Händedesinfektion im Krankenhaus – Nutzen und Risiken

The WHO regards hand hygiene as an essential tool for the prevention of noso‐comial infections. The hygienic hand disinfection has a superior antimicrobial efficacy compared to hand washing and should be performed as the treatment of choice before and after a variety of activities at the point of patient care. Washing hands should be preferred when the hands are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap and long lasting occlusion. Compliance with hand disinfection in clinical practice is often low. Measures to improve compliance include training, provision of hand rubs where they are needed, and the responsibility of doctors to set a good example. Improved compliance in hand hygiene and targeted use of alcohol‐based hand rubs can reduce the nosocomial infection rate by up to 40 %. The benefit of hand disinfection is therefore much larger than possible risks.     

Wet work exposure and hand eczema among healthcare workers: a cross‐sectional study

Hand eczema is common among healthcare workers. One reason is high exposure to soap and water. To prevent the spreading of infections more rigorous hygiene procedures have been implemented in healthcare during the last decade. The purpose of this study was to see how the use of disposable gloves, alcoholic hand disinfectants, and soap is associated with hand eczema. An electronic questionnaire was sent to all hospital employees in southern Sweden. Only the respondents working as nurses, assistant nurses and physicians were included in the analyses. In this group 21% had had hand eczema during the last 12 months, which is higher compared to the general population. 30% washed their hands with soap more than 20 times per day at work, 54% used non‐sterile disposable gloves for more than 2 hours per day, and 45% used alcoholic hand disinfectant more than 50 times per day. Hand eczema was more common among those who more often used soap, and among those who used disposable gloves for longer times. However hand eczema was not associated with the use of alcoholic disinfectants. This study shows that hand eczema still is common in healthcare workers. Educational programmes directed at prevention of hand eczema are needed.     

Skin protection in nursing work: promoting the use of gloves and hand alcohol

Nursing has been identified as a wet-work occupation, with a high prevalence of occupational irritant contact dermatitis. Reduction of exposure to skin irritants contributes to the prevention of occupational skin disease in nurses. The role of the use of soap and water, hand alcohol and gloves in prevention programmes is discussed. 2 additional measures for reducing exposure to skin irritants are postulated: use of hand alcohol instead of soap and water in disinfection procedures when the hands are not visibly dirty; use of gloves in wet activities such as patient washing to prevent the hands from becoming wet and visibly dirty. We investigated the effectiveness of these recommendations in a model. Mean daily wet-work exposure during nursing work was modelled: regular model. We also modelled exposure to skin irritants in combination with the implementation of these recommendations: prevention model. The hands of healthy volunteers were exposed to the regular or the prevention model over 3 weeks for 5 days a week. The change in transepidermal water loss (TEWL) on the back of the hands was measured after 3 weeks of exposure to these wet-work simulations. An increase in TEWL occurred with the regular model, while mean TEWL decreased in the prevention model. Skin irritation from occlusion by gloves appeared to be more pronounced in the regular model compared to the prevention model. The results of this study justify the conclusion that in nursing work, hand alcohol is the preferred disinfectant. Although the prevention model implies increased occlusive exposure, this has no additional irritant effect, probably because of the absence of soap exposure.     

Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use

BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.     

An Evaluation,Using Computerized Image Analysis,of Antimicrobial Efficacy of an Automatic Hand Washing Machine with Ultrasonic Wave Spraying

We studied the antimicrobial efficacy of hand washing with a quick-dry hand washing machine [TE-KIREIKI]® employing ultrasonic wave spraying and its incidental alcohol-based product [AROKULIN-E]®. The subjects of this study were 10 males who had been instructed not to use any antimicrobial agent for the previous 2 weeks or any hand soap for the previous 5 hours. They pressed their palms on agar before and after washing their hands. After 48-hour incubation at 37°C, the bacterial colonies grown on the agar were counted using the [ASPECT]® image processing system. The colony count was expressed as the post-stamp versus pre-stamp percent (%) reduction. Two patterns of hand washing were examined in this study: [A] a 3-second hand wash using an alcohol-based product [AROKULIN-E]® and [B] a 30-second hand wash using a non-medicated detergent soap with running water in addition to hand washing by [A]. The percent (%) reduction after hand washing patterns [A] and [B] were 49.1% and 51.3%. These reduction rates indicated that these patterns did not eradicate bacteria from the hand surface. Therefore, we concluded that this quick-dry hand washing machine employing an ultrasonic wave spraying method combined with an alcohol-based product needs improvement.     

