No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis

BACKGROUND: Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at the palms, soles and axillae. The underlying mechanism is unclear. In recent years botulinum toxin A has emerged as a useful treatment. Compensatory sweating, which is a major problem in many patients who have undergone transthoracic endoscopic sympathectomy for hyperhidrosis, has only rarely been reported after botulinum toxin. However, this potential side-effect of botulinum toxin treatment has not been systematically examined. OBJECTIVES: To investigate if treatment with botulinum toxin A in hyperhidrotic hands may cause compensatory sweating at other skin locations. METHODS: In 17 patients with a history of palmar hyperhidrosis repeated measurements of evaporation were made before and up to 6 months after treatment of the hands with botulinum toxin A. Recordings were made at 16 skin areas and compared with subjective estimates of sweating. RESULTS: Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area. CONCLUSIONS: Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories.     

Eccrine angiomatous hamartoma in a child

Eccrine angiomatous hamartoma (EAH) is a rare, benign malformation characterized by both eccrine and vascular components. It usually presents at birth or during early infancy and childhood as a nodule or a plaque, usually solitary, involving acral skin. Eccrine angiomatous hamartoma is usually asymptomatic, although focal hyperhidrosis, hypertrichosis, and pain can be observed. We report an additional case of this rare entity presenting in a 14-year-old boy.     

Two Cases of Coccygeal Polypoid Eccrine Nevi Presenting as Skin Tags

An eccrine nevus is a rare hamartoma characterized by an increase in the number or size of eccrine glands. Eccrine nevi usually present as localized hyperhidrosis and are not associated with overlying skin abnormalities. However, among the cases that have been reported in the literature, some unique presentations of eccrine nevi have been demonstrated, including a pigmented patch, a depressed nodule, linear papules, and a sacral skin tag. Herein, we report two unusual cases of coccygeal polypoid eccrine nevi and review the literature.     

Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis

Summary Tap-water iontophoresis (TWI) using direct current (DC) is the most effective therapy in palmoplantar hyperhidrosis. Side-effects of this method are discomfort, with burning and tingling, and skin irritation, including erythema and vesicles. Incorrect use may induce iontophoretic burns at sites of minor skin injury. Elaborate safety measures are required to prevent electric shock.
The aim of this study was to minimize side-effects and to increase technical and safety standards of TWI, without loss of efficacy. In a controlled blind study, treatment of palmar hyperhidrosis by alternating current (AC) or by AC with DC-offset (AC/DC) was compared with the conventional DC method.
Palmar hyperhidrosis was completely controlled after an average of 11 treatments by either AC/DC iontophoresis or the conventional DC method. Virtually no effect was seen when AC without DC-offset was used for TWI. There were no signs of cutaneous irritation, or subjective sensations of discomfort when AC with or without DC-offset was employed. AC/DC iontophoresis should become the treatment of choice for palmoplantar hyperhidrosis.
The mechanism of action is unknown. It is hypothesized that an interrupted stimulus-secretion-coupling leads to a functional disturbance of sweat secretion.     

Unilateral hyperhidrosis with accompanying contralateral anhidrosis

Localized unilateral or segmental hyperhidrosis is a rare form of increased sweat production of unknown origin. Most reported cases have occurred in otherwise healthy people, with none of the typical triggering factors found in essential hyperhidrosis. The localization of segmental hyperhidrosis is usually the forearm or forehead. We report a case of unilateral hyperhidrosis on the right sides of the forehead, and nose, and the palmar surface of the right hand with anhidrosis on the left hand.     

