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The Use of Oxybutynin for Treating Axillary Hyperhidrosis

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The Use of Oxybutynin for Treating Axillary Hyperhidrosis The Use of Oxybutynin for Treating Axillary Hyperhidrosis Nelson Wolosker,1 Jose Ribas Milanez de Campos,2 Paulo Kauffman,1 Samantha Neves,1 Marco Antonio Munia,3 Fabio BiscegliJatene,2 and Pedro Puech-Leao,~ 1 Sao~ Paulo, SP, Brazil Background: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin for treating axillary hyperhidrosis in a large series of patients. Methods: One hundred two patients with axillary hyperhidrosis were treated with oxybutynin. During the first week, patients received 2.5 mg of oxybutynin once a day in the evening. From the 8th to the 42nd day, they received 2.5 mg twice a day, and from the 43rd day to the end of the 12th week, they received 5 mg twice a day. All of the patients underwent two eval- uations: before and after (12 weeks) the oxybutynin treatment, using a clinical questionnaire; and a clinical protocol for quality of life (QOL). Results: More than 80% of the patients experienced an improvement in axillary hyperhidrosis; 36.3% of them presented a great improvement, and half of the patients showed improvements at all hyperhidrosis sites. Most of the patients showed improvements in the QOL (67.5%). The patients with very poor QOL before the treatment presented greater satisfaction levels after treatment. The side effects were minor, dry mouth being the most frequent (73.5%). Conclusions: Oxybutynin is a good alternative to sympathectomy. It presents good results and improves QOL without the side effects of sympathectomy. INTRODUCTION video-assisted thoracic sympathectomy (VATS) provides excellent resolution of axillary hyperhi- Axillary hyperhidrosis may lead patients to serious drosis (90-95%).5-7 it is associated with certain emotional disturbances.1 Local treatment and 2 complications, of which the most frequent and psychotherapy have low effectiveness. Injection most important is compensatory hyperhidrosis.8,9 of botulinum toxin provides good results, but only This occurs to a mild degree in most patients, but < 3 temporarily ( 6 months). Excision or resection of when it is severe, it may cause dissatisfaction with the eccrine sweat glands frequently presents low 10,11 4 the procedure. efficacy and high recurrence rates. Although Different anticholinergic drugs have been used in the past to treat hyperhidrosis, but because of side effects, their use has not become routine.12 ClinicalTrials.gov Identifier: NCT01118429. Oxybutynin is an anticholinergic drug that can be 1Division of Vascular Surgery, Hospital das Clı´nicas, University of used safely at high doses (over 15 mg/day) to treat Sao~ Paulo Medical School, Sao~ Paulo, SP, Brazil. urological disorders related to micturition.13 One 2Department of Thoracic Surgery, Hospital das Clı´nicas, University effect observed in such patients has been diminished of Sao~ Paulo Medical School, Sao~ Paulo, SP, Brazil. sudoresis. Its use for treating hyperhidrosis has only 3Department of Vascular Surgery, Hospital das Clı´nicas, University of Sao~ Paulo Medical School, Sao~ Paulo, SP, Brazil. been described in 3 case reports of patients with 14-16 Correspondence to: Nelson Wolosker, MD, PhD, Division of Vascular hyperhidrosis and 1 series of 14 patients with 17 Surgery, Hospital das Clı´nicas, University of Sao~ Paulo Medical School, compensatory hyperhidrosis. We have observed 627 Albert Einstein Avenue, 4th Floor, Room 423, 05652-000 Sao~ in daily practice that oxybutynin at low doses (up Paulo, SP, Brazil, E-mail: [email protected] to 10 mg/day) seems to generate fewer side effects, Ann Vasc Surg 2011; 25: 1057-1062 DOI: 10.1016/j.avsg.2011.06.007 while being effective in reducing sudoresis in Ó Annals of Vascular Surgery Inc. patients with axillary hyperhidrosis. 1057 1058 Wolosker et al. Annals of Vascular Surgery Considering that the standard treatment for axil- All the patients underwent three evaluations for lary hyperhidrosis is surgical (video-assisted the purpose of this study: The first before the thoracic sympathectomy),18 which is often accom- medical treatment, the second after 6 weeks, and panied by unpleasant side effects, oxybutynin the last after 12 weeks of oxybutynin treatment. provides a possible alternative for its treatment. These evaluations were used to assess (1) the We anticipated that low doses of oxybutynin (up patients’ clinical improvement in axillary hyperhi- to 10 mg/day) could cause fewer side effects and drosis and at the other sites at which patients could be effective in reducing the sweating in reported hyperhidrosis, using a clinical question- patients with axillary hyperhidrosis. naire; and (2) the negative impact of the condition The aim of the present study was to evaluate the on the quality of life (QOL), using protocol of effectiveness