A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis

Long-term results of oxybutynin treatment for palmar hyperhidrosis

PURPOSE

Palmar hyperhidrosis (PH) is a common illness that significantly impacts Quality of Life (QOL). Oxybutynin offers excellent short-term results, but long-term follow-up results are limited. We evaluated its effectiveness in a large group of patients who did not have surgery and who had at least 6 months of follow-up.

METHODS

Between September 2007 and September 2013, 570 consecutive patients were enrolled in our institutional protocol regarding the "pharmacological-first" treatment of primary PH with oxybutynin. Fifty-nine were lost to follow-up, and the data were available for 511 patients treated for at least 6 weeks. Data recorded at the start of the protocol, 6 weeks after beginning treatment, and during patients' final visits were analyzed.

RESULTS

112 patients (21.9 %) did not improve and were referred for surgery (sympathectomy). Eight (1.56 %) developed significant side effects (e.g., dry mouth) and discontinued therapy. Thirty (5.9 %) preferred surgery over pharmacological treatment. 111 have not yet received treatment for 6 months. The 246 patients with more than 6 months of follow-up (median 16 months, range 6-72) were analyzed, as follows: 90.2 % experienced moderate or great improvement in their PH; 90.34 % experienced improvement at other sites of hyperhidrosis following a median of 16 months.

CONCLUSION

Among patients with good initial responses to oxybutynin, more than 90 % experienced moderate or great improvement in their palmar sweating, as well as in their hyperhidrosis in other sites, after 6 months. The results were particularly favorable in those patients with BMI <25 kg/m(2), and in those who noted an improved QOL after 6 weeks.

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

Objective:

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.

Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut

INTRODUCTION

Limited procedures at the T4 ganglion show low rates of compensatory sweating (CS). The aim of the study was to compare endoscopic sympathetic block (ESB) via clip application with endothoracic sympathicotomy (ETS) via diathermy with special regard on patients' quality of life (Qol).

PATIENTS AND METHODS

Treatment success, side effects and patient satisfaction were evaluated in a prospectively gathered database of a tertiary-care referral hospital. Two disease-specific Qol questionnaires were used (Keller, Milanez de Campos).

RESULTS

406 operations were performed in 205 patients (ESB4 N = 114, ETS4 N = 91) with a median follow-up of 12 months. Both procedures improved Qol significantly (P < 0.001) and the degree of improvement was equal in both groups. Palmar and axillary HH were ameliorated after both procedures (P < 0.001). Accordingly, plantar HH decreased after ESB4 (P = 0.002), while remaining unaltered after ETS4. Nineteen patients (9.3%) reported CS and 10 patients (4.9%) judged it as "disturbing". Nine of the latter belonged to the ETS4 group compared to one ESB patient (P = 0.015). Patients developed higher rates of plantar CS after ETS4 compared to ESB4 (P = 0.006). Five patients (2.4%) from both cohorts reported persistence of axillary HH. Recurrence of axillary symptoms was found in 5 ESB4 patients. Satisfaction rates did not differ significantly.

CONCLUSION

Patients' Qol and satisfaction rates are similar in both treatment groups for upper limb HH. Outcome and recurrence rates speak in the favor of ETS4, severity of CS and potential reversibility argue for ESB4.

Management of hyperhidrosis

Primary hyperhidrosis (HH), a condition of sweating in excess of thermoregulatory requirements, affects nearly 3% of the US population and carries significant emotional and psychosocial implications. Unlike secondary HH, primary HH is not associated with an identifiable underlying pathology. Our limited understanding of the precise pathophysiologic mechanism for HH makes its treatment particularly frustrating. However, a wide array of interventions for the treatment of HH have been implemented throughout the world. Herein, we discuss the most extensively studied therapeutic options for primary HH, including systemic oxybutynin, botulinum toxin injections, skin excision, liposuction–curettage, and sympathotomy/sympathectomy. We conclude with a discussion of possible future therapies for HH, including the applications of laser, microwave, and ultrasound technologies.

Treatment of uncommon sites of focal primary hyperhidrosis: experience with pharmacological therapy using oxybutynin

OBJECTIVES

Primary hyperhidrosis usually affects the hands, armpits, feet and cranio-facial region. Sweating in other areas is common in secondary hyperhidrosis (after surgery or in specific clinical conditions). Oxybutynin has provided good results and is an alternative for treating hyperhidrosis at common sites. Our aim was to evaluate the efficacy of oxybutynin as a treatment for primary sweating at uncommon sites (e.g., the back and groin).

METHODS

This retrospective study analyzed 20 patients (10 females) who received oxybutynin for primary focal hyperhidrosis at uncommon sites. The subjects were evaluated to determine quality of life before beginning oxybutynin and six weeks afterward and they were assigned grades (on a scale from 0 to 10) to measure their improvement at each site of excessive sweating after six weeks and at the last consult.

RESULTS

The median follow-up time with oxybutynin was 385 days (133-1526 days). The most common sites were the back (n = 7) and groin (n = 5). After six weeks, the quality of life improved in 85% of the subjects. Dry mouth was very common and was reported by 16 patients, 12 of whom reported moderate/severe dry mouth. Five patients stopped treatment (two: unbearable dry mouth, two: excessive somnolence and one: palpitations). At the last visit, 80% of patients presented with moderate/great improvement at the main sites of sweating.