Usefulness of bilateral sympathectomy using video-assisted thorascopic surgery in the treatment of essential hyperhidrosis

Essential, idiopathic, or primary hyperhidrosis is defined as excessive sweating in certain areas of the body due to factors unrelated to other disease. Clinical presentation can be categorized as palmar, plantar, axillary, or craniofacial. Medical treatment (aluminium salts, iontophoresis, anticholinergic drugs, and alpha2-agonists) is of questionable effectiveness. Intradermal injections of botulinum toxin are very effective for the treatment of axillary hyperhidrosis. Surgical treatment involves resection (sympathectomy) or electrocautery (sympathicolysis) of the thoracic sympathetic chain, or compression of the sympathetic chain with clips, in all cases via video-assisted thorascopic surgery. One or more ganglia between T2 and T5 are usually resected depending on the area affected by hyperhidrosis: T2 for craniofacial hyperhidrosis, T3 and T4 for palmar hyperhidrosis, and T3 to T5 for combined palmar and axillary hyperhidrosis. The technique is very useful and is effective in those patients with primary hyperhidrosis who have not responded to conservative treatment.     

Neuropeptides in skin disease: increased VIP in eczema and psoriasis but not axillary hyperhidrosis

The neuropeptides vasoactive intestinal polypeptide (VIP), substance P and somatostatin were studied in skin biopsies from patients with eczema, psoriasis and axillary hyperhidrosis. VIP concentrations were elevated in skin affected by eczema and psoriasis, whereas substance P and somatostatin levels did not differ from controls. There was a higher concentration of VIP, but not of substance P or somatostatin, in normal axillary skin when compared to adjacent trunk skin, with abundant VIP-containing fibres surrounding eccrine sweat glands. The VIP concentration was unchanged in skin affected by axillary hyperhidrosis. VIP may increase local blood flow in eczema and psoriasis, but does not appear to play a role in axillary hyperhidrosis.     

Temperament and character profile in patients with essential hyperhidrosis

BACKGROUND/AIMS: The main debates on hyperhidrosis are whether there are some personality features such as anxiety or stress, or whether the psychological symptoms are due to negative social feedback from early life. We aimed to investigate the temperament and character dimensions with a psychobiological inventory. METHODS: We recruited patients with hyperhidrosis (n=26) and chronic renal failure (n=44) as well as healthy subjects (n=22) from dermatology and nephrology clinics and the general population in Afyonkarahisar. All subjects were required to perform a temperament and character inventory. RESULTS: The total novelty seeking score in hyperhidrosis was significantly lower than in controls. There was no significance in total harm avoidance scores between hyperhidrosis patients and controls. The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. CONCLUSION: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.     

Hyperhidrosis axillaris – Effektivität und Verträglichkeit eines aluminiumchloridhaltigen Antiperspirants

Background

The purpose of this study was to evaluate the efficacy and tolerability of aluminium chloride gel for treatment of axillary hyperhidrosis.

Patients and methods

A total of 20 patients aged 22–38 (mean age: 26.9±4.3) with idiopathic axillary hyperhidrosis were included and treated with an antiperspirant (Sweat-off®, Sweat-off® GmbH, Hügelsheim). Study duration was 42 days. Treatment efficacy was evaluated clinically, as well as by starch-iodine test, gravimetric analysis and evaluation of the skin surface pH.

Results

After treatment there was a significant clinical improvement accompanied by significant qualitative and quantitative reduction of sweat as well as a significant reduction of skin surface pH. Except for slight skin irritation in 6 patients, there were no other side effects. Patient satisfaction improved markedly during the study.

Conclusion

Treatment of axillary hyperhidrosis with aluminium chloride is an effective, safe and inexpensive treatment modality.     

Treatment of axillary hyperhidrosis with botulinum-A toxin

BACKGROUND: Severe axillary hyperhidrosis is a source of great embarrassment and considerable emotional stress to individuals afflicted with this condition. Existing topical and surgical therapies are either ineffective or associated with unacceptable morbidity. We attempt to determine the effect of botulinum-A toxin (Dysport) in the treatment of axillary hyperhidrosis. PATIENTS AND METHODS: After visualization of hyperhidrosis using the iodine-starch test, 10 patients with axillary hyperhidrosis underwent intradermal injection with 125 units of Dysport on each axilla. Patients were observed for 7 months after treatment. RESULTS: The treatment was well tolerated without side-effects. All patients experienced relatively complete anhidrosis of the axillary skin after about 1 week for periods ranging from 4 to 7 months. CONCLUSIONS: Botulinum-A toxin may offer a fast, safe, and highly effective therapeutic option for severe hyperhidrosis.     

