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Muacevic A, Adler JR, Mayrovitz HN. Impacts of Skin Eccrine Glands on the Measured Values of Transepidermal Water Loss. Cureus 2022; 14:e32266. [PMID: 36620832 PMCID: PMC9815790 DOI: 10.7759/cureus.32266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Transepidermal water loss (TEWL) is widely used to assess and quantify skin insensible water loss to assess skin's barrier function integrity. Low TEWL values are normally indicative of intact skin and a healthy functional barrier, whereas an increased TEWL reveals a disturbed or disrupted skin barrier. Because most skin sites at which these measurements are made have eccrine glands present, the contribution of the sweat gland activity to these measurements is variable and, in most cases, unknown. The separation between the contribution of water loss that is reflective of the skin barrier integrity versus that contributed via eccrine activation is not easy and is made more difficult since both components increase with increasing skin and environmental temperature. Endogenous factors that impact eccrine sweat gland activity include sympathetic nervous system activity, emotional stress, physical activity, eccrine gland density, and age. Exogenous factors that impact eccrine gland activity include ambient temperature and humidity and the climate where one resides. The aforementioned variables impact eccrine gland activity positively or negatively and therefore alter TEWL values accordingly. Although it may be theoretically possible to control all these factors, the difficulty in doing so results in only a few being controlled during most TEWL measurements. Such confounding processes may have impacted historical TEWL reference ranges and values previously reported. Thus, the impact of eccrine activation on standardly measured TEWL values is at this juncture unclear and may be a component contributing to some reported variability in TEWL values. To help clarify the issues, a literature review was conducted to investigate and summarize relevant prior research efforts and outcomes with respect to ways to consider eccrine activity in TEWL measurements and estimate the contribution of eccrine gland activity to TEWL values. Online databases such as Excerpta Medica Database (EMBASE), Public/Publisher Medline (PubMed), Elton B. Stephans Company (EBSCO), Google Scholar, and Wiley Online Library were searched with "transepidermal water loss" or "TEWL" in the title combined with "eccrine glands" or "sweat" anywhere in the text. The present findings indicate a multiplicity of biological and environmental variables impacting eccrine gland activity and thereby potentially affecting measured TEWL values. Even if laboratory conditions adhere to various guidelines and recommendations, it is not yet possible to separate the eccrine activation component from the parameter of true interest in the assessment of the skin's physiological barrier function except for full gland deactivation. The amount that such eccrine gland activation impacts the measured value of TEWL is generally not determined using currently available methods and the only sure way to eliminate a confounding effect is to inactivate the glands during such TEWL measurements. Because such eccrine gland deactivating approach is not usually desirable or even possible, other approaches would be recommended. One would be the development of a measuring device that could distinguish between the component of TEWL that is associated with the skin barrier function and the other that is attributable to sweat gland activation. Further research and development along these lines appear warranted.
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2
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Briatico G, Pampena R, Fulgione E, Babino G, Giorgio CM, D'Ambra I, Caccavale S, Longo C, Argenziano G. Real-life experience with oral oxybutynin long-term continuous therapy in severe hyperhidrosis and systematic review of the literature. Dermatol Ther 2021; 34:e14832. [PMID: 33527699 DOI: 10.1111/dth.14832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/28/2020] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
Hyperhidrosis is a disorder of excessive sweating severely impacting on patient's quality of life (Qol). Several studies have been published about oral oxybutynin, but no studies focused on the achievement of complete clinical and Qol response. The aim of this study was to report our real-life experience with oral oxybutynin in patients with severe hyperhidrosis significantly affecting their Qol. In this cohort retrospective study, we enrolled, in a 3-year period, patients affected by severe hyperhidrosis with poor Qol, continuously treated with oral oxybutynin. Our outcome was the obtainment of complete clinical and Qol improvement. A systematic review of the literature was also performed reporting efficacy and safety of oral oxybutynin for primary hyperhidrosis. We enrolled 62 patients, of which 53 (85.5%) received a mean daily dose of 10 mg and nine (15.5%) of 5 mg. Complete clinical response was achieved in 77.4% (48/62) of cases, while complete Qol improvement occurred in 51.6% (32/62) of cases. Adverse events were only reported as mild, with dry mouth being the most frequently observed (16.1%). Kaplan-Meier survival analysis highlighted that both median clinical and Qol complete responses were reached after 1 year of continuous therapy with oral oxybutynin. The main limitation of our study is the small number of patients enrolled. Long-term therapy with oral oxybutynin for severe hyperhidrosis, continuously administered at a mean daily dosage of 5 to 10 mg, allowed the majority of our patients to reach both clinical and Qol complete improvement, without significant adverse events.
