Using Neuromodulators for Salivary, Eccrine, and Apocrine Gland Disorders.

BACKGROUND: Sialorrhea, hyperhidrosis, bromhidrosis, and chromhidrosis are common glandular disorders that substantially impact patients' health and quality of life. Botulinum toxin can safely and temporarily decrease gland secretions by targeting the parasympathetic cholinergic neurons, resulting in diminished saliva and sweat production. OBJECTIVE: The objective of this article is to describe the applications of neuromodulators for the treatment of salivary, eccrine, and apocrine glands. METHODS: PubMed was searched from inception to February 1, 2024 using search terms "neurotoxin," "botulinum toxin," "sialorrhea," "hyperhidrosis," "bromhidrosis," and "chromhidrosis." RESULTS: Incobotulinumtoxin A and Rimabotulinumtoxin B are approved by the FDA for the treatment of sialorrhea. Onabotulinumtoxin A is the only FDA-approved botulinum toxin for axillary hyperhidrosis and is used off-label for hyperhidrosis of nonaxillary sites, bromhidrosis, and chromhidrosis. Compared to botulinum toxin serotype A, serotype B has been associated with more immunogenicity, which may have implications for patients requiring long-term treatment for chronic glandular disorders. CONCLUSION: Neuromodulators are safe and effective for the noninvasive treatment of excess gland activity and can improve patients' quality of life. While substantial literature supports botulinum toxin treatments for hyperhidrosis, further studies are needed to characterize standard dosing and administration techniques for sialorrhea, bromhidrosis, and chromhidrosis.

Sweating Blood: A Case Series of 2 Siblings With Hematohidrosis.

Hematohidrosis is a condition that presents with the excretion of blood from intact skin. Reported cases suggest emotional stress reactions as the most common inciting events. The pathogenesis of the condition is not well understood. We describe a 9-year old boy and his 6-month old half-sister with a history of bleeding episodes from the ears, eyes, and scalp, as well as other sites. Symptoms in both children have shown a positive response to propranolol, with decreased frequency and severity of bleeding. There are no prior reports of siblings with hematohidrosis, suggesting a possible genetic predisposition.

Neutrophilic superficial eccrine ductitis: Proposal of a new disease concept.

A 3-year-old Japanese boy presented with a 3-month history of itchy erythematous papules on his trunk and forearms, the histologic findings of which were characterized by predominantly neutrophilic inflammation within and around the eccrine sweat ducts and obliteration and disruption of the superficial eccrine sweat ducts. Although the skin disorder had some clinical and histopathologic similarity to miliaria and neutrophilic eccrine hidradenitis, it was ultimately conformed to be neither disorder. Based on this and a case report in the Japanese literature of a 1-year-old boy with erythematous eruptions whose clinical and histopathologic findings were similar to those in our case, we propose the skin disorder in our case, referred to as "neutrophilic superficial eccrine ductitis," as a unique entity.

Coloured sweat in two brothers: First report of familial chromhidrosis.

The uncommon diagnosis of chromhidrosis is most frequently made in young adults. This sweat gland disease, although benign, may impact significantly on the patient's quality of life. We describe the first report of familial chromhidrosis of pseudo-eccrine type (pseudochromhidrosis) occurring in two brothers aged 9 and 12 years. The classification and causality of chromhidrosis is described and approaches to assessment and management are outlined.

A case of generalized red sweating.

We report a case of a 70-year-old man with a 5-year history of red pigmented sweating on the axillae, groin, forearms, trunk, and and peri-nuchal sites. No identifiable cause of the pigmented sweat was identified. Biopsy revealed lipofuscin pigment leading to the diagnosis of idiopathic chromhidrosis. This case represents an unusual presentation of chromhidrosis that was not limited to the apocrine sweat gland distribution and ultimately revealed no identifiable cause. After failing multiple treatment options, the patient elected for a trial of treatment with 20% aluminum chloride solution.

[Botulinum toxin for the treatment of secretory disorders of the head and neck area]. / Botulinumtoxin für die Behandlung sekretorischer Störungen im Kopf-Hals-Bereich.

Botulinum toxin can be used for the temporary blockade of secretory glands in the head and neck area. Botulinum toxin is increasingly the therapy of choice for the treatment of Frey's syndrome and gustatory tearing, and it is gaining attention for hypersalivation therapy. For nasal hypersecretion, this drug has a very specific use. In comparison to the treatment of skeletal muscles, the individual effect and its duration are more difficult to predict. All indications presented here are for off-label use; therefore, careful counseling and informed consent are necessary. With botulinum toxin, for several diseases, as new treatment options are opening up, well-founded knowledge about the indications and treatment course is important for the ENT surgeon.

Facial and axillary apocrine chromhidrosis.

