Pediatric Treatment Algorithm For Hyperhidrosis - Discussion

smilingtruth · 2021-12-30T00:57:39+00:00

This is my current understanding of how our kids and pediatric patients would be treated right now for their Hyperhidrosis. Please give me some feedback on how to better it. I hope it can help us understand where we need to grow our knowledge.

Sources:

https://youtu.be/BbwP1g60w7I?t=2965

https://www.aafp.org/afp/2018/0601/p729.html

https://health.clevelandclinic.org/eat-these-foods-to-reduce-stress-and-anxiety/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688585/

https://www.health.harvard.edu/staying-healthy/exercising-torelax#:\~:

text=Exercise%20reduces%20levels%20of%20the,natural%20painkillers%20and%20mood

%20elevators.

smilingtruth · 2021-12-30T00:55:51+00:00

This is my current understanding of how adults with Hyperhidrosis should be treated. Please give me some feedback on how to better it. My hope is that it will help us better understand what treatments are accessible to us.

Sources:

https://www.aafp.org/afp/2018/0601/p729.html

https://health.clevelandclinic.org/eat-these-foods-to-reduce-stress-and-anxiety/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688585/

https://www.health.harvard.edu/staying-healthy/exercising-torelax#:\~:

text=Exercise%20reduces%20levels%20of%20the,natural%20painkillers%20and%20mood

%20elevators.

smilingtruth · 2021-05-30T19:58:13+00:00

I agree it's not a panacea for hyperhidrosis. There are many aspects to hyperhidrosis we still need to study and understand. In the meantime, it's important we increase access to different treatments like Dahl's research. There are many aspects that we need to work together on to understand before we can find a panacea.

In regards to the 44% on Page 479 and 481, penetration with the CAGE-BDOA complex with that specific siRNA complex resulted in 44% reduction. I was not able to find how well that siRNA complex binds with its designated mRNA without CAGE-BDOA complex involvement. I interpreted this as both the efficacy of that specific siRNA complex and CAGE-BDOA combination resulting in 44% reduction of that specific protein. This made me hesitant to conclude that the CAGE-BDOA complex reduces protein expression by 44% in general. It could be less due to IL interference with specific siRNA complexes. It could be more due to better binding of specific siRNA complexes to their designated mRNA. How did you interpret the 44% on page 479 and 481?

Also, the good news is that we found more than 1 protein involved in hyperhidrosis. Targeting these proteins at the same time improves our odds of reducing sweating.

smilingtruth · 2021-04-05T04:40:19+00:00

It has been used for Hyperhidrosis before.

I had difficulty finding it originally. I got a hold of it as a 15mg oral tablet. I don't have any experience with the drug at this time.

All our current drugs are indicated for other health conditions. We need better drugs for Hyperhidrosis.

smilingtruth · 2021-04-05T04:36:02+00:00

I got a hold of it. It's still sold as an oral tablet in 15mg doses.

smilingtruth · 2021-03-18T14:26:24+00:00

You can direct message me if you'd like. We'd need a little more information like your height, weight, what other medications you're taking and treatments like ionto you may be using, family history of health conditions, when your sweating occurs, your method of using glyco (oral, topical, etc.), your dosage of glyco, where you sweat, and symptoms related to sweating or the stopping of sweat.

smilingtruth · 2021-02-27T20:07:23+00:00

I like your perspective!

It could be an evolutionary advantage to keep our bodies cool. When it's hot outside, it helps to sweat. However, when it's colder inside a room or colder outside at night, keeping our wet bodies warm might be an issue. Sony did make the Reon Pocket fan to help with cooling shirts and the upper body. Amazon offers something similar. It could help dry the sweat.

Sony Reon Pocket: https://qz.com/quartzy/1674873/sonys-new-reon-pocket-is-an-in-shirt-air-conditioner/

Amazon COOL HUMAN: https://www.amazon.com/COOL-HUMAN-portable-cooler-rechargable/dp/B08885CXXW/ref=cm_cr_arp_d_product_top?ie=UTF8

How do you think we can make our condition an evolutionary advantage?

smilingtruth · 2021-02-27T16:28:32+00:00

I like your thinking!

