Maureen Connolly

Management of Primary Hyperhidrosis A Summary of the Different Treatment Modalities

Hyperhidrosis is a common and distressing condition involving increased production of sweat. A variety of treatment modalities are used to try to control or reduce sweating. Sweat is secreted by eccrine glands innervated by cholinergic fibers from the sympathetic nervous system. Primary hyperhidrosis most commonly affects palms, axillae and soles. Secondary hyperhidrosis is caused by an underlying condition, and treatment involves the removal or control of this condition.The treatment options for primary hyperhidrosis involve a range of topical or systemic medications, psychotherapy and surgical or non-surgical invasive techniques. Topical antiperspirants are quick and easy to apply but they can cause skin irritation and have a short half life. Systemic medications, in particular anticholinergics, reduce sweating but the dose required to control sweating can cause significant adverse effects, thus, limiting the medications’ effectiveness. Iontophoresis is a simple and well tolerated method for the treatment of hyperhidrosis without long-term adverse effects; however, long-term maintenance treatments are required to keep patients symptom free. Botulinum toxin A has emerged as a treatment for hyperhidrosis over the past 5–6 years with studies showing good results. Unfortunately, botulinum toxin A is not a permanent solution, and patients require repeat injections every 6–8 months to maintain benefits. Psychotherapy has been beneficial in a small number of cases. Percutaneous computed tomography-guided phenol sympathicolysis achieved good results but has a high long-term failure rate. Surgery has also been shown to successfully reduce hyperhidrosis but, like other therapies, has several complications and patients need to be informed of these prior to undergoing surgery. The excision of axillary sweat glands can cause unsightly scarring and transthoracic sympathectomy (either open or endoscopic) can be associated with complications of compensatory and gustatory hyperhidrosis, Horner syndrome and neuralgia, some of which patients may find worse than the condition itself.

Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma.

Background.  Subungual keratotic tumours are rare. The clinical and histological distinctions between subungual keratoacanthomas (SUKAs) and subungual squamous cell carcinomas (SCCs) are important, but often difficult. Adequate methods of differentiation between the two are required, both for the purpose of management and for assessment of prognosis.

Multiple myxoid cysts secondary to occupation

We report the case of a 50‐year‐old woman who presented with eight digital myxoid cysts (DMCs) involving the fingers of both hands. They developed within 12 months of the patient starting a job that involved pushing a garment into an embroidery mould, thus exerting a downward force on the fingertips. The pressure exerted from this force could have potentially damaged the joint synovial capsule, leading to rupture and loss of synovial gel, thus inducing myxoid cysts. This case suggests that DMCs may be related to occupation, and to our knowledge, this is only the second reported case of occupationally induced DMCs.

A cyst with inner meaning

An 18-year-old woman presented with a painless rounded swelling of her lower leg. The lesion had enlarged slightly over the preceding months. Past medical history and family history were noncontributory. Physical examination revealed a soft, solitary painless lump on her lower right leg with intact overlying skin (Fig. 1a). She was otherwise well. The swelling was excised and sent for histological evaluation. Histopathological findings

Disorders of hair in children

Abstract The patterns of presentation of paediatric hair problems can be divided into localized absence or localized abnormality of hair from birth, abnormality of hair pattern or character from birth, and acquired disorders resulting in a localized or generalized loss of hair. Hypertrichosis is uncommon in children and as a result will not be discussed in any detail. The evaluation of a child with a hair problem begins with a detailed history, followed by a thorough examination of the scalp, eyebrows, eyelashes, general body hair, nails and teeth. A general physical examination is indicated where the diagnosis is not immediately apparent and localized. Management is dependent on the condition but, in many cases, apart from infections or infestations, treatment options are limited. Often, a ‘wait and see’ approach with reassurance needs to be adopted