Hyperhidrosis treatments in hidradenitis suppurativa: A systematic review

Abstract

Hyperhidrosis impairs quality of life (QOL) in hidradenitis suppurativa (HS) patients and may exacerbate HS. However, there is limited literature on whether hyperhidrosis treatments improve HS disease. To systematically review literature on efficacy and tolerability of hyperhidrosis treatments in HS patients. In May 2021, MEDLINE and EMBASE databases were systematically searched by two reviewers per PRISMA guidelines for articles on hyperhidrosis and HS. Sixteen articles met inclusion criteria (2 randomized controlled trials [RCTs], one case-control study, three cross-sectional studies, 10 case-studies/ series), encompassing 252 HS patients across studies. They examined botulinum toxin A (BTX-A) (n = 6) and B (BTX-B) (n = 1), suction-curettage (n = 1), diode laser (n = 1), and microwave-based energy device (MED) (n = 3). Overall, BTX treatments improve HS severity, QOL, hyperhidrosis, and were well-tolerated. Suction-curettage did not improve disease. One HS patient tolerated diode laser well, with improvement in sweating and HS. One RCT studying MED was discontinued due to adverse events. Two studies reported MED-induced HS. BTX was overall helpful in HS patients, including in patients without concomitant hyperhidrosis. However, more prospective studies are needed to examine its utility in HS. There is potential harm of MEDs in HS. Most studies examining hyperhidrosis treatments in HS patients are low level of evidence. Larger RCTs should examine the efficacy and tolerability of hyperhidrosis treatments in HS.

Efficacy of procedural treatments for pediatric hidradenitis suppurativa: A systematic review

“…There was one case report on BTX injections in a 7‐year‐old girl. Although BTX may be particularly beneficial for patients who identify sweat as a trigger for their HS flares, a systematic review of adult HS patients found that BTX was successful even in patients without concomitant hyperhidrosis 46 . Nonetheless, caution is warranted in younger children because botulinum toxin has the potential to cause systemic side effects such as dysphagia and dyspnea, 47 especially with shorter durations between treatments and higher injection doses 48,49 .…”

“…Although BTX may be particularly beneficial for patients who identify sweat as a trigger for their HS flares, a systematic review of adult HS patients found that BTX was successful even in patients without concomitant hyperhidrosis. 46 Nonetheless, caution is warranted in younger children because botulinum toxin has the potential to cause systemic side effects such as dysphagia and dyspnea, 47 especially with shorter durations between treatments and higher injection doses. 48,49 Unique considerations regarding BTX in pediatric patients include using topical anesthetics, nitrous oxide gas, and distraction techniques to minimize the pain and anxiety associated with injections.…”

Oral oxybutynin chloride therapy in the management of hidradenitis suppurativa: A prospective study

“…1,2 Several factors including heat, physical activity, shaving and friction are key players in HS acute flares. 3 Hyperhidrosis significantly impairs the quality of life in HS patients by worsening odour and pruritus. Moreover, it may exacerbate HS manifestations by inducing microbial growth in the intertriginous body regions.…”

“…Moreover, it may exacerbate HS manifestations by inducing microbial growth in the intertriginous body regions. 3,4 Increasing evidence reported the efficacy of botulinum toxin in HS, suggesting that hyperhidrosis treatment may be helpful in the management of the disease. 5,6 No studies have investigated the role of oxybutynin in HS.…”

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

“…Moreover, the reduction of sweating might positively influence microbiome composition and bacterial growth [ 97 ]. A recent systematic review [ 98 ] examined the efficacy and tolerability of hyperhidrosis treatments in HS patients. Botulinum toxin (BTX) A or B treatments proved to be effective in HS patients, whereas suction curettage and microwave-based energy devices showed no efficacy and/or safety in HS.…”