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Affiliation(s)
- Giulia Briatico
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | | | - Graziella Babino
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Ilenia D'Ambra
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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3
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Soeberdt M, Kilic A, Abels C. Current and emerging treatments targeting the neuroendocrine system for disorders of the skin and its appendages. Exp Dermatol 2020; 29:801-813. [DOI: 10.1111/exd.14145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Ana Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
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4
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The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. J Am Acad Dermatol 2019; 81:669-680. [PMID: 30710603 DOI: 10.1016/j.jaad.2018.11.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
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5
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Madke B, Pradhan S, Sirka C. Review of oral anticholinergics in the treatment of palmoplantar hyperhidrosis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2019. [DOI: 10.4103/ijdd.ijdd_40_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Delort S, Marchi E, Corrêa MA. Oxybutynin as an alternative treatment for hyperhidrosis. An Bras Dermatol 2017; 92:217-220. [PMID: 28538882 PMCID: PMC5429108 DOI: 10.1590/abd1806-4841.201755126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/28/2016] [Indexed: 11/22/2022] Open
Abstract
Hyperhidrosis is the excessive production of sweating, which can be primary and focal or secondary to various pathologies. The exact cause of primary focal hyperhidrosis is still unknown, although a genetic basis is recognized, and its prevalence varies from 1% to 2.8%. The most affected sites are the armpits, palms, soles and face. It causes much discomfort, affects the quality of life, and is estimated to be undervalued by health professionals. Many treatment options are proposed, both clinical and surgical. The aim of this review is to focus on the treatment of hyperhidrosis with oxybutynin, an anticholinergic drug originally used to control overactive bladder.
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Affiliation(s)
- Sergio Delort
- Graduate program of the Faculdade de Medicina de Jundiaí (FMJ) - Jundiaí (SP), Brazil
| | - Evaldo Marchi
- Departament of Thoracic Surgery of the Faculdade de Medicina de Jundiaí (FMJ) - Jundiaí (SP), Brazil
| | - Marcos Antônio Corrêa
- Departament of Drugs and Medicines of the Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
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7
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Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes 2017; 15:121. [PMID: 28595584 PMCID: PMC5465471 DOI: 10.1186/s12955-017-0693-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An understanding of the daily life impacts of hyperhidrosis and how patients deal with them, based on qualitative research, is lacking. This study investigated the impact of hyperhidrosis on the daily life of patients using a mix of qualitative research methods. METHODS Participants were recruited through hyperhidrosis patient support groups such as the Hyperhidrosis Support Group UK. Data were collected using focus groups, interviews and online surveys. A grounded theory approach was used in the analysis of data transcripts. Data were collected from 71 participants, out of an initial 100 individuals recruited. RESULTS Seventeen major themes capturing the impacts of hyperhidrosis were identified; these covered all areas of life including daily life, psychological well-being, social life, professional /school life, dealing with hyperhidrosis, unmet health care needs and physical impact. CONCLUSIONS Psychosocial impacts are central to the overall impacts of hyperhidrosis, cutting across and underlying the limitations experienced in other areas of life.
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Affiliation(s)
- P Kamudoni
- Institute of Medicines Development, Duffryn House, Cardiff, CF, 23 6NP, UK.
