of Oxybutynin versus Aluminum Chloride Hexahydrate in Treating Primary Palmar Hyperhidrosis.

Palmar hyperhidrosis is characterized by excessive sweating beyond the physiological needs of the patient's body and the most frequent form is primary or essential. Different treatments protocols have been proposed to control or decrease sweating. This study aimed to compare the efficacy and safety of oral oxybutynin versus topical aluminum chloride hexahydrate (ACH) in treating primary palmar hyperhidrosis. Also, to assess quality of life (QOL) as a measure of improvement of hyperhidrosis state. Patients were randomized using the block randomization with sealed envelope method into two treatment groups; oral oxybutynin group and topical ACH group. Hyperhidrosis Disease Severity Scale (HDSS) was used as a primary outcome measure to assess the efficacy of the drug in both groups. Clinical grading and the QOL were used as secondary outcome measures. The safety was evaluated by recording side effects in the follow-up visits. HDSS, clinical grading and QOL score showed a statistically significant improvement in the oral oxybutynin groups. One week after stoppage of treatment, the symptoms recurred again in both groups with return of HDSS and QOL scores to pretreatment levels. The most common side effects were dry mouth (65.8%) and itching (65.0%) for oral oxybutynin group and topical ACH group; respectively. Treatment of primary palmar hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it gives better results and much more improvement in QOL when compared to topical ACH. QOL questionnaire and clinical grading should also be considered as useful tools in the assessment of response to treatment.

Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities.

Hyperhidrosis is a disorder of sweat glands characterized by overproduction of sweat, which is inadequate to the thermoregulatory needs of the body system. Owing to the heavy social and economic burden of the disproportionate perspiration, current treatment methods still do not seem to be sufficient enough to reach patients’ expectations. Therefore, the researchers continue a robust pursuit of novel therapy modalities such as topical treatment methods, oral agents, minimally-invasive medical approach and surgical techniques. In this review article authors summarise the disease outline with the emphasis on the new era of hyperhidrosis treatment methods.

Hyperhidrosis treatments in hidradenitis suppurativa: A systematic review.

Hyperhidrosis impairs quality of life (QOL) in hidradenitis suppurativa (HS) patients and may exacerbate HS. However, there is limited literature on whether hyperhidrosis treatments improve HS disease. To systematically review literature on efficacy and tolerability of hyperhidrosis treatments in HS patients. In May 2021, MEDLINE and EMBASE databases were systematically searched by two reviewers per PRISMA guidelines for articles on hyperhidrosis and HS. Sixteen articles met inclusion criteria (2 randomized controlled trials [RCTs], one case-control study, three cross-sectional studies, 10 case-studies/series), encompassing 252 HS patients across studies. They examined botulinum toxin A (BTX-A) (n=6) and B (BTX-B) (n=1), suction-curettage (n=1), diode laser (n=1), and microwave-based energy device (MED) (n=3). Overall, BTX treatments improve HS severity, QOL, hyperhidrosis, and were well-tolerated. Suction-curettage did not improve disease. One HS patient tolerated diode laser well, with improvement in sweating and HS. One RCT studying MED was discontinued due to adverse events. Two studies reported MED-induced HS. BTX was overall helpful in HS patients, including in patients without concomitant hyperhidrosis. However, more prospective studies are needed to examine its utility in HS. There is potential harm of MEDs in HS. Most studies examining hyperhidrosis treatments in HS patients are low level of evidence. Larger RCTs should examine the efficacy and tolerability of hyperhidrosis treatments in HS.

Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

BackgroundPrimary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH.MethodsRLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months.ResultsMean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed.ConclusionsRLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

Investigating Treatment of Primary Axillary Hyperhidrosis With a Topical Retrometabolic Anticholinergic Drug

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A Case Report of Hyperhidrosis with Sympathicotonia Detected by Iris Diagnosis

Objective: The aim of this case study was to describe a case of iris diagnosis of primary hyperhidrosis and the use of Korean medicine.Methods: A patient with symptoms of hyperhidrosis was diagnosed as having Taeeumin after assessment using the four basic Korean diagnostic methods. Iris diagnosis was used for further examination. The images obtained showed a remarkably defined collarette and increased nerve rings, which suggested an overactive sympathetic nerve system. Under the diagnosis of Taeeum, a Korean herbal medicine was prescribed with additional herbs to help alleviate the hyperactivity of the sympathetic nervous system.Results: The patient had been receiving treatment for hyperhidrosis for &gt;30 years, with various medical attempts to relieve her symptoms, which were ineffective. She showed signs of improvement from day 4 into the treatment, and 80% of her symptoms were improved after completing a 6-week treatment course.Conclusion: The herbal medicine prescribed to the patient proved effective for reducing her chronic symptoms that had been unresponsive to previous medical treatments.

Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation.

Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss. To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem. Narrative Literature Review. A literature review focused on the assessment and treatment of excessive sweating of residual limbs. There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation. Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.

Techniques to Relieve Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis.

Palmar and plantar hyperhidrosis (HH) is a common condition characterized by excessive sweating of the palms and soles. Botulinum neurotoxin (BTX) is a very effective and safe treatment. However, the associated intense injection pain is a major limiting factor deterring patients from selecting this treatment. The aim of this study was to review the numerous techniques used to minimize pain accompanying injections for palmoplantar HH. Additionally, the advantages and limitations of each modality will be discussed. The authors performed a comprehensive literature search in PubMed/MEDLINE, Embase, Cochrane Central, and Google Scholar on randomized controlled trials, cohort studies, and case series on techniques to relieve pain of BTX injections for treatment of palmar and plantar HH. Current available techniques in reducing botulinum injection with merits and drawbacks are nerve blocks, Bier blocks, cryoanalgesia, needle-free anesthesia, topical anesthetics, and vibration anesthesia. Topical anesthesia, ice, and vibration are the safest and most convenient noninvasive available methods to relieve pain associated with botulinum injection. Nerve blocks, Bier block, and needle-free anesthesia provide better anesthesia but are limited by the need for training and equipment.

The treatment of palmar hyperhidrosis - a systematic review.

Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management. A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017. Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients' symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement. There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.

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.

Efficacy and Safety of Topical 2% Glycopyrrolate in the Treatment of Facial Hyperhidrosis

Background: Facial hyperhidrosis is a frequent complaint characterized by excessive sweating which usually affects the forehead bilaterally but can also involve other regions of the face such as the scalp, nose, chin and less frequently cheeks. The topical application of 2% glycopyrrolate is safe, efficacious, well tolerated and convenient method in the treatment of facial hyperhidrosis. Objective: The aim of this study was to evaluate the clinical efficacy, safety and tolerability of topical 2% glycopyrrolate in the treatment of facial hyperhidrosis. Patients Methods: This clinical trial was conducted in the Outpatient Clinics of Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twelve patients suffering from primary facial hyperhidrosis were included in this study. They were treated by topical glycopyrrolate gel 2%. Each patient applied the test product to the area affected in their faces once a day for 9 days. Response to treatment was evaluated by starch iodine test. Patient’s satisfaction level and adverse effects were also evaluated. Follow up evaluation was done for detection of any recurrence. Results:9 patients (75%) showed complete response and 2 patients (16.7%) showed partial response. Only one patient showed no response to topical glycopyrrolate 2% after 10 days of treatment. The improvement was lost in 8 patients (66.7%) on the 3rd day of stoppage of treatment and on the next day of stoppage of treatment among 3 patients (25%). Conclusion: Topical glycopyrrolate 2% is safe, efficacious, well tolerated and convenient method in the treatment of facial hyperhidrosis with minimal, transient and well-tolerated side effects.

Effectiveness of Photodynamic Therapy for Management of Primary Palmar Hyperhidrosis

Abstract Background Hyperhidorsis is a condition in which sweat production exceeds that which is needed for thermoregulation, and can affect the hands, feet, axiall, face, back, grain, and legs. It is adisabling condition that affect, both children and adults, with in audience rate of 1-3% and onset usually during childhood or adokscne. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity. Objectives So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using two photosensitizers [MB2% and eosin]. Patients and Methods Twenty patients with primary palmar hyperhidrosis were recruited from the outpatient clinic of the Dermatology and Venereology department, Faculty of Medicine – Ain Shams University during the period from 2017 to 2018. The protocol was approved by Faculty of Medicine, Ain Shams University ethical committee (FWA000017585). An informed written consent was obtained from all patients prior to enrolment in the study. It is a right-left controlled study which included 20 patients with primary palmar hyperhidrosis. Results Our study showed that the PDT had positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least twelve weeks after treatment stoppage. Conclusion Photodynamic therapy is an effective, safe and cheap method for management of primary palmar hyperhidrosis. Both eosin and methylene blue 2% can be used effectively as photosensitizers for photodynamic therapy with good results for treatment of primary palmar hyperhidrosis with minimal tolerable side effects.