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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Kate Gamber
Second Advisor
Erin Wolf
Abstract
Hyperhidrosis is a common disorder that consists of excessive sweating, and in the population of people that have it, produces feelings of sadness and unhappiness. Primary, also known as focal hyperhidrosis, is referring to when there is localized sweating from specific areas of the body. People are most commonly affected in the axilla, palms and soles of their feet, and less often their face, groin, or other areas of their body. Currently, there is an idea that primary hyperhidrosis is related to primary overactivity of the central nervous system. However, for the most part these are researched theories with no specific, one culprit answer to the cause of hyperhidrosis. Presently in medical treatment of primary hyperhidrosis, treatments such as the use of onabotulinumtoxinA injections has been utilized since the early 1990s. Although this method has been proven to manage symptoms, there are potential dangerous adverse side effects that some patients may experience. This research hopes to determine the effectiveness of an alternative therapy (oral/systemic oxybutynin) that may help to manage the symptoms of hyperhidrosis on an equal or greater level of relief. This paper with address the following question: In individuals, ages 8 to 25, with primary hyperhidrosis affecting their axilla, palms, and/or soles (P), does oxybutynin oral/systemic treatment (I) provide equal or greater relief from symptoms and adverse side effects (O), compared to onabotulinumtoxinA localized injections (C)?
Methods: A literature search was conducted through both Google Scholar and PubMed in November, 2018. Seven articles were selected from these searches based on their relevance to the research question, study design, measurements, and date of publication.
Results: Based on the analysis and review of the 5 articles there is evidence of both oxybutynin, a systemic/oral therapy, and onabotulinumtoxinA, a localized injection therapy, being effective in improving sweat production in patients suffering from primary hyperhidrosis. Oxybutynin showed statistically significant improvement in the Quality of Life assessment (QOL) in two separate studies, as well as another study showing progress in both the Hyperhidrosis Disease Severity Scale (HDSS) and the Children’s Dermatology Life Quality Index (CDLQI). OnabotulinumtoxinA showed statistically significant improvement in the UCLA questionnaire on personal perception of loneliness and social isolation in one study, as well as an improvement in the Children’s Hyperhidrosis Impact questionnaire (CHHIQ) in the other study used. Both of the studies utilized the HDSS and CDLQI, showing positive improvement in both measurement assessments.
Discussion: All of the studies analyzed were able to find at least one statistically significant improvement in sweat reduction, as well as improvement in quality of life. Each of the studies, however, were limited by their study designs in multiple different ways. Only one of the five studies analyzed was the ideal random placebo-controlled trial, while the other four were non-randomized trials that focused specifically on whether or not the treatment tested actually worked on the subjects in the study. The sample sizes for all but one of the studies analyzed contained 60 subjects or less, and for the study that contained the largest sample size, gender diversity was lacking with over 86% of the subjects being female; such a large population of female subjects makes the results less generalizable, and instead more specific to the female population. Despite the positive improvements in both sweat reduction and subjective quality of life in patients, the lack of consistency in measurement assessments and questionnaires across the board made a direct comparison of Oxybutynin and OnabotulinumtoxinA difficult.
Conclusion: The results from the studies on Oxybutynin supported the idea that it can have symptomatic relief in patient ages 8 to 25 years old, but it was noted that efficacy of treatment decreased in patients with long-term use. With long-term use came a higher probability of experiencing anticholinergic effects, such as dry mouth, as well as the chore of needing to take the Oxybutynin as a daily prescription. OnabotulinumtoxinA proved to have positive results in the subjects tested in each of the two studies analyzed. However, efficacy and effects showed to wear off almost entirely after no later than a year after treatment, and localized pain was experienced by patients during administration. Both forms of treatment proved to be beneficial to the subjects treated in each study, however, neither were a definitive cure that eliminated primary hyperhidrosis entirely. While it is not possible to determine whether Oxybutynin or OnabotulinumtoxinA is more effective in treating patients ages 8 to 25 years old based on current data, both should continue to be utilized in clinical practice to treat primary hyperhidrosis. Future studies should utilize a universal measurement assessment to determine efficacy equally amongst all forms of treatment. Studies directly comparing Oxybutynin to OnabotulinumtoxinA, within the age range stated, need to be conducted in the future to determine which of the two is definitively superior to the other.