A double‐blind,randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use

Background Healthcare‐associated infection is an important worldwide problem that could be reduced by better hand hygiene practice. However, irritant contact dermatitis of the hands as a result of repeated hand washing is a potential complication that may be preventable by the regular use of an emollient. Objectives To assess the effect of moisturizer application after repeated hand washing (15 times daily) vs. soap alone. Methods In a double‐blind, randomized study, the effect of five different moisturizers on skin barrier function was determined by assessment after repeated hand washing over a 2‐week period in healthy adult volunteers. Assessments of transepidermal water loss (TEWL), epidermal hydration and a visual assessment using the Hand Eczema Severity Index (HECSI) were made at days 0, 7 and 14. Results In total, 132 patients were enrolled into the study. A statistically significant worsening of the clinical condition of the skin as measured by HECSI was seen from baseline to day 14 (P = 0·003) in those subjects repeatedly washing their hands with soap without subsequent application of moisturizer. No change was seen in the groups using moisturizer. Subclinical assessment of epidermal hydration as a measure of skin barrier function showed significant increases from baseline to day 14 after the use of three of the five moisturizing products (P = 0·041, 0·001 and 0·009). Three of the five moisturizers tested led to a statistically significant decrease in TEWL at day 7 of repeated hand washing. This effect was sustained for one moisturizing product at day 14 of hand washing (P = 0·044). Conclusions These results support the view that the regular application of moisturizers to normal skin offers a protective effect against repeated exposure to irritants, with no evidence of a reduction in barrier efficiency allowing the easier permeation of irritant substances into the skin as has been suggested by other studies. Regular use of emollient in the healthcare environment may prevent the development of dermatitis.     

The efficacy of '0.05% Clobetasol + 2.5% zinc sulphate' cream vs. '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema: a double-blind study

Background Many therapeutic modalities have been suggested for treatment of the chronic hand eczema. Despite good immediate efficacy of some of these treatments, there is high recurrence of the dermatitis following cessation of the treatment. Aim Regarding the beneficial effects of the zinc sulfate on the skin, we designed a double blind study to evaluate the efficacy of the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream versus ‘0.05% Clobetasol alone’ cream in the treatment of the chronic hand eczema. Subjects and Methods This study was a double‐blind, right to left, prospective, clinical trial. In total, 47 patients with chronic hand eczema admitted to dermatology center of Isfahan University of Medical Sciences were selected and their right hand or left hand were selected at random to be treated with either the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream or ‘0.05% Clobetasol alone’ cream twice daily for 2 weeks. All of the patients were treated for 2 weeks and were followed up at weeks 2, 4, 6 and 8 after starting the treatment. For determining the severity of chronic hand eczema, we assessed and scored 4 different characteristics of the lesions including redness; scaling; lichenification and pruritus. The data were analyzed using SPSS program (release 13) and statistical tests including Mann‐Whitney test. Results Overall, 47 patients (94 samples) were evaluated. All of these patients had similar and symmetrical lesions on their right and left hands. Out of them, 35 patients were females and 12 patients were male. In all of the evaluated characterisitics, the ‘0.05% Clobetasol + 2.5% zinc sulphate’ cream was more effective than ‘0.05% Clobetasol alone’ cream (P < 0.05). The recurrence rate of eczema was significantly lower in the group treated with this combination treatment (P < 0.05). Conclusion With regard to the encouraging results of the combination treatment with Clobetasol + zinc sulphate, we suggest that in a more extensive clinical trial, the efficacy of this treatment against chronic hand dermatitis be evaluated. In addition, evaluation of this combination therapy against other inflammatory dermatosis seems to be logical.     