Eccrine Nevus on the Neck: A Case Report and Review of the Literature

Eccrine nevus is an extremely rare benign cutaneous hamartoma that usually occurs in childhood and adolescence. It has a wide range of clinical manifestations, and histological findings reveal a proliferation of structurally normal eccrine ducts. Herein, we present a case of eccrine nevus on the neck of an 8-year-old girl. Our literature review reveals that the head and neck region is a rare anatomical location for eccrine nevus as it has a predilection for extremities. Our review also suggests that overlying skin changes are common in eccrine nevus regardless of accompanying localized hyperhidrosis.     

Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis

Focal hyperhidrosis can have a considerable impact on social and occupational activities and be associated with significant impairment in quality of life. Primary (idiopathic) hyperhidrosis is neither caused by systemic disorders nor by external factors. It usually occurs in areas characterized by a high density of sweat glands such as the axillae and hands. The diagnosis of focal hyperhidrosis is based on history and clinical findings. Supplementary diagnostic tests include gravimetry (measurement of the amount of sweat) and the iodine starch test (which shows the area of sweating). Treatment options consist of topical agents, botulinum toxin A injections, iontophoresis, treatment with radiofrequency, microwaves, or ultrasound as well as surgical procedures (axillary suction curettage, sympathectomy). Systemic agents such as anticholinergics may also be used. Selection of the most appropriate therapeutic approach depends on the site affected, prior treatment as well as the patient's requests.     

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis

Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.     

A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema.

We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.     

The successful use of botulinum toxin for the treatment of nasal hyperhidrosis

Background Patients with facial hyperhidrosis often experience occupational, social, and psychological problems. Botulinum toxin type A, which has been shown to be useful in the treatment of hyperhidrosis, can cause the paralysis of facial muscles if used in the skin overlying the facial muscles. It can, however, be used in the skin of the nose without significantly affecting the muscles of facial expression. Methods Two patients with severe nasal hyperhidrosis were treated with botulinum toxin. Results Two patients with severe nasal hyperhidrosis responded to a single session of treatment with intradermal injections of botulinum toxin. Conclusions This treatment method for nasal hyperhidrosis is simple, well tolerated, and effective, and significantly improves the quality of life of the affected individuals.     

Hyperhidrosis plantaris – a randomized,half‐side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride

Background: Primary focal hyperhidrosis plantaris can cause impairment in social, physical, leisure and occupational activities. Topical treatment with aluminium chloride is the first‐line treatment. The aim of this trial was to evaluate efficacy and safety of two different concentrations of aluminium chloride hexa‐hydrate (12.5%, 30%) for 6 weeks. Patients and methods: 20 volunteers with hyperhidrosis plantaris were included. Efficacy was evaluated using a clinical rating scale of the hyperhidrosis level and qualitative assessments including Minor's (iodine‐starch) test and a standardized sniff test. Furthermore a patient questionnaire and measurements of skin surface pH were done to evaluate the subjective assessments and side effects. Results: The hyperhidrosis level significantly decreased in both concentrations. There were no differences in tolerability regarding the skin surface pH and the patient questionnaires. In addition the hidrotic areas decreased after application of both products and the sniff test improved. Conclusion: Topical application of an antiperspirant containing aluminium chloride reduced sweat production in plantar hyperhidrosis significantly. As both 12.5% and 30% were efficacious and safe, we would recommend 12.5% for outpatient treatment.     

'Rusters'. The corrosive action of palmar sweat: II. Physical and chemical factors in palmar hyperhidrosis.