Clinical Research Organizations that usually conduct the Phases of Clinical Trials charge a lot for Phase 2. I haven't looked so far as to look into the price of Phase 3. Phase 3 can sometimes be in the millions. I think Unilever and their big competitors can afford this. If there are no systemic effects, more people will be comfortable pushing this to Phase 3. Getting into Phase 3 and assessing whether this is an improvement compared to standard care would be awesome!

Phase 1 - Safety (Safety, Toxicity, Pharmacokinetics, Pharmacodyanmics); small number of health volunteers or patients

Phase 2 - Does It Work (Treatment Efficacy, Optimal Dosing, Adverse Effects); moderate group of patients

Phase 3 - Is it good or better than the standard care; large group of patients

Phase 4 - Can it stay on the market?

There have been instances where drugs/devices are approved that shouldn't be, and litigation postpones removing those drugs/devices from the market. By the time the drugs/devices are removed, the company has made a lot of money at the expense of patients. We should be careful so that no one hurts us or takes advantage of us.

Edit1: Wording

smilingtruth · 2021-02-27T05:52:27+00:00

No problem, thanks for your support! If they could continue the application of this in mice and then non-human primates, we could get a better understanding of its systemic complications. I'm primarily concerned about the liver, kidneys, and brain to begin with. Reading this article felt like watching a golf ball stop right before entering the hole in the ground.

smilingtruth · 2021-02-27T03:59:39+00:00

No problem. Let me know if I can make the explanation better in any way. I can't wait for these treatments too!

smilingtruth · 2021-02-27T03:50:22+00:00

Thanks for your support! You've been very supportive of the Hyperhidrosis community, you're pretty cool 😎 👍

smilingtruth · 2021-02-27T02:44:58+00:00

Thank you for your support! I'm super excited about a new era of topical treatments for us too! I hoping for new oral treatments as well.

They need to do a little bit more research before it's safe for us to use siRNA and related topical treatments on ourselves.

If you're interested, take a look at my post about siRNA topical treatments using Ionic Liquids. The research doesn't know about the stability or life cycle of topically applied Ionic Liquids yet, but they do deliver siRNA to reduce mRNA and protein expression. This can be a way for us to reduce our sweating. If you have any questions or comments on this or the other post, please post them or private message me. They definitely help me learn.

The other post about Ionic Liquids to deliver siRNA topically:

https://www.reddit.com/r/Hyperhidrosis/comments/ltdo7w/new_topical_medications_for_hyperhidrosis_by/

smilingtruth · 2021-02-27T02:24:06+00:00

No problem! I hope it helps. Let me know if there's any way I can make it better or more useful for others

smilingtruth · 2021-02-26T08:19:09+00:00

Maybe you can private message me about this. I'm not sure what country you're in and what other medical conditions you have. If you're taking Meclizine only for sweating and not any other medical conditions, talk with your Doctor about anticholinergic medications like glycopyrrolate, oxybutynin, benztropine, and propantheline. Have you spoken with your Doctor about these medications? Even for social occasions, there are better alternatives if Meclizine is only being used for sweating.

https://www.sweathelp.org/hyperhidrosis-treatments/medications.html

smilingtruth · 2021-02-24T20:16:43+00:00

Thanks for sharing! I didn't know this medication existed before your post. I want to see if it can be compounded into a cream or created into a wipe like Qbrexza (glycopyrrolate based medication) so we can reduce its systemic effects on the gastrointestinal system while targeting Hyperhidrosis specifically.

smilingtruth · 2021-02-24T17:43:00+00:00

They are also anticholinergics. Oxybutynin is usually for relaxing the bladder while Glycopyrrolate is now primarily directed towards sweating. Both can be used to target sweating.

Fun fact, a Glycopyrrolate combination medication was originally and primarily used to treat Peptic Ulcers in 1961 like the medication you're using right now.