| | - B Mueller
- Medical Science and Operations Department, Riemser Pharma GmbH, Greifswald, Germany
| | | | | | | | - M S Salek
- Institute of Medicines Development, Duffryn House, Cardiff, CF, 23 6NP, UK.,Department of pharmacy, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Herts, UK
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8
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Cruddas L, Baker D. Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review. J Eur Acad Dermatol Venereol 2017; 31:952-963. [DOI: 10.1111/jdv.14081] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Cruddas
- University College London Medical School; London UK
| | - D.M. Baker
- Department of Surgery; Royal Free Hospital; London UK
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9
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Del Boz J, Millán-Cayetano JF, Rivas-Ruiz F, de Troya-Martín M. Oral glycopyrrolate after the failure of oral oxybutynin in the treatment of primary hyperhidrosis. Br J Dermatol 2016; 176:821-823. [PMID: 27436700 DOI: 10.1111/bjd.14876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Del Boz
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J F Millán-Cayetano
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain.,University of Málaga, Málaga, Spain
| | - F Rivas-Ruiz
- Research Unit, Hospital Costa del Sol, Marbella, Málaga, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Marbella, Málaga, Spain
| | - M de Troya-Martín
- Dermatology Department, Hospital Costa del Sol, Marbella, Málaga, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Marbella, Málaga, Spain
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10
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Millán-Cayetano JF, del Boz J, Rivas-Ruiz F, Blázquez-Sánchez N, Hernández Ibáñez C, de Troya-Martín M. Oral oxybutynin for the treatment of hyperhidrosis: outcomes after one-year follow-up. Australas J Dermatol 2016; 58:e31-e35. [DOI: 10.1111/ajd.12473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Javier del Boz
- Department of Dermatology; Hospital Costa del Sol; Marbella Spain
| | - Francisco Rivas-Ruiz
- Research Unit; Hospital Costa del Sol; Marbella Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Marbella Spain
| | | | | | - Magdalena de Troya-Martín
- Department of Dermatology; Hospital Costa del Sol; Marbella Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Marbella Spain
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11
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Abtahi-Naeini B, Naeini FF, Adibi N, Pourazizi M. Quality of life in patients with primary axillary hyperhidrosis before and after treatment with fractionated microneedle radiofrequency. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:631-5. [PMID: 26622250 PMCID: PMC4638063 DOI: 10.4103/1735-1995.166196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Primary axillary hyperhidrosis (PAH) is a common condition with a great impact on the patient's quality of life (QOL). It is associated with serious social, emotional, and occupational distress. The aim of this study was to investigate the QOL in patients with PAH before and after treatment with fractionated microneedle radiofrequency (FMR). Materials and Methods: We evaluated 25 patients with severe PAH. Each patient had three sessions of FMR treatment using a novel applicator at 3-week intervals. The study was based on Dermatology Life Quality Index (DLQI) Questionnaires. Patients were evaluated at baseline and 3 months after the last session. Results: Our patients included 32% males and 68% females. The mean ± standard deviation (SD) age of subjects was 30.2 ± 6.27 years. The mean ± SD of the DLQI before and after treatment was 12.96 ± 5.93, and 4.29 ± 2.21, respectively. There was a statistically significant difference between the before and after intervention (P < 0.001). No major, permanent adverse effects were shown. Conclusion: Treatment with FMR can improve the DLQI of patients with PAH.
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Affiliation(s)
- Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farahnaz Fatemi Naeini
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Adibi
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Cancer Research Center, Students' Research Committee, Semnan University of Medical Sciences, Semnan, Iran
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12
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Schollhammer M, Brenaut E, Menard-Andivot N, Pillette-Delarue M, Zagnoli A, Chassain-Le Lay M, Sassolas B, Jouan N, Le Ru Y, Abasq-Thomas C, Greco M, Penven K, Roguedas-Contios AM, Dupré-Goetghebeur D, Gouedard C, Misery L, Le Gal G. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. Br J Dermatol 2015; 173:1163-8. [PMID: 26114588 DOI: 10.1111/bjd.13973] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. OBJECTIVES To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. METHODS We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2·5 mg per day and increased gradually to 7·5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. RESULTS Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0·009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6·9) than in the placebo arm (2·3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. CONCLUSIONS Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth.