of the use of oxybutynin at low doses QOL19 that was adapted to English,20 and the occur- for treating axillary hyperhidrosis in a large series rence of side effects. of patients, and patient satisfaction with the To evaluate the patients’ improvement in treatment. hyperhidrosis, they filled out the clinical improvement questionnaire, after completion of the treatment, according to their subjective MATERIALS AND METHODS perception of improvement in sudoresis. They evaluated it on a scale from 0 to 10, where 0 rep- This was a nonrandomized and uncontrolled study resented no improvement and 10 represented in accordance with the ethical standards of the uni- absence of hyperhidrosis, based on their own esti- versity’s Committee of Ethics for Analysis of mates without any intervention or advice from Research Projects on Human Experimentation. the interviewer. For data analysis, the improve- From January 2007 to June 2009, 102 consecutive ment was recorded as null when the score was patients with axillary hyperhidrosis were treated 0; slight, when it was 1-4; moderate, when it with oxybutynin. Of these, 20 patients (19.6%) was 5-7; or great, when it was 8-10. were lost to follow-up. Thus, data were collected The negative impact of hyperhidrosis on QOL from 82 patients who underwent clinical treatment. before the treatment was classified into five Patients with glaucoma and micturition disorders different levels, calculated as the summed total score were not included. from the protocol (range from 20 to 100). The higher The patients were aged between 14 and 51 years, the level, the greater is the impact and the poorer is with a mean of 28.0 ± 9.0 years and median of 23.1 the QOL. When the total was greater than 84, the years. The group was composed of 63 women QOL was considered very poor; from 68 to 83, (76.8%). The patients’ body mass index (BMI) poor; from 52 to 67, good; from 36 to 51, very ranged from 16.8 to 35.5, with a mean of 23.7 ± good; and from 20 to 35, excellent. 3.7 and median of 23.1. Improvement of QOL after the treatment was In addition to axillary hyperhidrosis, 67 of these also classified into five different evolution levels: patients (83.7%) presented hyperhidrosis at other When the total was greater than 84, the QOL was sites on the body. Palmar hyperhidrosis was considered much worse; from 68 to 83, slightly observed in 39 patients (48.7%), plantar in 36 worse; from 52 to 67, the same; from 36 to 51, (45.0%), craniofacial in 10 (12.5%), thoracic and slightly better; and from 20 to 35, much better. abdominal in 10 (12.5%), gluteal and leg in 6 The following parameters were studied: evolu- (7.5%), and dorsal in 6 (7.5%). In 26 cases tion of axillary hyperhidrosis; evolution of hyperhi- (32.5%), hyperhidrosis was found in association drosis at other sites on the body; negative impact of with osmidrosis. hyperhidrosis in the QOL before the treatment; Oxybutynin was prescribed for 12 weeks, in evaluation of improvement in QOL after the treat- progressively increasing doses throughout treat- ment; analysis of the patients’ improvement in the ment. At their first visit, the patients were given QOL according to QOL levels before the treatment; 2.5 mg of oxybutynin to be taken once a day in improvement in QOL according to sex, age, and the evening, were instructed to increase the dose BMI; and, finally, any complications and side to 2.5 mg twice a day from the 8th to the 42nd effects. day, and to contact the doctor if they experienced For categorical variables, the c2 or the Student t test any side effect. After this period, they were seen in was used. These statistical tests were used to compare a second visit, and the dose was increased to 5 mg gender, age, and BMI with the satisfaction (QOL). The twice a day from the 43rd to the end of the 84th associations between the improvements of QOL day, to when a third visit was scheduled. according to the levels before the treatment were Vol. 25, No. 8, November 2011 The use of oxybutynin for hyperhidrosis 1059 investigated using the McNemar test. The significance Table I. Evolution of axillary hyperhidrosis with level considered for all tests was p ¼ 0.05. the use of oxybutynin Improvement n (%) RESULTS Axillary hyperhidrosis Worse 0 (0.0) Null 9 (11.2) The results of the treatment related to axillary Slight 14 (17.5) hyperhidrosis are presented in Table I. Moderate 28 (35.0) More than 70% of the patients evolved with an Great 29 (36.3) improvement in axillary hyperhidrosis, and 36% Total 80 of them presented a great improvement. The results of the treatment related to other sites at which the patients had complained of hyperhi- Most of the patients presented some degree of dry drosis are presented in Table II. mouth during the treatment. With higher doses, the More than half of the patients showed significant frequency and intensity of this side effect increased.
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