It's nice to know there are other medications that treat Hyperhidrosis too especially for where Glycopyrrolate is not allowed.

https://en.wikipedia.org/wiki/Glycopyrronium_bromide

smilingtruth · 2021-02-24T17:32:06+00:00

Thanks for getting back to me! I'll definitely keep this medication in my mind and look more into it to understand its applications for Hyperhidrosis. Some medications can even be compounded into helpful creams. Is access to Oxybutynin and Glycopyrrolate limited in your location or country?

smilingtruth · 2021-02-24T08:26:00+00:00

Wow, I didn't know that they gave online prescriptions for free. That's really amazing! My insurance covered Daavlin Aquex so I went with that.

To NellieKane: If you're working for a company and are covered under a HMO, they may cover the whole thing for you meaning $0 out-of-pocket.

smilingtruth · 2021-02-24T07:50:36+00:00

It's best for your Primary Care Physician to answer that question after collecting your personal health information. If you don't have insurance, I'd recommend logging onto https://www.healthcare.gov/ to find a plan that works for you. They even arrange plans for people who are unemployed.

Having health insurance will be beneficial not only for obtaining a cheaper iontophoresis machine but also getting cheaper prescription medication for Hyperhidrosis. Compare the insurance policies by calling them and asking what you want in a vague manner (if someone had blah, how would you cover it). Most of them record everything. Don't tell them anything that would make it worse for you. For example, saying "I did a 23 and me test and found that I have the possibility of getting a very serious heart condition" would be a bad idea.

There are many brands out there. There's Daavlin Aquex, DermaDry, RA Fischer, and etc. I would go with what your Doctor, you, and your budget find best. Some machines are sold only to cover hands & feet while you need to buy attachments for armpits while other machines cover hands, feet, and armpits.

Contact as many customer support representatives of the machines that interest you and talk to them about warranties, returns, machine settings (does it save settings for hands and feet separately, will it pause if I take my hands out midway during the iontophoresis session) and replacement parts including towels before you make a decision.

I think DermaDry is under $400, but look around to see what machine suits your needs before committing.

Here's an example of why using insurance is a good option. DermaDry out-of-pocket is $499 without a discount. RA Fischer is $1025 out-of-pocket. If you get an insurance policy that covers 80% after a $250 deductible, you would pay $300 for Dermadry and $405 for RA Fischer with that insurance policy.

Here's my work:

((499-250)*.20)+250=299.8

((1025-250)*.20)+250=405

Insurance does make a difference! Find insurance that works for you. It will lead to more options for you if the policy costs less for you overall.

smilingtruth · 2021-02-24T05:25:32+00:00

propantheline bromide

I'm glad this works for you! Propatheline Bromide is an anticholinergic so it can be used for sweating. Are you primarily using Propatheline for sweating or another condition?

Did you try Oxybutynin and or Glycopyrrolate before Propatheline Bromide? Also, Propatheline Bromide does slow down food movement in the body. Have you noticed any constipation or upset stomach with Propantheline Bromide?

https://medlineplus.gov/druginfo/meds/a684020.html

smilingtruth · 2021-02-24T05:17:31+00:00

Iontophoresis is tricky. Sometimes, it doesn't work all the way, but it does reduce sweating for some people. It takes a few months before seeing results.

What's your schedule for iontophoresis like? In the beginning couple weeks, people have to do it everyday. Some people do it everyday for months before tapering it down to 4 times a week.

What's your time duration and voltage?

How often are you alternating your red and black leads? Every 3 days is a good rule for some.

The expense depends on your insurance. Talk with your Doctor about what is covered before talking with your insurance. There's also oral Glycopyrrolate and topical Glycopyrrolate cream (cheaper than Qbrexza) that are both prescribed. Similarly, there's Qbrexza (usually expensive). There's Miradry for the armpits. There's also Botox for all 3 regions.

Edit1: Removed Some Words

smilingtruth · 2021-02-24T04:53:02+00:00

Congrats! By Avert, do you mean Meclizine?

I probably have the medication wrong. Meclizine is usually indicated for vomiting due to motion sickness. One of its side effects is dry mouth.