Anti-thyroid peroxidase antibody and vitiligo: a controlled study

Background

Aim of the study was to determine the effect of the regular use of a hand cream after washing hands on skin hydration and skin roughness.

Methods

Twenty-five subjects washed hands and forearms with a neutral soap four times per day, for 2 minutes each time, for a total of two weeks. One part of them used a hand cream after each hand wash, the others did not (cross over design after a wash out period of two weeks). Skin roughness and skin hydration were determined on the forearms on days 2, 7, 9 and 14. For skin roughness, twelve silicon imprint per subject and time point were taken from the stratum corneum and assessed with a 3D skin analyzer for depth of the skin relief. For skin hydration, five measurements per subject and time point were taken with a corneometer.

Results

Washing hands lead to a gradual increase of skin roughness from 100 (baseline) to a maximum of 108.5 after 9 days. Use of a hand cream after each hand wash entailed a decrease of skin roughness which the lowest means after 2 (94.5) and 14 days (94.8). Skin hydration was gradually decreased after washing hands from 79 (baseline) to 65.5 after 14 days. The hand wash, followed by use of a hand cream, still decreased skin hydration after 2 days (76.1). Over the next 12 days, however, skin hydration did not change significantly (75.6 after 14 days).

Conclusion

Repetitive and frequent hand washing increases skin dryness and roughness. Use of a hand cream immediately after each hand wash can confine both skin dryness and skin roughness. Regular use of skin care preparations should therefore help to prevent both dry and rough skin among healthcare workers in clinical practice.     

Soap or alcohol-based products? The effect of hand hygiene on skin characteristics during the COVID-19 pandemic

Background

Different strategies for hand skin hygiene have been used to prevent the spread of SARS-CoV-2. However, frequent hand sanitization has been associated with skin damage. The present study aimed to evaluate hand hygiene habits during the COVID-19 pandemic and the effect of the repetitive use of soap or alcohol-based products on skin characteristics.

Methods

We conducted a survey regards hand hygiene habits acquired during the COVID-19 pandemic. Also, we performed cutometry in a cohort of individuals who cleansed their volar forearms every 30 min, during 4 h, using soap or alcohol-based products.

Results

We received 138 responses from people with medium-high educational level who reported a 2.5-time increase in the frequency of hand cleansing (p < 0.0001) that resulted in skin damage. An in vivo analysis of skin moisture and elasticity was also performed among 19 health workers and students. In general, skin moisture decreased with every cleansing, mainly after 2 h of washing with soap (p < 0.01), while skin elasticity only reduced after 4 h of treatment (p < 0.05). Alcohol-based solution or alcohol-based gel (70% ethanol, both) did not affect skin moisture or elasticity during testing.

Conclusion

It is known that the excessive use of soap or alcohol-based products causes dermatological issues. The present study demonstrates that non-medicated soap significantly affects skin moisture and elasticity, probably because the soap removes the hydrolipidic protective barrier, favoring transepidermal water loss, where the lack of the appropriate stratum corneum hydration also affects skin elasticity, mainly associated with changes in epidermal structure.     

Short-term effects of alcohol-based disinfectant and detergent on skin irritation

The most important risk factor for occupational contact dermatitis in hospital personnel is the exposure to irritants such as water, detergents and alcohol-based solutions. This study was undertaken to evaluate the short-term effects of repeated exposure to an alcohol-based disinfectant, to a detergent and to an alcohol-based disinfectant/detergent alternately. The hardening effect in preirritated skin after a 4-week interval was also evaluated. Detergent, disinfectant and disinfectant/detergent alternately were applied daily every 15 min for 6 h for 2 days to the flexor upper arms and forearms of 15 volunteers. A control area was included. After 4 weeks, a sodium lauryl sulfate patch was applied to each area. Irritant reactions were quantified by visual score, transepidermal water loss (TEWL) and skin colour at baseline, D3, D8, D35 and D37. As evaluated by clinical assessment, detergent caused more redness of the skin than both disinfectant applied alone and disinfectant/detergent alternately at D3 and D8, P < 0.001 and P < 0.001, respectively. An increased irritant response for detergent as compared to disinfectant alone and disinfectant/detergent was confirmed by TEWL and colour evaluations, P = 0.001 and P = 0.001 and P = 0.006 and P = 0.009, respectively. No hardening effect in preirritated skin was found after a 4-week interval. In conclusion, hand disinfection with alcohol-based disinfectant or alternate use of disinfectant/detergent causes less skin irritation than hand disinfection with a detergent. This study evaluated the short-term effects of disinfectant and detergent exposure only, and more long-term studies are necessary before recommendations can be made.     

