الفهرس 
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Abstract
Hyperhidrosis is a disorder of excess sweating because of over-stimulation of cholinergic receptors on eccrine glands. It may cause deeply dramatic effect on a patient’s quality of life, leading to marked impairment of activities, social interactions in addition to occupational activities. In fact, the options of treatment for primary hyperhidrosis include a wide range of topical or systemic medications along with surgical & non-surgical invasive techniques. Aluminum chloride is commonly used topically as the first-line therapy for primary hyperhidrosis. Several studies have shown that aluminum salts can cause an obstruction of the distal sweat gland ducts. Oxybutynin is an anticholinergic drug that has proven to be effective and safe for the treatment of hyperhidrosis. When oxybutynin is used topically, it achieves direct passage to the systemic circulation, obviating the first hepatic pass and significantly reducing the formation of active metabolites. Hence, topical oxybutynin is believed to have high efficacy with a much lower rate of side effects. This study aimed at comparing the efficacy of topical oxybutynin 3% gel versus topical aluminum chloride 15% lotion in the treatment of primary focal hyperhidrosis. The current study was carried out on 40 patients presented with hyperhidrosis who were randomly selected from the outpatient clinics of Dermatology and Venereology Department, Tanta University Hospitals. All patients were subjected to the following before procedure:- I. Complete history taking including present (onset, course and duration), past history and family history of hyperhidrosis. II. General and dermatological examination to exclude any systemic or other dermatological diseases. III. An informed consent was obtained from all participants after full explanation of the procedure, risks and purpose of the study. IV. Severity of hyperhidrosis at the affected site was evaluated using the Minor’s iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS) and dermatology life quality index (DLQI) and digital photographs were taken for each patient. V. Laboratory investigations to exclude causes of secondary hyperhidrosis including thyroid function tests and hemoglobin A1C. Therapeutic regimen: • Patients were divided into two equal, randomly distributed groups; each consisted of 20 patients. • Patients of group (A) were treated with topical oxybutynin 3% gel at each affected site. • Patients of group (B) were treated with topical aluminum chloride 15% lotion at each affected site. • All patients were instructed to apply the treatment once daily, at night, on clean dry and intact skin to be washed off next morning. Treatment continued for 4 weeks. • All patients were followed up after 2 weeks, 4weeks of treatment and one month after stopping treatment, with photographs taken at each visit. • Oxybutynin 3% gel preparation: Oleic acid (20 grams) was mixed with tween-80 (30 grams) and ethanol (10 grams) to produce homogenous liquid. Oxybutynin (3 grams) was then added with mixing until solubility then water (40 ml) was added with stirring to produce homogenous liquid crystalline gel. It was prepared freshly every week and stored in the fridge. • Aluminum chloride 15% lotion preparation: 15 grams of aluminum chloride were dissolved with 1 gram of menthol in 100 ml absolute ethanol. The solution was packed in air tight container. Assessment of the efficacy of the therapeutic procedure: I. Clinical assessment Photographs were taken at baseline, 2 and 4 weeks of treatment and at 1 month follow up after stoppage of treatment. Minor’s iodine starch test and hyperhidrosis disease severity (HDSS) were performed at baseline, 2 and 4 weeks of treatment and at 1 month follow up after stoppage of treatment. Dermatology life quality index (DLQI) was performed at baseline, at end of treatment (after 4 weeks) and at 1 month follow up. Two dermatologists were asked to record improvement by comparing before-and-after digital photographs. II. Safety assessment - Patients were informed to report any treatment related complication and side effects such as itching, skin irritation, dry mouth, nausea, diarrhea, gastro-oesophageal reflux, abdominal pain, headache, asthenia, dizziness, flush, blurred vision and urinary difficulty. Results: I) Regarding Minor’s iodine starch test: The improvement in both groups at 2 weeks of treatment was close, while at 4 weeks of treatment, patients of group A showed statistically significant higher degree of improvement than group B. At 1 month follow up, there was decline in improvement in both groups, however, patients of group A still showed significantly better results. II) Regarding hyperhidrosis disease severity scale (HDSS): There was no statistically significant difference in HDSS after 2 weeks of treatment. However, after 4 weeks of treatment and at 1 month follow up after stoppage of treatment, patients of group A showed statistically significant decline of HDSS. These results came in accordance with those obtained by Minor’s test. III) Regarding dermatology life quality index (DLQI): Patients of both groups showed statistically significant decline of DLQI score at 4 weeks of treatment and at 1 month follow up compared to baseline. However, DLQI scores in patients of group A were statistically significantly better. IV) Safety assessment: No serious side effects were reported in both groups except for 2 patients, 1 in each group, who reported mild irritation and scaling not necessitating withdrawal from the study.