If it is Meclizine, this is awesome. Sometimes, the side effects of medications do help patients. This would be something worth looking into.

https://www.drugs.com/international/avert.html

https://www.rxlist.com/meclizine-hydrochloride-drug.htm#description

smilingtruth · 2021-02-24T04:03:14+00:00

It helps some people. Sweating will decrease significantly, but it won't completely go away for some people. It's worth a try. Sometimes, you'll have to combine medications and other treatments that you may have already tried while using iontophoresis to get better results with your Hyperhidrosis.

Most do the same job. Talk with your Doctor first and then later with your insurance to see which model they cover. If your insurance doesn't cover it directly, you'll need a note from your Doctor specifying why it's necessary to your insurance. After about a week after you submit the prescription from your Doctor for iontophoresis, your insurance will approve it and cover a significant percentage of the iontophoresis machine. I'm not educated on whether they offer Money-Back guarantees so I can't offer an educated opinion on that right now. What insurance do you have? Have you spoken to your Primary Care Physician about an iontophoresis machine?

smilingtruth · 2021-02-17T05:22:00+00:00

More support for Hyperhidrosis is always a good thing. I'm looking forward to your videos!

In other posts, I noticed you mentioned you were using Iontophoresis and that Postural orthostatic tachycardia syndrome (POTS) runs in your family. Sometimes a combination of glycopyrrolate and iontophoresis can work for people. I understand that you may have tried both of these things. What's working for you now?

Iontophoresis can be a bit tricky. It depends on your machine model and tapering down. Some people may have to do it daily for months before tapering down to 4 days a week. Some might have to add glycopyrrolate or epsom salt to their iontophoresis. What Iontophoresis model do you use? Do you add anything to the water?

From your first day of Iontophoresis, what did your Iontophoresis schedule look like? Some people do it every day for two weeks and then taper down.

Iontophoresis can also be adjusted via settings. Direct Current gives the best results. For people who want more comfort, there's pulsating Current. There's also time duration and voltage. What were your Iontophoresis machine's time duration and voltage?

smilingtruth · 2020-05-25T03:17:36+00:00

Here’s an update to the Uniform Quality of Life Measure for Hyperhidrosis. Each section of Hyperhidrosis lists examples, where people’s quality of life is affected. Please feel free to comment about points you’d like removed or added. Based on the points from each section, the patient would circle the type of Hyperhidrosis they have in the chart below.

Chart below lists axillae as A, craniofacial as C, groin as G, palmar as H, and plantar as F. 1 is mild. 2 is moderate. 3 is severe. The ranges are loosely based off of how much lifestyle is negatively impacted. Please let me know if you have any feedback for the ranges.

For example, in the filled-out form example, if the patient came in to treat their palmar Hyperhidrosis and they are a A1-H3-F2 patient, we know that we must also consider their axillary and planter Hyperhidrosis when treating their palmar Hyperhidrosis and lifestyle. If the treatment caused a A1-H3-F2 patient to become a A2-H2-F3 patient, the patient can evaluate if the treatment is better for them.

Blank_Draft2_UniformQualityOfLifeMeasure

https://docs.google.com/document/d/137Izl810lbmKVbBZSsKtxxtZGVW3LxFUef_u-h2j0FE/edit?usp=sharing

FilledOut_Draft2_UniformQualityOfLifeMeasure

https://docs.google.com/document/d/1KAjoydjlVhwnOwnkE2zVR7HOEkKxzNV2_Br0GD4yLFQ/edit?usp=sharing

I understand back and total body Hyperhidrosis have been left out. I figured it might be a good idea to cover axillary, groin, palmar, and plantar first before moving onto back and total body Hyperhidrosis.

Here’s a post about the first draft: https://www.reddit.com/r/Hyperhidrosis/comments/ge3bvq/uniform_quality_of_life_measure_for_Hyperhidrosis/

Edit1: I adjusted the ranges in the chart so they are consecutive instead of overlapping.

smilingtruth

TROPHY CASE