Effects of disinfectants and detergents on skin irritation

We investigated the biological response of regular human skin to alcohol-based disinfectants and detergents in a repetitive test design. Using non-invasive diagnostic tools such as transepidermal water loss, laser-Doppler flowmetry and corneometry, we quantified the irritative effects of a propanol-based hand disinfectant (Sterillium), its propanol mixture (2-propanol 45% w/w and 1-propanol 30% w/w), sodium lauryl sulfate (SLS) 0.5% and distilled water. The substances were applied in a 2-D patch test in a repetitive occlusive test design to the back. Additionally, we performed a wash test on the forearms that was supposed to mimic the skin affection in the normal daily routine of health care workers. In this controlled half-side test design, we included the single application of the hand rub, SLS 0.5% and water as well as a tandem application of the same substances. Patch test and wash test showed similar results. The alcohol-based test preparations showed minimal irritation rather comparable to the application of water. However, the detergent SLS produced stronger barrier disruption, erythema and dryness than the alcohol-based preparations. There was no additional irritation at the combined use of SLS and disinfectants. By contrary, there was even a decrease in barrier disruption and erythema induced by the tandem application of SLS followed by alcohol-based disinfection compared with the use of SLS alone. These findings show a less irritant effect of alcohol-based disinfectants on the skin than detergents. Our study shows that there is no summation of irritating effects of a common detergent and propanol and that the combination of washing and disinfection has a rather protective aspect compared with washing alone.     

Study of the Efficacy of Antiseptic Handrub Lotions with Hand Washing Machines

The effectiveness of quick handwashing in regards to four alcohol-based handrub lotions, including two products already on the market and our original lotions 1, 2, with two different kinds of hand washing machines was studied in vivo. We also tried to evaluate the efficacy of the four lotions in vitro. The in vivo testing of each lotion, including ethanol, was evaluated using two hand washing methods, first with and then without a previous soap wash. Computerized image analysis was used to calculate the bacterial count on the hand surface. The results showed that a 3 second application of the original lotion 2 (0.5% chlorhexidine in a 77% ethyl alcohol solution) preceded by a soap wash eradicated 89.3% of the bacteria on the hands; this was the highest reduction rate of all four detergents. AROKULIN-E (67.9% ethyl alcohol solution) without a prior handwashing produced the lowest reduction, 49.1% against hand surface bacteria. These results were compatible with those in vitro. It seems that an alcohol-based solution containing an effective antimicrobial detergent preceded by a soap wash is neccessary to acceptably reduce hand surface bacteria.     

A comparison of the antimicrobial effect of 0.5% chlorhexidine (Hibistat®) and 70% isopropyl alcohol on hands contaminated with Serratia marcescens

Two antimicrobial preparations for handwashing were compared by the‘gloved handwash method’ in seventy-two subjects. The test preparation was 0.5% chlorhexidine gluconate alcoholic-emollient handwash (Hibistat®); the reference agent was 70% isopropyl alcohol. The hands were contaminated with Serratia marcescens and disinfected with each antiseptic twenty-five times over an 8 h day. Bacterial counts were obtained for each hand after initial contamination, and after 5, 10, 15, 20 and 25 contamination treatment procedures. There was a statistically significant reduction in recovery of S. marcescens after chlorhexidine treatment compared to alcohol (P < 0.01). When recovery of organisms was plotted against the number of handwashes, there was a significant linear reduction in transient flora for chlorhexidine treated hands (P < 0.01) but not for alcohol treated hands (P < 0.20).     

