Correspondence

with paraneoplastic SCLE was a supraglottic laryngeal SCC, reported by Chaudhry et al. in 2005.4 Other cutaneous paraneoplastic syndromes that have been associated with head and neck malignancies include acrokeratosis paraneoplastica, dermatomyositis and eruptive seborrhoeic keratoses.5 Regression of skin eruptions usually occurs after treatment of the primary malignancy. In our case, the patient underwent palliative radiotherapy for a locally advanced SCC that was not amenable tor surgery. His rash improved with topical betamethasone valerate 0.1% ointment and photoprotection. He did not require any systemic treatment, and was still in remission at follow-up 3 months later. A. Murad,1 B. O’Donnell,1 H. Rowley,2 and N. Mulligan3 Departments of 1Dermatology, 2Ear, Nose and Throat, and 3 Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland E-mail: [email protected] Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 16 May 2014

References 1 McLean DJ. Cutaneous paraneoplastic syndromes. Arch Dermatol 1986; 122: 765–7. 2 Evans KG, Heymann WR. Paraneoplastic subacute cutaneous lupus erythematosus: an underrecognized entity. Cutis 2013; 91: 25–9. 3 McKenna KE, Hayes D, McMillen JC. Subacute cutaneous lupus erythematosus-like gyrate erythema and hypertrichosis lanuginosa acquisita associated with uterine adenocarcinoma. Br J Dermatol 1992; 127: 443– 4. 4 Chaudhry SI, Murphy LA, White IR. Subacute cutaneous lupus erythematosus: a paraneoplastic dermatosis? Clin Exp Dermatol 2005; 30: 655–8. 5 Li M, Yang LJ, Zhu XH et al. The Leser-Trelat sign is associated with nasopharyngeal carcinoma: case report and review of cases reported in China. Clin Exp Dermatol 2009; 34: 52–4.

Tap water iontophoresis may be ineffective for axillary hyperhidrosis doi: 10.1111/ced.12485 Focal hyperhidrosis is usually idiopathic, and affects mainly the palms, soles and axillae in an otherwise healthy person. It can have a marked negative effect on patients’ quality of life.1 Therapy for hyperhidrosis is limited. Lifestyle advice and aluminium chloride preparations are the first-line recommendations for management in the primary care

ª 2015 British Association of Dermatologists

setting. Botulinum toxin type A injections and systemic anticholinergic treatment are available treatment options in secondary care. Surgical options such as axillary clearance and endoscopic thoracosympathectomy are reserved for those patients who have not responded to conservative measures.1 Iontophoresis is promoted as a treatment option for hyperhidrosis. The exact mode of its action remains unclear. One hypothesis suggests that charged ions are driven into the skin by the current, and inhibit the function of sweat glands.1 Axillary hyperhidrosis is most common after the onset of puberty, when the axillary apocrine glands begin to proliferate.2 In iontophoresis for axillary hyperhidrosis, foam pads are soaked in tap water, and electrodes are inserted into the pads, which are then placed in the axillae. A low-intensity (5–10 mA) pulsed electric current is run through the electrodes for 10 min, and the polarity of the current is then reversed, and run through for a further 10 min. A course of therapy consists of seven 20-min sessions over 4 weeks. Data supporting the use of tap water iontophoresis for axillary hyperhidrosis is sparse. Anecdotally, Sharpe et al., in a sub-group analysis, noted improvement in only one out of four patients treated for axillary hyperhidrosis with tap water iontophoresis.3 Recently, we assessed the effectiveness of a course of tap water iontophoresis in the management of axillary hyperhidrosis in a more substantial cohort, to inform a decision on whether the service should be continued. Discussion among local dermatologists suggested that tap water iontophoresis needed to be effective in over 30% of cases for it to be considered a worthwhile treatment option. We performed a retrospective survey of 17 patients (12 female, 5 male; median age 30 years, range 15–71) who had received solely axillary iontophoresis between January 2012 and October 2013. Responsiveness was assessed by reviewing the medical entries in patients’ notes and treatment cards, and the summary outcome letter to the patients’ general practitioners. Treatment effectiveness was recorded as successful/adequate clinical response, clinically inadequate improvement or no change or worsening. Results showed that only 4 of the 17 patients (24%) deemed the treatment successful and reported an adequate clinical response, while 6 (35%) reported clinically inadequate improvement, and 7 (41%) reported no change or worsening of their symptoms. As < 30% of patients showed an adequate clinical response to tap water iontophoresis, this treatment for the management of axillary hyperhidrosis has been withdrawn. We would recommend others to reconsider this treatment option for axillary hyperhidrosis, in the absence of evidence of substantial benefit.

Clinical and Experimental Dermatology (2015) 40, pp331–338

337

Correspondence

L. Thomas, S. Fatah and A. J. Carmichael Department of Dermatology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK E-mail: [email protected] Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 12 May 2014

2 Benson RA, Palin R, Holt PJE et al. Diagnosis and management of hyperhidrosis. BMJ 2013; 347: 28–9. 3 Sharpe C, Schofield JK, Hepburn NC. Iontophoresis for hyperhidrosis: effectiveness of treatment. Br J Dermatol 2013; 169 (Supp 1): 49–50.

References 1 Mahendiran S, Burkhart CN, Burkhart CG. Hyperhidrosis: a review of a medical condition. Open Derm J 2009; 3: 195–7.

338

Clinical and Experimental Dermatology (2015) 40, pp331–338

ª 2015 British Association of Dermatologists

Tap water iontophoresis may be ineffective for axillary hyperhidrosis.

Tap water iontophoresis may be ineffective for axillary hyperhidrosis. - PDF Download Free
46KB Sizes 0 Downloads 5 Views