When measuring sweating rates, close correspondence was found with the clinical estimation of hyperhidrosis. Corrosion was seen to increase with increasing sweat rates, reaching its maximum after an assumed rise in the actual sodium chloride concentration on the skin surface due to evaporation of water. The findings confirm that hyperhidrosis is of primary importance in the constitution of a 'ruster', and are also in good agreement with experimental reports. The small variations in palmar skin pH had no influence on the degree of corrosion; nor had the character of the metal surface. Of the two types of metal studied. corrosion was much more severe on the type having the lowest concentration of copper, thus confirming that increasing copper concentrations have a positive effect in reducing corrosion rates. At 50--60% relative humidity (RH) corrosion increased as time elapsed, whereas at 40% RH no corrosion developed on a sweat-contaminated plate. When exposed to 75% RH, metal samples became severely corroded in the course of a few days. Protective methods for the avoidance of rust are mentioned, with special emphasis on frequent handwashing.     

Enhanced anti-mycobacterial immunity in children with erythema nodosum and a positive tuberculin skin test

Erythema nodosum (EN) may follow a variety of infections, but in regions with a high prevalence of tuberculosis, is frequently associated with a positive tuberculin skin test (TST) and tuberculosis infection. We aimed to investigate the immunological differences between patients with EN as a manifestation of primary tuberculosis, and those with progressive pulmonary tuberculosis (PTB) or asymptomatic infection. We studied the inflammatory response to both mycobacterial and non-mycobacterial antigens in 11 children with EN associated with a positive TST, 22 children with culture-confirmed tuberculosis, and 53 healthy skin test-positive children. In addition, we evaluated functional anti-mycobacterial immunity using an ex vivo assay of mycobacterial growth restriction in five children with EN and 15 with PTB. Patients with EN were distinguished by enhanced mycobacterial growth restriction on the functional assay, which was associated with a markedly increased production of IFNgamma in response to stimulation with purified protein derivative of Mycobacterium tuberculosis. Children presenting with EN and a positive TST show evidence of responses associated with enhanced anti-mycobacterial immunity.     

Long-term efficacy and side effects of tap water iontophoresis of palmoplantar hyperhidrosis--the usefulness of home therapy

Treatment of palmoplantar hyperhidrosis was carried out with a conventional galvanic generator in 40 patients and with a newly developed iontophoresis apparatus, which is suited for home treatment, in 31 patients. The new apparatus is operated by a rechargeable energy source or by batteries and is disconnected from the electrical net during treatment. It conforms to most recent safety regulations as approved by Underwriter's Laboratory. Hyperhidrosis was completely controlled after 10-12 treatments as revealed by quantitative gravimetric measurements of sweat rates and semiquantitative estimation of starch iodine paper imprints. There was no apparent difference in efficacy between the two apparatuses. Not only hyperhidrosis was abolished, but associated symptoms, such as lividity of palms or soles, acral hypothermia and edema of fingers or toes, also subsided. Skin temperature on palms rose from 29.7 +/- 1.8 degrees C before treatment to 32.2 +/- 1.4 degrees C thereafter. Maintenance treatment was continued on an average for 14 months, in 4 patients for more than 3 years. No loss of efficacy was found during that period. Side effects were minimal and depended upon amperage used. Only slight discomfort during treatment and mild short-lasted skin irritation were observed. Long-term side effects did not occur.     

Eccrine angiomatous hamartoma: a report of 2 cases

Eccrine angiomatous hamartoma is a rare, benign tumor characterized by a proliferation of eccrine and vascular structures. We present 2 cases and review the characteristics of this disorder. The first patient was a 33-year-old woman who consulted for a brownish lesion on her back associated with local hyperhidrosis. The second patient was a 25-year-old man with an asymptomatic erythematous lesion on his left palm. In both patients a diagnosis of eccrine angiomatous hamartoma was made based on the histological findings. Eccrine angiomatous hamartoma is usually present at birth or develops during childhood. It is typically a solitary lesion and signs and symptoms can vary; diagnosis is therefore based on histological study. The most common site is on the distal parts of limbs. The lesions tend to be asymptomatic, but there may be associated pain and hyperhidrosis. Treatment is not usually necessary except in cases with persistent symptoms, excessive sweating, or cosmetic concerns.