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Affiliation(s)
- M Schollhammer
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital, Brest, France
| | | | - M Pillette-Delarue
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | | | | | - B Sassolas
- Department of Internal Medicine, University Hospital, Brest, France
| | - N Jouan
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | - Y Le Ru
- Dermatologist, Brest, France
| | - C Abasq-Thomas
- Department of Dermatology, University Hospital, Brest, France
| | - M Greco
- Dermatologist, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | | | | | | | | | - L Misery
- Department of Dermatology, University Hospital, Brest, France
| | - G Le Gal
- INSERM CIC 1412, Université de Brest, Brest, France
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13
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, Schvartsman C, Kauffman P, de Campos JRM, Puech-Leão P. Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years. Pediatr Dermatol 2015; 32:663-7. [PMID: 25490865 DOI: 10.1111/pde.12385] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Oxybutynin for treating hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Vascular and Endovascular Division, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo P Teivelis
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Krutman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rafael P de Paula
- Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Claudio Schvartsman
- Division of Pediatrics, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - José R M de Campos
- Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil.,Division of Thoracic Surgery, Hospital das Clinicas, University of São Paulo and Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Vascular and Endovascular Division, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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14
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Systemic Treatment of Hyperhidrosis. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Tratamiento sistémico de la hiperhidrosis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:271-7. [DOI: 10.1016/j.ad.2014.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/05/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022] Open
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16
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Wolosker N, Teivelis MP, Krutman M, Campbell TPDDA, Kauffman P, Campos JRD, Puech-Leão P. Long-term results of oxybutynin use in treating facial hyperhidrosis. An Bras Dermatol 2015; 89:912-6. [PMID: 25387496 PMCID: PMC4230660 DOI: 10.1590/abd1806-4841.20143272] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/11/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months. METHODS 61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites. RESULTS Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites. CONCLUSION Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.
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Affiliation(s)
| | | | | | | | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Pedro Puech-Leão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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17
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Prise en charge d’une hyperhidrose. Ann Dermatol Venereol 2015; 142:252-61. [DOI: 10.1016/j.annder.2014.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
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18
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Ayhan E. A case of multiple eccrine hidrocystoma successfully treated with oral oxybutynin. Dermatol Ther 2015; 28:107-9. [PMID: 25753778 DOI: 10.1111/dth.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erhan Ayhan
- Department of Dermatology, Tokat Zile State Hospital, Tokat, Turkey
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19
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Campanati A, Gregoriou S, Kontochristopoulos G, Offidani A. Oxybutynin for the Treatment of Primary Hyperhidrosis: Current State of the Art. Skin Appendage Disord 2015; 1:6-13. [PMID: 27172124 DOI: 10.1159/000371581] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022] Open
Abstract
Oxybutynin is an anticholinergic drug with an emerging role in the treatment of hyperhidrosis. Several recent studies have documented that it is effective both in focal and generalized hyperhidrosis and shows universally good response among different groups of patients regardless of age, gender, and weight. The most common adverse event is dry mouth reported by almost all patients treated. The way this might affect long-term compliance and tolerability should be better investigated in the future.
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Affiliation(s)
- Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Stamatis Gregoriou
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - George Kontochristopoulos
- Hyperhidrosis Clinic, Andreas Sygros Hospital, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, de Campos JRM, Kauffman P, Puech-Leão P. Long-term results of oxybutynin treatment for palmar hyperhidrosis. Clin Auton Res 2014; 24:297-303. [PMID: 25427685 DOI: 10.1007/s10286-014-0264-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 Room 423, A1 Building São Paulo, São Paulo, 05652-000, Brazil
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Wolosker N, Krutman M, Teivelis MP, Paula RPD, Kauffman P, Campos JRMD, Puech-Leão P. Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years. EINSTEIN-SAO PAULO 2014; 12:42-7. [PMID: 24728245 PMCID: PMC4898238 DOI: 10.1590/s1679-45082014ao2841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Pedro Puech-Leão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Teivelis MP, Wolosker N, Krutman M, Milanez de Campos JR, Kauffman P, Puech-Leão P. Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin. Ann Thorac Surg 2014; 98:1797-802. [DOI: 10.1016/j.athoracsur.2014.05.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 11/24/2022]
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Abstract
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.