Apocrine chromhidrosis is a rare, chronic, idiopathic disorder, characterized by the excretion of pigmented sweat. A 26-year-old woman presented with a 3-year history of dark blue secretions on bilateral malar cheeks. On examination, upon pressure on the cheeks, a dark blue fluid was expressed, which appeared to arise primarily from the follicle. The patient had not appreciated it, but on examination of her axillae, a very subtle blue coloring was observed. Histopathologic examination revealed apocrine glands in the deep reticular dermis. Bluish cytoplasmic granules were observed in the apocrine epithelium lining, which correspond to lipofuscin granules. The diagnosis of apocrine cromhidrosis was made. We began treatment with 20 percent aluminum chloride hexahydrate solution and capsaicin cream with poor tolerance. Finally, we treated with botulinum toxin type A with a successful response. We report a case of facial and axillary apocrine cromhidrosis with good response to botulinum toxin type A.

[Applications of botulin]. / Silmä, nenä, suu, kurkku, kaula, kaikki muu --botuliinin käyttömahdollisuuksia.

Among the ailments of the ocular region, the use of botulin has become established in the treatment of blepharospasm and hemifacial spasm in Finland. Botulin has also been used successfully after peripheral facial palsy to improve facial symmetry, reduce lachrymal flow, treat dribbling of saliva as well as spasmodic dysphonia of laryngeal muscles. It may be effective in dysphagia caused by tightness of the upper esophageal sphincter or in several dyshidroses. Gastroenterologic indications include anal fissure and spasm and achalasia of the lower esophageal sphincter. In urology, botulin is effective in overactive bladder and incomplete voiding.

Soy Isoflavone Genistein Inhibits an Axillary Osmidrosis Risk Factor ABCC11: In Vitro Screening and Fractional Approach for ABCC11-Inhibitory Activities in Plant Extracts and Dietary Flavonoids.

Axillary osmidrosis (AO) is a common chronic skin condition characterized by unpleasant body odors emanating from the armpits, and its aetiology is not fully understood. AO can seriously impair the psychosocial well-being of the affected individuals; however, no causal therapy has been established for it other than surgical treatment. Recent studies have revealed that human ATP-binding cassette transporter C11 (ABCC11) is an AO risk factor when it is expressed in the axillary apocrine glands-the sources of the offensive odors. Hence, identifying safe ways to inhibit ABCC11 may offer a breakthrough in treating AO. We herein screened for ABCC11-inhibitory activities in 34 natural products derived from plants cultivated for human consumption using an in vitro assay system to measure the ABCC11-mediated transport of radiolabeled dehydroepiandrosterone sulfate (DHEA-S-an ABCC11 substrate). The water extract of soybean (Glycine max) was found to exhibit the strongest transport inhibition. From this extract, via a fractionation approach, we successfully isolated and identified genistein, a soy isoflavone, as a novel ABCC11 inhibitor with a half-maximal inhibitory concentration value of 61.5 µM. Furthermore, we examined the effects of other dietary flavonoids on the ABCC11-mediated DHEA-S transport to uncover the effects of these phytochemicals on ABCC11 function. While further human studies are needed, our findings here about the natural compounds will help develop a non-surgical therapy for AO.

Treatment of menopausal symptoms with Er-xian decoction: a systematic review.

The purpose of this systemic review is to assess the efficacy of Er-xian decoction (EXD), a formula of Chinese medicine, in relieving menopausal symptoms. Seven databases were extensively retrieved. The Chinese electronic databases include VIP Information, CBMdisc, and CNKI. The English electronic databases include AMED, CINAHL, Cochrane Library, and MEDLINE. Randomized controlled trials using EXD as a main intervention were included in the study selection. The quality of studies was assessed by Jadad scale and the criteria referred in Cochrane reviewers' handbook. Two independent reviewers were responsible for data extraction and assessment. Discrepancies were rectified referring to the original articles. The efficacy of EXD treatment for menopausal symptoms was evaluated by meta-analysis. There were 154 articles retrieved according to the search strategy, 677 participants involved in the 5 studies that satisfied the selection criteria. Meta-analysis indicated that administration of EXD significantly relieved at least one menopausal symptom when compared to the control group at a 95% confidence interval (p<0.01). The curing effect of EXD with all symptoms relieved was significant as compared with the control groups (p<0.01). The results also indicated that the efficacy of EXD was better than the other non-menopausal hormone therapy (p<0.01), while there was no significant difference between the EXD and menopausal hormone therapy groups. The EXD is effective in treating menopausal symptoms. However, owing to the low quality of the investigated studies, more randomized controlled trials are needed before evidence-based recommendation regarding the effectiveness of EXD in the management of menopausal symptoms can be provided.

A low initial botulinum toxin A treatment response does not predict poor long-term outcomes in patients with axillary bromhidrosis.

