Hyperhidrosis

Hyperhidrosis

1. Hyperhidrosis Ade Wijaya , MD October 2019

2. Outline: Introduction Epidemiology Etiology Pathophysiology Diagnosis Treatment and management Summary

3. Introduction A disorder of  excessive sweating due to over-stimulation of cholinergic receptors on eccrine glands Physical discomfort and social embarrassment  functionally morbid and disabling Sammons JE, Khachemoune A. Axillary hyperhidrosis : a focused review. J Dermatolog Treat. 2017 Nov;28(7):582-590. Perri , B., Vaynman , S., Ghostine , S., Samudrala , S., Johnson, J. P., & Siddique , K. (2016). Hyperhidrosis : pathophysiology and available therapies. Surgery of the Autonomic Nervous System , 285.

4. Epidemiology 3 % in USA 1 % in W estern population 0.15 – 0.25 % Israeli population 0.05 % in the Japanese or other asian ethnic population Onset: childhood and adolescence in primary hyperhidrosis ; later age onset  secondary 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 Aug;51(2):241-8. Perri , B., Vaynman , S., Ghostine , S., Samudrala , S., Johnson, J. P., & Siddique , K. (2016). Hyperhidrosis : pathophysiology and available therapies. Surgery of the Autonomic Nervous System , 285. Menzinger S, Quenan S. [Evaluation and management of hyperhidrosis ]. Rev Med Suisse. 2017 Mar 29;13(556):710-714.

5. Etiology Primary  genetics Secondary  medications such as dopamine agonists, SSRIs, antipsychotics, alcohol, and insulin, systemic disorders such as diabetes mellitus, hyperthyroidism, Parkinson disease, and other neurologic disorder, and tumors such as pheochromocytoma and lymphoma, also chronic infections, dermatological ailments. Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis : clinical, pathophysiological , diagnostic and therapeutic aspects. An Bras Dermatol . 2016 Nov-Dec;91(6):716-725. Perri , B., Vaynman , S., Ghostine , S., Samudrala , S., Johnson, J. P., & Siddique , K. (2016). Hyperhidrosis : pathophysiology and available therapies. Surgery of the Autonomic Nervous System , 285.

6. Pathophysiology S weating beyond what the body uses for homeostatic temperature regulation Eccrine glands are concentrated in areas such as the axillae , palms, soles, and face, so these are the areas most commonly affected by hyperhidrosis The acetylcholine negative feedback loop is likely impaired in these patient's which may help explain how a physiologic response can become pathologic Menzinger S, Quenan S. [Evaluation and management of hyperhidrosis ]. Rev Med Suisse. 2017 Mar 29;13(556):710-714. Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis : clinical, pathophysiological , diagnostic and therapeutic aspects. An Bras Dermatol . 2016 Nov-Dec;91(6):716-725.

7. Pathophysiology hyperactivity of the sympatheti c nervous system  excessice release of acethylcoline Acetylcholine will innervate the epidermal eccrine sweat glands as a physiologic response to core body temperature control during times of physical or psychological stress Fujimoto T. Pathophysiology and Treatment of Hyperhidrosis . Curr . Probl . Dermatol . 2016;51:86-93. Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis : clinical, pathophysiological , diagnostic and therapeutic aspects. An Bras Dermatol . 2016 Nov-Dec;91(6):716-725.

8. Diagnosis History and Physical Laboratory Radiology Histopatology Brackenrich , J., & Fagg , C. (2018). Hyperhidrosis . In StatPearls [Internet] . StatPearls Publishing.

9. History and Physical Location Family history I odine-starch test Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis : clinical, pathophysiological , diagnostic and therapeutic aspects. An Bras Dermatol . 2016 Nov-Dec;91(6):716-725. Menzinger S, Quenan S. [Evaluation and management of hyperhidrosis ]. Rev Med Suisse. 2017 Mar 29;13(556):710-714.

10. Laboratory & Radiology A complete blood count Basic metabolic panel Thyroid-stimulating hormone Chest x-ray S edimentation rate ANA Hemogblin A1C Nawrocki S, Cha J. The Etiology , Diagnosis and Management of Hyperhidrosis : A Comprehensive Review. Part I. Etiology and Clinical Work-Up. J. Am. Acad. Dermatol . 2019 Jan 30; Menzinger S, Quenan S. [Evaluation and management of hyperhidrosis ]. Rev Med Suisse. 2017 Mar 29;13(556):710-714.

11. Histopathology Eccrin glands  normal size Larger sympathetic ganglia Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis : clinical, pathophysiological , diagnostic and therapeutic aspects. An Bras Dermatol . 2016 Nov-Dec;91(6):716-725.

12. Treatment and Management First line: Anticholinergics Aluminum chloride hexahydrate 20% ( Drysol ) for 3 to 4 nights then nightly as needed. Mild skin irritation may result from the application If a patient does not respond to topical treatment or there are more generalized symptoms, oral anticholinergic medications which block the cholinergic receptors (including oxybutynin 5 mg to 10 mg per day or topical glycopyrrolate 0.5% to 2.0%) Delort S, Marchi E, Corrêa MA. Oxybutynin as an alternative treatment for hyperhidrosis . An Bras Dermatol . 2017 Mar-Apr;92(2):217-220. Fujimoto T. Pathophysiology and Treatment of Hyperhidrosis . Curr . Probl . Dermatol . 2016;51:86-93.

13. Treatment and Management Iontophoresis First introduced by Bouman et al. In the 1950s Applying a low level electric current 15-20 mA to the skin under an electrolyte solution for 30 minutes Perri , B., Vaynman , S., Ghostine , S., Samudrala , S., Johnson, J. P., & Siddique , K. (2016). Hyperhidrosis : pathophysiology and available therapies. Surgery of the Autonomic Nervous System , 285.

14. Treatment and Management Botulinum toxin A injections every 3 to 4 weeks if patients fail topical and oral medication therapy Sympathectomy or local excision T reatment of the underlying disorder or discontinuing the suspected medication Hosp C, Hamm H. Safety of available and emerging drug therapies for hyperhidrosis . Expert Opin Drug Saf . 2017 Sep;16(9):1039-1049. Al- Hashel JY, Youssry D, Rashaed HM, Shamov T, Rousseff RT. Botulinum toxin A for palmar hyperhidrosis : assessment with sympathetic skin responses evoked by train of stimuli. Auton Autacoid Pharmacol . 2016 Jul;36(3-4):23-26

15. Summary Hyperhidrosis can affect not only a patient's physical health but also his or her psychological health.  affect QOL Excessive sweating; overstimulation of cholinergic receptors Primary vs secondary

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