Assessment of Efficacy of Daylight Photodynamic Therapy in Treatment of Primary Palmar Hyperhidrosis

Abstract Background Hyperhidorsis is a condition in which sweat production exceeds that is needed for thermoregulation, and can affect the hands, feet, axilla, face, back, groin, and legs. It is a disabling condition that affect, both children and adults, with in a rate of 1-3% and onset usually during childhood or adolescence. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity. Objective To evaluate the efficacy and tolerability of photodynamic therapy (PDT) using daylight for treatment primary palmar hyperhidrosis. Patients and Methods We studied the effect of PDT on 20 patients with primary palmar hyperhidrosis. The night before every session the patient used a cream containing (10 % urea, 5% salicylic acid) under occlusion as an emollient and to facilitate the photosensitizer skin delivery in the next morning. Application of methylene blue 2% for the right palm as a photosensitizer and hematoxylin stain as a placebo for the other palm for one hour under occlusion as an incubation period. After one hour of incubation, exposure to daylight for one hour from 11 am to 12 pm. The patients were advised to continue using the moisturizing cream containing (urea 10%, salicylic acid 5%) daily in between sessions but on the night before the session, the patient was asked to keep it under occlusion the whole night. The treatment sessions were done twice weekly for a maximum of 8 sessions. A starch-iodine test was done before each session. Results We found that we could reach good response for treatment of primary palmar hyperhidrosis with reduction of the hyperhidrosis scores after eight sessions of treatment with PDT using MB as the photosensitizer and the daylight as the light source while hematoxylin use, as a placebo, showed almost no effect. The effect was maintained at least for two months after the last treatment session. The side effects were mostly limited to transient palm staining by the photosensitizer. Conclusion Daylight photodynamic therapy is an effective, safe method for managing primary palmar hyperhidrosis.