RECENT MEDICAL JOURNAL ABSTRACTS AND RESEARCH PAPERS
1: Dermatol Surg. 2008 Jun;34(6):751-5. Epub 2008 Mar 3. Efficacy of botulinum toxin type A in the treatment of focal axillary hyperhidrosis. Absar MS, Onwudike M.
Vascular Unit, Department of Surgery, Royal Bolton Hospital, Bolton, United Kingdom.
BACKGROUND: Local intradermal injection of botulinum toxin Type A has become a recognized treatment for axillary hyperhidrosis. This study has investigated the efficacy of this method of treatment in terms of symptom-free interval between treatments and patients' satisfaction. We also investigated the reliance on patients' subjective assessment of the recurrence of symptoms in determining the timing of repeat injections. METHODS: All patients referred to our clinic between May 2001 and December 2005 with a diagnosis of focal primary axillary hyperhidrosis were included in this study. Data were collected prospectively in a standard proforma. Every patient received a questionnaire to complete over a 4-week period. The questionnaire included visual analogue scales for periprocedural pain, degree of dryness, satisfaction, regret, and complications. Final symptom-free interval was recorded when the patient requested a repeat injection. The data were recorded on a spreadsheet and analyzed using standard statistical methods. RESULTS: A total of 52 consecutive patients and 238 axillary injections were analyzed. The symptom-free interval ranged from 3 to 14 months with a median of 5.97 months. There were no significant complications from this treatment modality. A total of 97% of the patients were highly satisfied with only 1 patient regretting the treatment. CONCLUSION: Botulinum toxin Type A is an effective and well-tolerated treatment for axillary hyperhidrosis. Timing of repeat injections as determined subjectively by patients is comparable to studies using colorimetric and gravimetric techniques to quantify the severity of sweating prior to the administration of repeat injections. The authors have indicated no significant interest with commercial supporters.
2: J Drugs Dermatol. 2008 Mar;7(3):221-7.Links Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis. Flanagan KH, King R, Glaser DA.
Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO, USA.
Severe hyperhidrosis affects 2.8% of the population and can be emotionally devastating. First-line therapy employs topical agents such as aluminum chloride (AC), but efficacy and tolerability vary widely. Botulinum toxin type A (BTX-A) is FDA-approved for the treatment of primary focal axillary hyperhidrosis unresponsive to topical therapy. A single-center, randomized, parallel, open-label, 12-week study was performed to compare the efficacy and safety of BTX-A with 20% AC for the treatment of primary focal axillary hyperhidrosis. Twenty-five subjects were randomized to either BTX-A or AC treatment, and were evaluated for treatment response by an improvement of > or =2 grades on the Hyperhidrosis Disease Severity Scale (HDSS). At week 4, 92% of the subjects in the BTX-A group achieved treatment response compared with 33% of the subjects in the AC group. Overall, treatment with BTX-A was more effective and provided greater patient satisfaction than with AC. Treatment with AC was effective and tolerated in 29% of the subjects.
3: J Cosmet Dermatol. 2005 Sep;4(3):163-6.Links Treatment of palmar hyperhidrosis with botulinum toxin type A: 44 months of experience. Pérez-Bernal AM, Avalos-Peralta P, Moreno-Ramírez D, Camacho F.
Department of Dermatology, Hospital Virgen Macarena, Seville, Spain.
Background Palmar hyperhidrosis (PH) can produce social and occupational difficulties and reduce the quality of life of those who suffer from this kind of problem. When dealing with focal hyperhidrosis, the patients' attitudes and their subjective approaches regarding the process may influence the objective evaluation of the disorder. Objective To evaluate, by means of a scale, the subjective improvement of sweat production after treatment with botulinum toxin type A (BTX-A) in a group of patients with severe, invalidating PH. Patients and methods Over a period of 44 months, 69 patients were treated and followed-up, 27 patients had to be treated twice, and 11 patients required a third application; 80-100 U was injected in each palm. Regional nerve block was performed before the procedure. The patients were asked to evaluate their improvement at 1, 3, 6, 9, and 12 months of baseline. Results At 1 month, 53.6% of the patients reported an excellent improvement. Three months later, results were still excellent in 33.3% of the patients, and acceptable in 29%. From then on there was a statistically significant decrease of BTX-A effectiveness. A second application was carried out at an interval of 7.5 +/- 2.6 months, and a third one at 9 +/- 4.4 months. The following complications could be observed: transitory weakness of hand muscles in 13 patients, wrist pain in 5 patients, and cramps in 1 patient. Conclusions Botulinum toxin is an effective alternative for the treatment of severe, invalidating PH. The maximum improvement persists up to 3 months; from then on, the effects slowly diminish. In our experience, there were no statistically significant differences with further applications of BTX-A. The patients' subjective assessment can be used to evaluate the sweat production after treatment with BTX-A in those medical centers where a more objective evaluation becomes difficult or impossible
4: Semin Cutan Med Surg. 2007 Mar;26(1):29-33. Complications with the use of botulinum toxin type A for cosmetic applications and hyperhidrosis. Pena MA, Alam M, Yoo SS.
Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
In dermatology, botulinum toxin is now most often used to reduce dynamic facial creases and treat primary focal hyperhidrosis. The exemplary safety record of this medication is such that after nearly 2 decades, it is not known to have any long-term adverse events. Transient adverse events, such as mild injection pain, are typically minor and spontaneously remitting. Headache, nausea and flu-like symptoms, lid and brow ptosis after upper face injection, lower face asymmetry after perioral injection, and fine motor impairment after palmar injection are uncommon to rare. Understanding of anatomic landmarks and site-specific precautions can further mitigate the incidence of unwanted effects. Patients who do experience uncommon, transient effects can be reassured that these are not dangerous and will resolve completely without intervention.
5.Rodríguez PM, Freixinet JL, Hussein M, Valencia JM, Gil RM, Herrero J, Caballero-Hidalgo A.
Thoracic Surgery Department, Hospital Universitario de Gran Canaria "Dr. Negrín", C/ Barranco de la Ballena s/n, 35020 Las Palmas de Gran Canaria, Spain.
BACKGROUND: Thoracic sympathectomy (TS) is the treatment of choice for severe primary hyperhidrosis. However, complications, side effects and satisfaction have not been well defined. OBJECTIVE: To analyze the complications, side effects, satisfaction degree and quality of life of patients after TS for primary upper limb hyperhidrosis. METHODS: One-year follow-up after 406 consecutive TS for primary upper limb hyperhidrosis. RESULTS: Bilateral TS was completed in all patients. Complications arose in 23 cases (5.6%), with pneumothorax being the most frequent. The success rate after discharge, 6 and 12 months was respectively, 100%, 98.1% and 96.5% for palmo-axillary hyperhidrosis; 100%, 99.3% and 97.8% for isolated palmar hyperhidrosis and 100%, 85.7% and 71.4% for isolated axillary hyperhidrosis. No persistence of hyperhidrosis was observed. Global recurrence was 3.7% (28.5% axillary hyperhidrosis group). Compensatory sweating (CS) appeared in 55% and was not related to the extension of the TS. Being female was a predisposing factor of CS (p<0.004). Excessive dryness appeared at 9% and was associated with extensive TS (P<0.001). Plantar hyperhidrosis improved at 33.6%, worsened at 10% and remained stable during the follow-up. Satisfaction degree decreased with the passage of time and was associated with recurrence. Quality of life was excellent at discharge, 6 and 12 month in 100%, 100% and 97%, respectively. CONCLUSIONS: Pneumothorax is the most frequent complication of TS. CS is the main and undesirable side effect, appears with the passage of time, and is not related to the extension of TS. Being female is the only predictor factor of suffering CS. Plantar hyperhidrosis improves initially, although tends to reappear. Excessive dryness appears in extensive TS and does not improve over time. Postoperative satisfaction degree is high but decreases over time owing to the appearance of recurrence. Effectiveness and the absence of CS determine an excellent quality of life. Six percent of the patients regret the surgery because of severe CS. Informing patients of possible side effects before TS is essential.
6.Complications of video assisted thoracoscopic sympathectomy for primary hyperhidrosis. Al-Tarshihi MI, Khamash FA, El-Khushman HM.
Thoracic Surgery Division, King Hussein Medical Center, PO Box 6926, Amman 11118, Jordan. mtarshihi@gmail.com
OBJECTIVE: To document the possible complications of video-assisted thoracoscopic sympathectomy procedure and their frequency of occurrence. METHODS: This retrospective study was conducted at King Hussein Medical Center, Amman, Jordan, between April 2001 and January 2006. Two hundred and seven patients underwent thoracoscopic sympathectomy for the treatment of facial, axillary, and/or palmar hyperhidrosis. Follow up was completed for one year. All possible early and late complications were documented and analyzed. RESULTS: Males constituted 59.4% of the studied patients. Mean age (range) was 25.2+/-4.6 (13-34) years. One hundred and fifty-three patients (73.9%) had palmar hyperhidrosis as the main indication for sympathectomy, 4 patients (1.9%) had axillary hyperhidrosis, and facial sweating or blushing in 7 patients (3.4%). Palmar hyperhidrosis combined with axillary and/or facial sweating were found in 43 patients (20.8%). The most common recorded complication was compensatory hyperhidrosis, which occurred in 142 patients (68.6%). CONCLUSION: Compensatory sweating remains the most common, and most disabling complication of video-assisted thoracoscopic sympathectomy. Other alternative more selective methods, rather than cutting the main trunk should be studied thoroughly to assess their efficacy in reducing the complication of compensatory sweating.