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Affiliation(s)
- Anna-Bianca Stashak
- Internal Medicine Residency Program, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Teivelis MP, Wolosker N, Krutman M, Kauffman P, Campos JRMD, Puech-Leão P. Treatment of uncommon sites of focal primary hyperhidrosis: experience with pharmacological therapy using oxybutynin. Clinics (Sao Paulo) 2014; 69:608-14. [PMID: 25318092 PMCID: PMC4192402 DOI: 10.6061/clinics/2014(09)06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/26/2014] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Vascular Surgery, São Paulo, SP, Brazil
| | - Mariana Krutman
- Hospital Israelita Albert Einstein, Vascular Surgery, São Paulo, SP, Brazil
| | - Paulo Kauffman
- Hospital Israelita Albert Einstein, Vascular Surgery, São Paulo, SP, Brazil
| | - José Ribas Milanez de Campos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Thoracic Surgery Division, São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Department of Surgery, Vascular and Endovascular Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, Kauffman P, de Campos JRM, Puech-Leão P. Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis. Ann Vasc Surg 2014; 28:1106-12. [DOI: 10.1016/j.avsg.2013.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/12/2013] [Accepted: 12/15/2013] [Indexed: 11/24/2022]
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Costa ADS, Leão LEV, Succi JE, Perfeito JAJ, Filho Castelo A, Rymkiewicz E, Filho Aurelio Marchetti M. Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy. Clinics (Sao Paulo) 2014; 69:101-5. [PMID: 24519200 PMCID: PMC3912338 DOI: 10.6061/clinics/2014(02)05] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/27/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p=0.001). The placebo group showed modest improvement (p=0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p=0.95), whereas the oxybutynin group revealed a significant decrease (p=0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p=0.001). CONCLUSION Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy.
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Affiliation(s)
- Altair da Silva Costa
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
| | - Luiz Eduardo Villaça Leão
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
| | - José Ernesto Succi
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
| | - Joao Aléssio Juliano Perfeito
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
| | - Adauto Filho Castelo
- Federal University of São Paulo, Paulista School of Medicine, Department of Infectious Diseases, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Infectious Diseases, São Paulo/SP, Brazil
| | - Erika Rymkiewicz
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
| | - Marco Filho Aurelio Marchetti
- Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São PauloSP, Brazil, Federal University of São Paulo, Paulista School of Medicine, Department of Thoracic Surgery, São Paulo/SP, Brazil
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Abstract
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.
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Affiliation(s)
- Kevin Yc Lee
- Department of Dermatology, Norfolk and Norwich University Hospital, UK
| | - Nick J Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, UK
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Wolosker N, de Campos JRM, Kauffman P, Yazbek G, Neves S, Puech-Leao P. Use of oxybutynin for treating plantar hyperhidrosis. Int J Dermatol 2013; 52:620-3. [DOI: 10.1111/j.1365-4632.2012.05746.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nelson Wolosker
- Division of Vascular Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
| | - José Ribas Milanez de Campos
- Department of Thoracic Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
| | - Paulo Kauffman
- Division of Vascular Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
| | - Guilherme Yazbek
- Division of Vascular Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
| | - Samantha Neves
- Division of Vascular Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
| | - Pedro Puech-Leao
- Division of Vascular Surgery; Hospital das Clínicas; University of São Paulo Medical School; Sao Paulo; Brazil
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Ghaleiha A, Shahidi KM, Afzali S, Matinnia N. Effect of terazosin on sweating in patients with major depressive disorder receiving sertraline: a randomized controlled trial. Int J Psychiatry Clin Pract 2013; 17:44-7. [PMID: 22731399 DOI: 10.3109/13651501.2012.687449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE By considering the role of adrenergic nervous system in sweat secretion, we postulated that terazosin may be able to improve sweating after taking sertraline, a selective serotonin reuptake inhibitor (SSRI) drug. This study was designed to evaluate the effect of terazosin on sertraline -related sweating. METHODS All patients diagnosed with major depressive disorder based on the DSM-IV criteria who were taking sertraline and suffered from excessive sweating were enrolled in the study and randomly allocated into two groups of receiving terazosin (1 mg) or placebo. Sweating severity was classified using Hyperhidrosis Disease Severity Scale. The patients were evaluated regarding the severity of sweating before beginning of the study and 14 days after taking either terazosin or placebo. RESULTS Baseline characteristics including age, sex proportion and weight were not significantly different between the two groups (P > 0.05). At the beginning of the study, 33 (48.5%) and 31 (47%) patients in the terazosin and placebo groups, respectively, suffered from the highest grade of sweating. Fourteen days after treatment with terazosin severity of sweating reduced to the lowest grade in 46 (68%) and two (6%) cases in the terazosin and placebo groups, respectively (P < 0.001). CONCLUSIONS Our findings revealed that terazosin may be effective in decreasing sweating severity in patients using sertraline.
