Successful treatment of refractory dermal pain with etizolam and clonazepam in a patient with acquired idiopathic generalized anhidrosis

Okamoto, Minoru; Takahagi, Shunsuke; Kamegashira, Akiko; Yanase, Yuhki; Hide, Michihiro

doi:10.1111/1346-8138.14921

Cited by 4 publications

(5 citation statements)

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“…3,4 A follow-up study showed that increased awareness of the minimal need for opioids after MMS, provider awareness of overprescribing, and awareness of a national epidemic led to a significant decrease in opioid prescription. 5 Prescription recommendations for opioid prescriptions after Mohs have been developed with the aim of decreasing interprovider variability and unnecessary prescriptions. 6,7 Although anxiety related to MMS should not be ignored because it is associated with increased postoperative pain, patient dissatisfaction, and risk of patient-initiated termination of MMS before achieving clear margins, pharmacologic interventions including benzodiazepines should be used responsibly, and nonpharmacologic interventions should be used.…”

Section: Commentary On Benzodiazepine Utilization In Medicare Benefic...mentioning

confidence: 99%

“…The results of our study suggest that a small portion of Mohs surgeons and dermatologists prescribe benzodiazepines for an extended duration. Indications for extended duration courses while not that common may be for nonpreprocedural uses such as for stress-related hyperhidrosis, somatoform pruritus, neurotic excoriations, burning mouth syndrome, 4 refractory dermal pain in patients with acquired idiopathic generalized anhidrosis, 5 or specific dermatologic conditions associated with anxiety such as psoriasis, lichen planus, lichen simplex chronicus, atopic dermatitis, or acne vulgaris; it is also plausible that some providers may give extended courses if patients will be undergoing consecutive procedures or for the treatment of postprocedure anxiety related to surgical recovery. Nevertheless, given this degree of variability in benzodiazepine prescribing, there are opportunities to standardize and optimize prescribing practices among Medicare beneficiaries in dermatology and MMS.…”

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confidence: 99%

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Benzodiazepine Utilization in Medicare Beneficiaries by Mohs Surgeons and Dermatologists From 2013 to 2017

et al. 2020

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Section: Commentary On Benzodiazepine Utilization In Medicare Benefic...mentioning

confidence: 99%

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confidence: 99%

Benzodiazepine Utilization in Medicare Beneficiaries by Mohs Surgeons and Dermatologists From 2013 to 2017

et al. 2020

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“…[1,3] However, these treatments fail to fully alleviate pain triggered by such stimuli. [1,5,6] The use of psychotropic drugs and neuropathic pain medications has also been explored, but their efficacy varies among patients. [1,5,6] The absence of a suitable animal model for sweating-induced dermal pain complicates the evaluation of therapeutic agents.…”

Section: Introductionmentioning

confidence: 99%

A single-blind, randomized, crossover study on the efficacy of icatibant for sweating-induced dermal pain (icatibant for sweating-induced dermal pain)

et al. 2023

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Introduction: Severe dermal pain triggered by sweating stimuli, such as bathing, exercise, and mental stress, significantly affects patients’ daily lives. The pathomechanism underlying the sweating-induced dermal pain remains poorly understood and there exists no standard treatment for such pain. This study aims to evaluate the effectiveness of icatibant as an analgesic, a bradykinin B2 receptor antagonist, in treating sweating-induced dermal pain, and to establish the role of bradykinin in pain induction. Methods/design: A multicenter, exploratory, crossover, single-blinded, placebo-controlled randomized, comparative study will be conducted to evaluate the efficacy of subcutaneous icatibant injection (30 mg) in treating sweating-induced dermal pain. Ten patients will be enrolled and assigned randomly in a 1:1 ratio to either the icatibant-placebo or placebo-icatibant groups. The primary endpoint is the change in the visual analog scale scores for dermal pain induced by thermal load before and after treatment with icatibant or placebo. Secondary endpoints include changes in the duration of dermal pain, blood and plasma histamine levels, serum angiotensin-converting enzyme levels, and histological evaluation of skin tissue samples at the site of dermal pain. Discussion: The effectiveness of icatibant against sweating-induced dermal pain would provide clear evidence for the involvement of the bradykinin-bradykinin B2 receptor pathway in the pathogenesis of this condition. This finding may contribute to a better understanding of the underlying mechanisms of dermal pain associated with sweating stimuli and has the potential to improve patients’ quality of life by suggesting potential treatment options, specifically, using drugs that inhibit bradykinin or suppress its production.

