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.

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.

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.

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.

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.

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.

Local injection of botulinum toxin A: an alternative therapy for axillary osmidrosis.

The objective of this study was to investigate the efficacy of local injection of botulinum toxin A for treating axillary osmidrosis. One hundred and fifty patients with axillary osmidrosis were randomly divided to receive botulinum toxin A injection treatment (50 U of botulinum toxin A was injected intracutaneously into 6-20 different sites within each axilla, n = 74) or surgical excision of the apocrine glands (n = 76). The patients were followed up for 1-3 months to analyze the therapeutic effect and complications of the two methods. The curative effect in patients with mild and moderate axillary osmidrosis was not significantly different between the botulinum toxin A injection group and operation group. However, for patients with severe axillary osmidrosis, surgery treatment seemed to be superior to botulinum toxin A treatment (P = 0.005). There was also no significant difference in the modified Dermatology Life Quality Index between the two treatments. Two cases showed complications related to hemorrhage and incision infection in the operation group. In conclusion, local injection of botulinum toxin A is a safe, fast and effective treatment for mild and moderate axillary osmidrosis, but the long-term effect remains to be further investigated.

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.

[Contribution of botulinum toxin to maxillo-facial surgery]. / Apport de la toxine botulique en chirurgie maxillo-faciale.

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed.

Clinical utility of different botulinum neurotoxin preparations.

Comparative literature assessing the relative safety and efficacy of different BoNT products is limited. The quantity and quality of data vary by preparation and indication. Clinicians seeking data relevant to the care of patients with specific conditions may find only reports about small numbers of patients with varying symptoms. While a literature search for "botulinum neurotoxins" will yield a large number of publications; only a fraction of these meet criteria for an academic evidence-based review. Patients may have been treated with a different BoNT formulation than that with which the physician is familiar, or there may be little or no clinical data on the use of a specific BoNT product for the proposed intervention. This paper is an introduction to a series of papers (which follow) in which an expert panel reviewed the BoNT clinical trial literature in order to provide evidence-based recommendations regarding the clinical use and efficacy of available BoNT preparations for four major therapeutic areas: movement disorders, spasticity, urology, and secretory disorders. Expert opinion is also included to address practical issues where more evidence and further research is needed.

Ús dels antibiòtics i els antisèptics en les infeccions bacterianes cutànies / No disponible

No disponible

[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.

A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with Botulinum toxin A.

BACKGROUND: Botulinum toxin A (BTX-A) has been demonstrated to be only effective for some types of axillary bromhidrosis. It is necessary to explore the indications for BTX-A application. METHODS: Sixty-seven consecutive outpatients with axillary bromhidrosis were recruited after informed content. Then, 50 U of BTX-A was injected intracutaneously into 20 different sites within each axilla. The follow-up was done every month and terminated when the malodor returned to the previous level. RESULTS: Of 67 cases, 74.6% (50/67) had mild or moderate malodor, and 80.6% (54/67) experienced mild or moderate sweating. In 76.1% (51/67) of patients, there were a close correlation between malodor and sweating. After BTX-A injection, the malodor was eliminated in 73.1% (49/67) of patients. Logistic regression analysis revealed that the correlation between malodor and sweating differed significantly between the group that maintained no malodor after initial injection and the group that still exhibited malodor. CONCLUSION: BTX-A ameliorates malodor mainly by the inhibition of eccrine and apoeccrine sweating but no apocrine sweating. A close positive correlation between malodor and sweating is the indication for BTX-A treatment.

[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.

Axillary chromhidrosis: report of a case, review of the literature and treatment considerations.

Chromhidrosis is a rare but troubling syndrome whose cardinal feature is the appearance of colored sweat. In some instances, this may be associated with the use of drugs or ingested materials [Dermatology vol. 199 (1999) 149-52] but in others it is idiopathic. Irrespective of the etiology, the appearance of colored sweat can be profoundly psychologically disturbing. We report the case of a woman who had been affected by chromhidrosis for several years. Treatment with botulinum toxin type A resulted in a cessation of the problem with profoundly improved quality of life for this individual. This is significant because it is the first case of isolated axillary chromhidrosis treated with botulinum toxin A and, as with reports of facial chromhidrosis [Journal of the American Academy of Dermatology vol. 52 (2005) 89-91], resolution of the symptoms supports the eccrine etiology of this entity.