Craniofacial Hyperhidrosis

Craniofacial Hyperhidrosis

1. Craniofacial Hyperhidrosis Ade Wijaya, MD – August 2020

2. Outline: 2 Introduction Epidemiology Etiology Diagnosis Treatment Summary

3. Introduction 3 Facial form of focal hyperhidrosis referring to excess sweating beyond normal physiological function U sually affects the forehead bilaterally Predominantly a primary condition characterised by sudomotor dysregulation stimulated by triggers such as heat and stress Hyperactive eccrine glands if severe enough, can have debilitating effects on an individual’s quality of life Glaser DA, Hebert AA, Pariser DM, Solish N. Facial hyperhidrosis: best practice recommendations and special considerations. Cutis. 2007;79:29–32 . Eisenach JH, Atkinson JLD, Fealey RD. Hyperhidrosis: evolving therapies for a well-established phenomenon. Mayo Clin Proc. 2005;80(5):657–66 . Bovell DL, Clunes MT, Elder HY, Milsom J, McEwan Jenkinson D. Ultrastructure of the hyperhidrotic eccrine sweat gland. Br J Dermatol. 2001;145(2):298–301 . Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci. 2000;37(1):25–31.

4. Epidemiology 4 The incidence of primary hyperhidrosis is 2.9 % Between 18 and 54 years Focal Craniofacial Hyperhidrosis: 22.8 % of this population More common in Men and older patients Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004;51(2):241–8 . Lear W, Kessler E, Solish N, Glaser DDA. An epidemiological study of hyperhidrosis. Dermatologic Surg. 2007;33:69–75.

5. Etiology 5 Primary: genetic Secondary: onset of menopause, diabetes mellitus, endocrine disorders and certain medications such as nortriptyline hydrochloride and pilocarpine Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg. 2002;35(2):382–6 Glaser DA, Hebert AA, Pariser DM, Solish N. Facial hyperhidrosis: best practice recommendations and special considerations. Cutis. 2007;79:29–32.

6. Diagnosis 6 Subjective symptoms Objective: - Gravimetry - The Minor iodine starch test Stefaniak T, Tomaszewski KA, Proczko-Markuszewska M, Idestal A, Royton A, Abi-Khalil C. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults. J Dermatol. 2013;40(10):819–23 . Stefaniak TJ, Proczko M. Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals. Clin Auton Res. 2013;23(4):197–200 . Hexsel D, Rodrigues TC, Soirefmann M, Zechmeister-Prado D. Recommendations for performing and evaluating the results of the minor test according to a sweating intensity visual scale. Dermatol Surg. 2010;36(1):120–2.

7. Treatment 7 2 % Topical glycopyrrolate: strength of recommendation B, level of evidence Ib ). Oxybutynin 5 mg: Strength of recommendation B, level of evidence III . Intradermal injection of botulinum toxin A: Strength of recommendation B, Level of evidence Ib . Endoscopic thoracic sympathectomy and its variations: Strength of recommendation B, Level of evidence III . Other treatments: topical antiperspirant therapy (e.g. aluminium salts ) and propranolol Nicholas R, Quddus A, Baker DM. Treatment of primary craniofacial hyperhidrosis: a systematic review. American journal of clinical dermatology. 2015 Oct 1;16(5):361-70.

8. 8 Nicholas R, Quddus A, Baker DM. Treatment of primary craniofacial hyperhidrosis: a systematic review. American journal of clinical dermatology. 2015 Oct 1;16(5):361-70.

9. Summary 9 Craniofacial hyperhidrosis (CH) is a facial form of focal hyperhidrosis referring to excess sweating beyond normal physiological function, which can have a profoundly negative impact upon quality of life . Clinical evidence supporting the effective treatment of CH is weak due to a lack of published randomised controlled trials . Based on the findings from our systematic review, we recommend topical glycopyrrolate, oral oxybutynin and intradermal botulinum toxin A as first-line therapies due to their high efficacy and favourable safety profiles. T2 sympathectomy should be reserved for patients who are refractory to firstline therapy due to the high incidence of postoperative compensatory sweating and rare yet significant postoperative complications.

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