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Affiliation(s)
- Ali Ghaleiha
- Department of Psychiatry, Behavioral Disorders & Substance Abuse Center of Hamadan University of Medical Sciences, Hamadan, Iran
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Wolosker N, de Campos JRM, Kauffman P, Puech-Leão P. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg 2012; 55:1696-700. [PMID: 22341836 DOI: 10.1016/j.jvs.2011.12.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/09/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects. OBJECTIVE This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis. METHODS This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life. RESULTS Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%). CONCLUSIONS Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life.
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Affiliation(s)
- Nelson Wolosker
- Division of Vascular Surgery, University of São Paulo Medical School, São Paulo, SP, Brazil.
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Ghaleiha A, Jahangard L, Sherafat Z, Ahmadpanah M, Brand S, Holsboer-Trachsler E, Bajoghli H, Haghighi M. Oxybutynin reduces sweating in depressed patients treated with sertraline: a double-blind, placebo-controlled, clinical study. Neuropsychiatr Dis Treat 2012; 8:407-12. [PMID: 23028229 PMCID: PMC3446858 DOI: 10.2147/ndt.s36329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors are primarily used in the pharmacological treatment of patients experiencing a major depressive disorder. However, one of the common unwanted effects is excessive sweating or hyperhidrosis. Oxybutynin is an anticholinergic medication which reduces sweating. The aim of this double-blind study was to examine the effect of administration of oxybutynin on subjective sweating in patients treated with sertraline. METHODS A total of 140 patients experiencing a major depressive disorder (mean age 37.69 ± 10.44 years, 86 females [61.4%]) treated with sertraline (mean dose 83 mg/day) were consecutively enrolled in the study, and all reported excessive sweating as a side effect. Thereafter, the patients were randomly assigned to either an oxybutynin 5 mg/day group or to a placebo group. At the beginning and end of the 2-week trial, the patients completed questionnaires related to sweating and medication-related side effects. RESULTS Over time, subjective sweating reduced significantly in the treatment group as compared with the control group. Oxybutynin-induced side effects were uncommon. Relative to male patients, female patients reported less subjective sweating. CONCLUSION Administration of oxybutynin successfully reduced excessive sweating in patients experiencing a major depressive disorder and treated with sertraline. However, possible gender effects should be taken into account.
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Affiliation(s)
- Ali Ghaleiha
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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The Use of Oxybutynin for Treating Axillary Hyperhidrosis. Ann Vasc Surg 2011; 25:1057-62. [DOI: 10.1016/j.avsg.2011.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/24/2011] [Accepted: 06/03/2011] [Indexed: 11/17/2022]
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Maillard H, Fenot M, Bara C, Célérier P. Intérêt de l’oxybutynine à dose modérée dans l’hyperhidrose étendue. Ann Dermatol Venereol 2011; 138:652-6. [DOI: 10.1016/j.annder.2011.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/13/2011] [Accepted: 07/01/2011] [Indexed: 11/26/2022]
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Wolosker N, de Campos JR, Kauffman P, Neves S, Yazbek G, Jatene FB, Puech-Leão P. An alternative to treat palmar hyperhidrosis: use of oxybutynin. Clin Auton Res 2011; 21:389-93. [DOI: 10.1007/s10286-011-0128-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 05/11/2011] [Indexed: 11/30/2022]
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Wolosker N, Campos JRMD, Kauffman P, Munia MA, Neves S, Jatene FB, Puech-Leão P. The use of oxybutynin for treating facial hyperhidrosis. An Bras Dermatol 2011; 86:451-6. [DOI: 10.1590/s0365-05962011000300005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 07/20/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy
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Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol 2010; 34:e990-1. [PMID: 20055880 DOI: 10.1111/j.1365-2230.2009.03645.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Houte M, Harmsze AM, Deneer VHM, Tupker RA. Effect of oxybutynin on exercise‐induced sweating in healthy individuals. J DERMATOL TREAT 2009; 19:101-4. [DOI: 10.1080/09546630701418754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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