Fokale Hyperhidrose

BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…289 Use of this tool was identified in only one quality-of-life review of patients with hyperhidrosis. 288 …”

Section: Patient Benefit Indexmentioning

confidence: 99%

“…258,288 Study designs included one case series, 305 two RCTs, 80,86 two economic studies 303,304 and two of quality of life only.…”

Section: Short Form Questionnaire-12 Itemsmentioning

confidence: 99%

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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“…Sie stellt ein weit verbreitetes Problem dar, das in einer akzentuierten Form zur sozialen Ausgrenzung und psychischen Belastung der Betroffenen und somit zu einer ausgeprägten Minderung der Lebensqualität führen kann [11,16].…”

Section: Originalien Hintergrund Und Fragestellungunclassified

“…Sie tritt als fokale Hyperhidrose bevorzugt an Achseln, Handinnenflächen und Fußsohlen auf. Ihre Prävalenz liegt bei 1-3% der Bevölkerung [16]. Die Ätiopathogenese ist bis heute unklar, eine genetisch determinierte komplexe Störung der Steuerung des emotionellen Schwitzens im Bereich des Gyrus cinguli sowie der zentralen Thermoregulation im präoptischen anterioren Hypothalamus erscheint wahrscheinlich [2].…”

Section: > Limitierend Für Den Einsatz Von Aluminiumchloridhexahydratunclassified

“…In der Regel wird bei Hyperhidrosis axillaris nach einem Stufenschema mit konservativen Methoden begonnen, bei Versagen geht man über zur physikalischen und dann zur operativen Therapie [16]. Bei den konservativen, nichtinvasiven Therapiemodalitäten stellt Aluminiumchloridhexahydrat in Konzentrationen von 15-25% auch aufgrund seiner Kostengünstig-keit häufig eine Therapie der ersten Wahl dar.…”

Section: > Limitierend Für Den Einsatz Von Aluminiumchloridhexahydratunclassified

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