PURPOSE: For patients with axillary bromhidrosis, it is not clear that whether a low response to initial botulinum toxin A (BTX-A) treatment is related to poor long-term outcomes. PATIENTS AND METHODS: From August 2011 to March 2016, 31 patients with primary axillary bromhidrosis were recruited. They had the duration of efficacy for less than 4 weeks (median, 3 weeks; range, 1-3 weeks) after the first BTX-A injection (50 U per underarm) and were considered to have a low response to BTX-A treatment. The second injection with the same dose was immediately administered once the symptoms recurred. Subsequent sessions were performed with a double dose. RESULTS: The duration of efficacy rose significantly to 10 weeks (range, 1-24 weeks) after the second injection (p < .01). Twenty-five patients received the third injection. The resultant duration further increased to 16 weeks (range, 12-26 weeks). No patients reported adverse effects during our follow-up period. CONCLUSIONS: For patients with primary axillary bromhidrosis, a low initial BTX-A treatment response does not predict poor long-term outcomes. Immediate reinjection with the same dose and subsequent sessions with a double dose is a safe strategy and can increase the duration of BTX-A therapy.

Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial.

BACKGROUND: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. METHODS: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12-35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. RESULTS: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. LIMITATIONS: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. CONCLUSIONS: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.

Bilateral facial pigmentation.

A 38-year-old man presented with a chief complaint of blue-speckled secretions on his cheeks, brought on by exertion. Based on the clinical features, a diagnosis of apocrine chromhidrosis was made. Histopathologic exam further supported this diagnosis. Possible treatment options for apocrine chromhidrosis are discussed.

Treatment of facial chromhidrosis with botulinum toxin type A.

BACKGROUND: Hyperhidrosis is an idiopathic condition of exaggerated sweat production by the eccrine glands that affects approximately 1% of the population. There are many viable therapeutic options and the use of botulinum toxin has become an important treatment option and received FDA approval for this disorder in July 2004. The other forms of aberrant sweating; bromhidrosis (malodorous) and chromhidrosis (pigmented) are much rarer and more recalcitrant to treatment. METHOD: This is the first case report of dark-colored facial sweat in a young woman that was adequately controlled with botulinum toxin. CONCLUSION: Chromhidrosis is an unusual clinical entity with an ill-defined glandular etiology. The successful response to botulinum toxin supports the eccrine gland as a source of the sweat production and, furthermore, that the administration of this toxin should be considered as a form of therapy.

Bacteriology and antibiotic treatment of perineal suppurative hidradenitis.

A plausible bacterial pathogen (Streptococcus milleri, Staphylococcus aureus, anaerobic streptococcus, or Bacteroides species) was isolated at least once in 26 of 32 patients with active perineal suppurative hidradenitis. The main pathogen was S milleri, whose presence was significantly associated with disease activity and whose disappearance significantly correlated with clinical improvement; S aureus nd anaerobic streptococci were also implicated.

Correlation between bacterial population and axillary and plantar bromidrosis: study of 30 patients.

Although studies on the chemistry of odors are expanding to identify the chemical structures of odorous substances, there are no universal standards as yet to measure odor and intensity of bromidrosis. Clinical evaluation can be made on a subjective scoring from 0 to 3 prior to prescription of an antiseptic soap. In order to appreciate the correlation between the intensity of bromidrosis (BI) and bacterial activity, a study was carried out with both clinical and bacterial assessment in thirty patients with axillary or plantar BI. Odor intensity was evaluated by two physicians using a score from 0 to 3 (i.e. absent, minor, moderate, major), meanwhile bacterial composition and density were assessed before and after 10 days of hygiene using an antiseptic detergent (trichlocarbanilide) provided on the first visit. Baseline count of diphtheroids/cm2 was 35.104 and baseline micrococci average was 32.104/cm2. At the end of the study, the reduction of odor intensity was observed in 20 patients (67%) without any change in sweat production. The clinical improvement correlated with a reduction of both micrococci (70%) or diphtheroids (73%) as compared with initial data. In patients presenting persistant bromidrosis, the bacterial count/cm2 did not significantly decrease and remained above 104 diphtheroids/cm2. Thus, this study suggests that body odor may be at least indirectly correlated to microbia counts with a bacteria threshold of BI ranging around and above 104.

Treatment of hidradenitis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal suppression. A case report.

A 33-year-old woman with severe familial hidradenitis suppurativa of the vulva and perineum was treated with a combination of dexamethasone and a new synthetic gonadotropin releasing hormone agonist, leuprolide acetate. The clinical improvement paralleled the adrenal and ovarian suppression, as demonstrated by falling blood levels of testosterone, dehydroepiandrosterone sulfate, androstenedione and estradiol.