الفهرس 
HyperhidrosisOnly 14 pages are availabe for public view
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Abstract
Hyperhidrosis is a condition in which sweat production exceeds that is needed for thermoregulation, and can affect the hands, feet, axilla, face, back, groin, and legs. It is a disabling condition that affect, both children and adults, with in a rate of 1-3% and onset usually during childhood or adolescence. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity.
Hyperhidrosis is usually primary or can be secondary to number of causes such as diabetes, hyperparathyroidism, chronic infections, and malignancy. Once a diagnosis of primary hyperhidrosis is established, the extent of hyperhidrosis can be measured by the production of sweat rate by gravimetric assessment, scoring by HDSS and visual intensity scale of the iodine starch test.
Treatment of hyperhidrosis can be topical, systemic, surgical, and interventional non-surgical treatment. Treatment of hyperhidrosis needs to be individualized depending on the clinical presentation and according to the discussion with the patient to ensure reasonable expectations and avoid unnecessary frustration.
The most common treatment modalities are topical agents such as aluminum salts and topical glycol pyrolate but these agents are limited due to their side effects as skin irritation, contact allergy, itching, high cost and staining. Systemic anticholinergics can be used for treatment generalized or focal hyperhidrosis, but side effects are common and long-term treatment are limited.
Surgical treatments for hyperhidrosis include excision of the axillary vault to remove eccrine glands, curettage, or liposuction to remove glandular tissue and, finally, sympathectomy. The main complications with sympathectomy include compensatory sweating, gustatory sweating, Horner’s syndrome, and neuralgia.
Botulinum toxin intradermal injection is one of the most common treatments of hyperhidrosis. However, its use is limited by several factors such as high cost, relatively short duration of improvement which doesn’t exceed 6 months, and the pain during its intradermal delivery which may need nerve blocking anesthesia.
Photodynamic therapy involves the use of photosensitizer agent followed by exposure to light source to trigger production of reactive oxygen species (ROS) which have a destructive powers. It is considered as simple modality which needs only a photosensitizer and light source. Thus, it can be practiced easily in the dermatology clinic or as a non-clinic treatment via daylight PDT Photodynamic therapy (PDT) is a modern, noninvasive treatment for skin disorders with good successful outcomes as hidradenitis suppurative and acne vulgaris through destruction of pilosebaceous glands. This mechanism has been tried in axillary hyperhidrosis with high efficacy. So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using a photosensitizer [MB 2%].
In view of the continuous need for new methods for treatment of primary palmar hyperhidrosis and the successful use of PDT for treatment of hyperhidrosis, and the accessibility of daylight, we investigated the efficacy of daylight photodynamic therapy using methylene blue as a photosensitizer as a method for treatment of primary palmar hyperhidrosis.
We studied the effect of PDT on 20 patients with primary palmar hyperhidrosis. The night before every session the patient used a cream containing (10 % urea,5% salicylic acid) under occlusion as an emollient and to facilitate the photosensitizer skin delivery in the next morning. Application of methylene blue 2% for the right palm as a photosensitizer and hematoxylin stain as a placebo for the other palm for one hour under occlusion as incubation period. After one hour of incubation, exposure to daylight for one hour from 11 am to 12 pm. The patients were advised to continue using the moisturizing cream containing (urea 10%, salicylic acid 5%) daily in between sessions but on the night before the session, the patient was asked to keep it under occlusion the whole night. The treatment sessions were done twice weekly for a maximum of 8 sessions. A starch-iodine test was done before each session.
The following methods were used to assess the response to treatment: the hyperhidrosis disease severity scale in which (grade 1 sweating is never noticeable and never interferes with daily activities, grade 2 sweating is barely tolerable but sometimes interferes with daily activities, grade 3 sweating is tolerable and frequent interferes with daily activities, grade 4 sweating is intolerable and always interferes with daily activities), Minor’s starch-iodine and the sweating rate by the gravimetric method.
We found that we could reach nearly complete response for treatment of primary palmar hyperhidrosis after eight sessions of treatment with PDT using MB as the photosensitizer and the daylight as the light source while hematoxylin use, as a placebo, showed almost no effect. The effect was maintained at least for two months after the last treatment session. The side effects were mostly limited to transient palm staining by the photosensitizer. So, our study showed that the PDT had a positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least 2 months after treatment stoppage.
So, our work supports the use of daylight as an effective light source in PDT to induce significant reduction of the sweating in cases of primary palmar hyperhidrosis. The use of cheap photosensitizers as MB adds more privilege to this treatment line. Thus, daylight PDT by MB could be considered to offer an easy cheap self-treatment option for treatment of palmar hyperhidrosis.