Recommended Citation
Guarino, Joseph, "Efficacy of Oxybutynin, an oral/systemic therapy, compared to OnabotulinumtoxinA, a localized injection therapy, in treating primary hyperhidrosis in individual, ages 8 to 25" (2020). Capstone Showcase. 66.
https://scholarworks.arcadia.edu/showcase/2020/pa/66
Efficacy of Oxybutynin, an oral/systemic therapy, compared to OnabotulinumtoxinA, a localized injection therapy, in treating primary hyperhidrosis in individual, ages 8 to 25
Hyperhidrosis is a common disorder that consists of excessive sweating, and in the population of people that have it, produces feelings of sadness and unhappiness. Primary, also known as focal hyperhidrosis, is referring to when there is localized sweating from specific areas of the body. People are most commonly affected in the axilla, palms and soles of their feet, and less often their face, groin, or other areas of their body. Currently, there is an idea that primary hyperhidrosis is related to primary overactivity of the central nervous system. However, for the most part these are researched theories with no specific, one culprit answer to the cause of hyperhidrosis. Presently in medical treatment of primary hyperhidrosis, treatments such as the use of onabotulinumtoxinA injections has been utilized since the early 1990s. Although this method has been proven to manage symptoms, there are potential dangerous adverse side effects that some patients may experience. This research hopes to determine the effectiveness of an alternative therapy (oral/systemic oxybutynin) that may help to manage the symptoms of hyperhidrosis on an equal or greater level of relief. This paper with address the following question: In individuals, ages 8 to 25, with primary hyperhidrosis affecting their axilla, palms, and/or soles (P), does oxybutynin oral/systemic treatment (I) provide equal or greater relief from symptoms and adverse side effects (O), compared to onabotulinumtoxinA localized injections (C)?
Methods: A literature search was conducted through both Google Scholar and PubMed in November, 2018. Seven articles were selected from these searches based on their relevance to the research question, study design, measurements, and date of publication.
Results: Based on the analysis and review of the 5 articles there is evidence of both oxybutynin, a systemic/oral therapy, and onabotulinumtoxinA, a localized injection therapy, being effective in improving sweat production in patients suffering from primary hyperhidrosis. Oxybutynin showed statistically significant improvement in the Quality of Life assessment (QOL) in two separate studies, as well as another study showing progress in both the Hyperhidrosis Disease Severity Scale (HDSS) and the Children’s Dermatology Life Quality Index (CDLQI). OnabotulinumtoxinA showed statistically significant improvement in the UCLA questionnaire on personal perception of loneliness and social isolation in one study, as well as an improvement in the Children’s Hyperhidrosis Impact questionnaire (CHHIQ) in the other study used. Both of the studies utilized the HDSS and CDLQI, showing positive improvement in both measurement assessments.
Discussion: All of the studies analyzed were able to find at least one statistically significant improvement in sweat reduction, as well as improvement in quality of life. Each of the studies, however, were limited by their study designs in multiple different ways. Only one of the five studies analyzed was the ideal random placebo-controlled trial, while the other four were non-randomized trials that focused specifically on whether or not the treatment tested actually worked on the subjects in the study. The sample sizes for all but one of the studies analyzed contained 60 subjects or less, and for the study that contained the largest sample size, gender diversity was lacking with over 86% of the subjects being female; such a large population of female subjects makes the results less generalizable, and instead more specific to the female population. Despite the positive improvements in both sweat reduction and subjective quality of life in patients, the lack of consistency in measurement assessments and questionnaires across the board made a direct comparison of Oxybutynin and OnabotulinumtoxinA difficult.
Conclusion: The results from the studies on Oxybutynin supported the idea that it can have symptomatic relief in patient ages 8 to 25 years old, but it was noted that efficacy of treatment decreased in patients with long-term use. With long-term use came a higher probability of experiencing anticholinergic effects, such as dry mouth, as well as the chore of needing to take the Oxybutynin as a daily prescription. OnabotulinumtoxinA proved to have positive results in the subjects tested in each of the two studies analyzed. However, efficacy and effects showed to wear off almost entirely after no later than a year after treatment, and localized pain was experienced by patients during administration. Both forms of treatment proved to be beneficial to the subjects treated in each study, however, neither were a definitive cure that eliminated primary hyperhidrosis entirely. While it is not possible to determine whether Oxybutynin or OnabotulinumtoxinA is more effective in treating patients ages 8 to 25 years old based on current data, both should continue to be utilized in clinical practice to treat primary hyperhidrosis. Future studies should utilize a universal measurement assessment to determine efficacy equally amongst all forms of treatment. Studies directly comparing Oxybutynin to OnabotulinumtoxinA, within the age range stated, need to be conducted in the future to determine which of the two is definitively superior to the other.