CONCLUSION

After six weeks, more than 80% of the patients presented with improvements in their overall quality of life and at the most important site of sweating. Side effects were common (80% reported at least one side effect) and caused 25% of the patients to discontinue treatment. Oxybutynin is effective for treating bothersome hyperhidrosis, even at atypical locations and most patients cope well with the side effects.

Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis

PURPOSE OF REVIEW

Primary focal hyperhidrosis is a common condition that negatively impacts quality of life for many pediatric patients and can be challenging to treat. Standard treatments for hyperhidrosis can be used with success in many patients, and newer therapies and techniques offer options that have demonstrated efficacy and safety. This review highlights standard therapies for primary focal hyperhidrosis as well as the most recent technique advancements and alternative treatment options.

RECENT FINDINGS

The standard approach to treating primary focal hyperhidrosis remains initiation of topical preparations, followed by advancement to systemic medications, local administration of medication and/or surgical procedures. Recent studies focus on enhancing tolerability of topical preparations as well as evaluating the efficacy of neuromodulator injections, oral anticholinergic medications and laser therapy. Microwave technology has also been introduced for the treatment of focal hyperhidrosis with promising results.

SUMMARY

Many therapies exist for hyperhidrosis, and each treatment plan must be evaluated on a patient-by-patient basis. Advances in standard therapies and emergence of new treatment techniques are the main emphases of current published literature on hyperhidrosis. This article presents recent therapeutic options as well as updates on more established strategies to help practitioners treat this challenging condition.

Efficacy of botulinum toxin type B for the treatment of primary palmar hyperhidrosis: a prospective, open, single-blind, multi-centre study

Primary palmar hyperhidrosis is a distressing and disabling condition that can produce social, psychological and occupational problems. Although the use of botulinum toxin type A (BoNT-A) has been reported as an efficacious and safe intervention to improve palmar hyperhidrosis, only one study concerned botulinum toxin type B (BoNT-B) in this disorder. The aim of study was to evaluate the efficacy and safety of BoNT-B in treating primary palmar hyperhidrosis. Participants were injected with 5,000 IU of BoNT-B in each palm. Visual analogue test (VAS) to evaluate the intensity of decrease in sweat production, Minor's iodine starch test and measurement of paper towels' weight were used to ascertain palmar sweating at baseline, 4, 12 and 24 weeks after BoNT-B injections by a blind examiner. Thirty-two subjects (12 males, 20 females, mean age 31 ± 11) were enrolled. Significant reduction of palmar sweating was detected after BoNT-B injection: 2.9 ± 1.4, 0.3 ± 0.4, 0.9 ± 0.8, and 2.1 ± 1.5 g (p < 0.001) of paper towels' weight for the right palm at baseline, 4, 12 and 24 weeks; and 2.8 ± 1.7, 0.5 ± 0.6, 0.8 ± 0.7, and 1.8 ± 1.25 g (p < 0.001) at same time, respectively for the left palm. Significant reduction of mean VAS values were also detected after BoNT-B injections: 8.6 ± 1.1, 0.6 ± 0.8, 3.5 ± 2.5, and 7.1 ± 2.4 (p < 0.0001) at baseline, 4, 12 and 24 weeks, respectively. Mild side effects consisting in local pain and hand weakness were observed in 4 (12.5%) subjects. The findings indicated that the use of 5,000 IU BoNT-B injection in each palm was safe and significantly improved the severity of palmar hyperhidrosis.

Turning the tide: a history and review of hyperhidrosis treatment

Hyperhidrosis is a potential cause of severe physical and psychological distress, interfering in activities of daily living. Over the past 100 years, advances have been made regarding the treatment of this debilitating condition with some success. Surgical treatment with sympathectomy was successfully performed for hyperhidrosis in the early part of the 20th century, with various modifications of the technique over the past 100 years. Topical aluminium salt antiperspirants, anticholinergic medications, iontophoresis and botulinum toxin introduced less invasive ways to manage this condition. This historical review will enable dermatologists and non-dermatologists to manage this distressing condition.

Efficacy and quality of life outcomes of oxybutynin for treating palmar hyperhidrosis in children younger than 14 years old

The effects of oxybutynin for treating hyperhidrosis in children are still unknown. Therefore the aim of this study was to investigate the effects of oxybutynin on improving symptoms of hyperhidrosis and quality of life (QOL) in children with palmar hyperhidrosis (PH). Forty-five children ages 7-14 years with PH were evaluated 6 weeks after protocol treatment with oxybutynin. QOL was evaluated before and after treatment using a validated clinical questionnaire. More than 85% of the children with PH treated with oxybutynin experienced moderate or greater improvement in the level of sweating and 80% experienced improvement in QOL. Children who initially presented with very poor QOL were those who benefited most from oxybutynin therapy. Side effects occurred in 25 children (55.5%) and were mainly dry mouth. Only one patient had neurologic symptoms, which was reported as drowsiness. Oxybutynin is an effective treatment option for children with PH because it improves clinical symptoms and QOL. Further studies are required to determine the long-term outcomes of treatment with oxybutynin.