The use of a measure of acute irritation to predict the outcome of repeated usage of hand soap products

Background Healthcare‐associated infection is an important worldwide problem that could be reduced by better hand hygiene practice. However, an increasing number of healthcare workers are experiencing irritant contact dermatitis of the hands as a result of repeated hand washing. This may lead to a reduced level of compliance with regard to hand hygiene. Objectives To assess whether a measure of acute irritation by hand soaps could predict the effects of repeated usage over a 2‐week period. Methods In a double‐blind, randomized comparison study, the comparative irritation potential of four different hand soaps was assessed over a 24‐h treatment period. The effect of repeated hand washing with the hand soap products over a 2‐week period in healthy adult volunteers on skin barrier function was then determined by assessment of transepidermal water loss (TEWL), epidermal hydration and a visual assessment using the Hand Eczema Severity Index (HECSI) at days 0, 7 and 14. Results A total of 121 subjects from the 123 recruited completed phase 1 of the study. All four products were seen to be significantly different from each other in terms of the irritant reaction observed and all products resulted in a significantly higher irritation compared with the no‐treatment control. Seventy‐nine of the initial 121 subjects were then enrolled into the repeated usage study. A statistically significant worsening of the clinical condition of the skin as measured by HECSI was seen from baseline to day 14 in those subjects repeatedly washing their hands with two of the four soap products (products C and D) with P‐values of 0·02 and 0·01, respectively. Subclinical assessment of the skin barrier function by measuring epidermal hydration was significantly increased from baseline to day 7 after repeated hand washing with products A, B and D but overall no significant change was seen in all four products tested by day 14. A statistically significant increase in TEWL at day 14 was seen for product A (P = 0·02) indicating a worsening of skin barrier function. This effect was also seen initially for product D at day 7 although this was then lost at day 14. Further regression analysis was then performed to see if the acute irritant test data for each product correlated with the skin barrier data from the repeated usage component of the study. This showed that the results of acute irritant testing of the individual products did not predict the results of chronic use of hand soaps. Conclusions The results from phase 2 of our study confirm the work of previous studies that show that regular exposure to irritants in daily life leads to stratum corneum damage and impairment of the skin barrier. Although significant differences were seen between the products in phase 1 of the study, regression analysis showed that the results of patch testing of the individual products did not predict the results of chronic use of hand soaps. When designing a study to assess the effects of cumulative use of a product on the skin, the study should mirror the use conditions of the product as closely as possible.     

Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema

Summary Background Patients with severe chronic hand eczema (CHE) often respond to therapy with oral alitretinoin (9‐cis retinoic acid). However, the efficacy of alitretinoin after disease relapse has not been demonstrated. Objectives To assess the efficacy and safety of a second course of oral alitretinoin in patients with severe CHE who relapsed after achieving ‘clear’ or ‘almost clear’ hands following a previous course of alitretinoin. Methods The double‐blind study included 117 patients with CHE who had responded to therapy in an earlier clinical trial and subsequently relapsed. Patients were randomized to receive their previous treatment or placebo. Treatment was alitretinoin 30 mg or 10 mg or placebo given once daily for 12–24 weeks. Response was defined as an overall Physician’s Global Assessment rating of ‘clear’ or ‘almost clear’ hands at the end of therapy. Results Response rates were 80% in patients retreated with 30 mg alitretinoin compared with 8% for placebo (P < 0·001). In patients retreated with 10 mg alitretinoin response rates were 48%, compared with 10% in the placebo group. Alitretinoin was well tolerated. Adverse reactions comprised typical retinoid class effects, and no late‐arising side‐effects were observed during this second course of treatment. Conclusions The majority of patients with CHE who previously achieved ‘clear’ or ‘almost clear’ hands following treatment with alitretinoin 30 mg per day also responded to a second course of treatment. Retreatment was well tolerated. Intermittent treatment with alitretinoin is suitable for the long‐term management of CHE.     

