1/4. Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate.Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and beta-blockers may be effective but also carry significant side effects. We describe a healthy, active 27-year-old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating was especially pronounced on the forehead, nose, and upper lip. Daily topical application of a 0.5% glycopyrrolate solution to the face and forehead was offered. After the first treatment, facial sweating was significantly reduced and was well controlled under stressful situations, without any discomfort to the skin. No loss of efficacy was seen after multiple face washings. Facial hyperhidrosis recurred after withdrawal of the glycopyrrolate for 2 days, confirming its therapeutic effect. Two years later, he continues to use glycopyrrolate as needed. We conclude that topical glycopyrrolate is effective in treating craniofacial hyperhidrosis and is associated with few adverse effects.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Aquagenic syringeal acrokeratoderma: report of a case with histologic findings.Aquagenic syringeal acrokeratoderma is a rare acquired condition characterized by painful symmetric swelling and hypopigmentation of the palms and lateral fingers, which develops after brief exposure to water. Histopathologic examination suggests that an aberration in the eccrine sweat gland apparatus may be the underlying cause of this condition. The "hand-in-the-bucket sign," in which patients arrive in their physician's office with their hand in a bucket of water to more readily demonstrate their lesions, is such a common presentation that it almost can be regarded as pathognomonic. All 12 cases reported to date have been in young females. We report a case of aquagenic syringeal acrokeratoderma in a male with unique histologic findings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. hyperhidrosis: a management dilemma.hyperhidrosis is excessive sweating in response to psychological stress and emotional stimuli. The sweat is usually limited to the palms, soles, and axillae, and is greatly accentuated by mental stimuli rather than temperature and exercise. The severity is such that for many, sweating has become socially and emotionally devastating and may predispose to other cutaneous diseases. More than 60 research papers on eccrine glands and sweating have been published since 1978. Little progress, however, has been made on the control of hyperhidrosis, and the process remains a treatment dilemma among both family physicians and dermatologists. The many treatment modalities documented in the literature have been for the most part unsuccessful or unacceptable. This report describes the use of phenoxybenzamine, an alpha-adrenergic antagonist, for control of excessive sweating in two patients. After a trial of topical medication, phenoxybenzamine is useful for the reduction of sweating to an acceptable level.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Pourfour du Petit syndrome: a case following a traffic accident with severe cranioencephalic trauma.Poufour du Petit syndrome is an extraordinarily unusual clinical condition produced by hyperactivity of the sympathetic cervical chain as a consequence of irritation of these nerves. It causes an ipsilateral mydriasis, which, in patients suffering a head injury as in the case reported here, can confuse the diagnosis and disconcert physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |