BackgroundHyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then.ObjectivesTo present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients.MethodsWe analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used.ResultsPre‐treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups.ConclusionsThis study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

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Nelson (2020) Analysis of the results of videotoracoscopic sympathectomy in the treatment of hyperhidrosis in patients 40 years or older. Annals of Vascular Surgery, 65. pp. 107-112.

Type V collagen (Col V) is a "minor" component of normal lung extracellular matrix, which is subjected to decreased and abnormal synthesis in human lung infiltrating adenocarcinoma. We previously reported that a direct link between low amounts of Col V and decreased cell apoptosis may favor cancer cell growth in the mouse lung after chemical carcinogenesis. Moreover, this collagen species was able to trigger DNA fragmentation and impair survival of neoplastic cells. In this study, we have extended our investigation with the aim to obtain further evidence that the death induced by Col V-treatment is of the caspase-9 apoptotic type. We used (1) optical and electron microscopy, (2) quantitation of TUNEL-labeled cells and (3) analysis of the expression levels of Col V and selected genes coding for apoptosis-linked factors, by conventional RT-PCR. BALB/c mice were injected intraperitoneally with 1.5 g/kg body weight of urethane. After urethane injection, the animals received intranasal administration of 20 µg/20 µl of Col V every day during 2 months. We report here that Col V treatment was able to determine significant increase in Col V protein and gene expression and in the percentage of TUNEL-positive cells, to up-regulate caspase-9, resulting in low growth of tumor cells. Our data validate chemical carcinogenesis as a suitable "in vivo" model for further and more detailed studies on the molecular mechanisms of the death response induced by Col V in lung infiltrating adenocarcinoma opening new strategies for treatment.

Hyperhidrosis is a condition in which there is excessive production of sweat that is disproportional to thermoregulation needs and that profoundly hampers the quality of life (QOL) of the population that is affected by it. The disorder is typically limited to the palms, the plantar and craniofacial regions, armpits, and manifests itself in a symmetrical fashion in addition to being associated to family history. At present, sympathectomy is considered the golden standard treatment and there are a number of approaches a surgeon may elect to adopt in its care. The clinical treatment with oxybutynin also improves screening of the group of patients that will benefit the most with this indication. However, the efficacy of the surgical method, what most counts for a successful outcome is the occurrence or not of compensatory hyperhidrosis whose intensity may impact the results. All patients are and must be thoroughly informed of this possibility prior to surgery. For the others indications, is also one of the final approaches necessary for a fruitful treatment.

INTRODUCTIONPrimary hyperhidrosis (PH) is a condition characterized by excessive sweating that is inconsistent with thermoregulation needs. It has a large impact on patients' quality of life and affects their personal and professional relationships. 1,2 In the majority of cases, PH manifests in childhood and adolescence and persists throughout life. The typical clinical presentation is limited to the palms of the hands, the plantar region of the foot and/or the axilla, and it is symmetrical. It can also affect the head and face and often occurs in two or more regions of the body. The pathophysiology of PH is not fully understood, but it is known to result from stimulation of the sympathetic nervous system in its regulatory center. PH affects approximately 2.8% of the population, and there is a positive family history in 12.5% to 56.5% of the patients. 3 Patients generally seek medical care later in life, and more frequently at a more financially secure age. Thus, young people end up suffering for many years before being able to receive the current well-known medical treatment. 4,5 The initial treatment for patients with PH, until 2010, was sympathectomy. Thereafter, we began to use oxybutynin chloride as the first-line treatment. In patients for whom no adequate response to medication is attained, video-assisted thoracoscopic sympathectomy (VATS) becomes the treatment of choice.VATS is considered to be the gold standard for the definitive treatment of hyperhidrosis. It provides excellent clinical results (reduced sweating at specific sites) and leads to a significant improvement in quality of life. These positive results are, among other causes, based on factors that are known to influence the effectiveness of sympathectomy among patients with hyperhidrosis, 1 such as body mass index, resection level, 6,7 preoperative quality of life 8 and the number of resected ganglia. 9

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Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.