An improved method for measurement of change in skin roughness caused by cleansing products under mild application conditions

Background: The aim of this study was to develop a method for the evaluation of subtle change in skin roughness caused by cleansing products under mild application conditions using a non‐invasive three‐dimensional (3D) analysis system. Methods: A double‐blind comparative study of the modified soap chamber test was performed using two soap bars and a syndet bar. Skin changes were evaluated by visual scoring [mean cumulative irritation index (MCII)] and by bioengineering measurements [transepidermal water loss (TEWL), skin capacitance, and skin surface roughness]. Results: MCII of the syndet bar was statistically higher than that of one soap bar, and TEWL increase after application of the syndet bar was statistically higher than that of both soap bars. Skin capacitance decreased significantly only after application of the syndet bar. The change in the average roughness of the skin surface was significantly greater after the application of the syndet bar than with classic soap bars. Conclusion: A simple, fast, and objective evaluation of skin surface topography was performed using a modified soap chamber test and a non‐invasive 3D analysis system. The results suggest that measurement of skin roughness using a non‐invasive 3D analysis system might be a good method for the evaluation of a subtle change caused by cleansing products under mild application conditions.     

Comparison of topical PUVA with UVA for chronic vesicular hand eczema.

Topical PUVA was compared with UVA for the treatment of chronic vesicular hand eczema in a double-blind randomized within-patient trial. Twelve of 15 patients completed 8 weeks' treatment and were followed up for 8 weeks. Both sides improved over the 8-week treatment period (p less than 0.05) and both remained substantially better objectively and subjectively at 8 weeks' follow-up. There was no statistical difference between assessments of the treated hands at any stage. Nine of the patients who completed the study answered a questionnaire up to 18 months later. In 4, eczema was healed, 3 were better on the PUVA-treated hand and 1 on the UVA-treated hand. It is possible that UVA alone is beneficial for chronic hand eczema.     

The influence of soap on eczematous dermatitis.

A controlled study of the influence of soap on eczematous dermatitis of the hands (housewives' eczema) failed to show any significant influence of soap on the disease process.     

Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya

OBJECTIVE: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. METHODS: This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs. Consenting women were administered a questionnaire and screened for STIs. RESULTS: The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV infection was significantly associated with bacterial vaginosis (BV), trichomoniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was the fluid most often used (81%), followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). Douching in general and douching with soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increased frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs. CONCLUSION: The widespread habit of douching among African female sex workers was confirmed. The association between vaginal douching and BV is of concern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a direct association between douching and HIV infection. Further research is required to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.     

Quantitative effect of anodal current in the treatment of primary hyperhidrosis by direct electrical current

AIM: To determine the quantitative effect and technique of use of the anodal current for the treatment of palmoplantar hyperhidrosis on local areas of the palms and soles. METHODS: Twelve patients (four males and eight females) with idiopathic palmoplantar hyperhidrosis were enrolled in this study. Having determined the initial sweat intensities of both hands using the pad glove method, direct electrical current (d.c.) treatment was applied to the palms of the patients using a complete regulated d.c. unit for which the current and potential ranges were 0-30 mA and 0-90 V, respectively. Electrodes were placed into two separate water plates, and covered with pad made from gauze and cotton material. The pads were moisturized with tap water for current conduction. The anodal current was applied to the right hands of six patients (group I) and to the left hands of the remainder (group II). After seven treatments had been completed for the palms, the final sweat intensities of the hands were measured. RESULTS: In both groups, the final sweat intensities of the hands subjected to the anodal current were significantly decreased in comparison with the initial values, regardless of whether the anodal current was applied to the right or left hand (P < 0.05). In contrast, the final sweat intensities of the other hands subjected to the cathodal current were not significantly decreased (P > 0.05). CONCLUSIONS: It can be concluded that the anodal current is more effective in reducing sweating on the palms when applied either to the right or left hand. In the treatment of palmoplantar or localized hyperhidrosis, the anodal current should be referenced first to treat the sweatier hand or foot, or a local hyperhidrotic area of the skin. The selection of the anodal current for one hand for the first five or seven sessions appears to be more effective than the use of polarity changes for each session.