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“…Although the main symptom of AGAH is heat retention due to decreased perspiration, AIGA is characteristically accompanied by cholinergic urticaria (CholU)‐like rash, stinging dermal pain, or both, triggered by sweating stimuli 1 . Anhidrosis is effectively treated by steroid pulse therapy; 2,3 however, the pain can be intractable in some cases of AIGA 4,5 . The site affected by the rash and pain is not necessarily the same as that of anhidrosis 6 .…”

Section: Introductionmentioning

confidence: 99%

“…1 Anhidrosis is effectively treated by steroid pulse therapy; 2,3 however, the pain can be intractable in some cases of AIGA. 4,5 The site affected by the rash and pain is not necessarily the same as that of anhidrosis. 6 Thus, different mechanisms may be involved in the development of anhidrosis and rash/dermal pain in AIGA.…”

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confidence: 99%

Anhidrosis accompanied by cholinergic urticaria‐like rash and dermal pain in a patient with Sjögren's syndrome

Yanagida

Takahagi

Aoyama

et al. 2022

The Journal of Dermatology

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Cholinergic urticaria (CholU)‐like rash and dermal pain on sweating occur in patients with acquired idiopathic generalized anhidrosis (AIGA). However, it is unclear whether these are symptoms specific to AIGA among the various types of acquired generalized anhidrosis/hypohidrosis (AGAH). Moreover, the pathogenesis underlying CholU‐like rash and dermal pain observed with anhidrosis remains to be clarified. A 20‐year‐old Japanese man with Sjögren's syndrome (SS) presented with anhidrosis. Transient stinging pain on the skin and pinpoint wheals were observed when his body temperature increased. Thermoregulatory sweat testing revealed anhidrotic areas covering 69% of the body surface area with a symmetrical distribution. A high concentration of histamine was detected (506 ng/mL) in the sweat. A skin biopsy specimen from the anhidrotic area showed the inflamed secretory portion of eccrine glands. This suggested inflammation‐mediated damage to sweat glands, consistent with AGAH related to SS. Furthermore, immunohistochemical analysis revealed an ectopic distribution of dermcidin, a sweat‐specific peptide, in the dermal tissue surrounding the secretory portion of eccrine glands. The expression of claudin‐3, a tight junction (TJ) component of sweat glands, decreased or distributed in a mottled manner in the secretory portion. No decreased expression of muscarinic cholinergic receptor M3 was detected. These results suggested that sweat had leaked into the dermis in association with impaired TJ in the secretory portion, along with the damage to inflamed sweat glands related to SS. Collectively, CholU‐like rash and dermal pain on sweating were observed in an AGAH patient with SS. The sweat leakage into the dermis may contribute to the development of the rash and pain.

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Successful treatment of refractory dermal pain with etizolam and clonazepam in a patient with acquired idiopathic generalized anhidrosis

Cited by 4 publications

References 5 publications

Benzodiazepine Utilization in Medicare Beneficiaries by Mohs Surgeons and Dermatologists From 2013 to 2017

Benzodiazepine Utilization in Medicare Beneficiaries by Mohs Surgeons and Dermatologists From 2013 to 2017

A single-blind, randomized, crossover study on the efficacy of icatibant for sweating-induced dermal pain (icatibant for sweating-induced dermal pain)

Anhidrosis accompanied by cholinergic urticaria‐like rash and dermal pain in a patient with Sjögren's syndrome

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