In this study, we examined the efficacy and safety of topical aluminum chloride solution on palmar hyperhidrosis. The patients were 90 cases with moderate to severe primary palmar hyperhidrosis (sweating amount ≥0.5 mg/cm2/min) who visited Tokyo Medical and Dental University and Aichi Medical University from August of 2011 through January of 2012. They were randomly allocated to 3 groups given 20% aluminum chloride solution (hexahydrate), 50% aluminum chloride solution (hexahydrate) or placebo, and each solution was simply applied twice a day for 8 weeks using a double blind method. The measures for evaluation included sweating amount, HDSS (Hyperhidrosis disease severity scale) and DLQI (Dermatology life quality index). In addition, the improvement rates of objective and subjective symptoms were assessed. The 85 cases that completed the treatment were included in the alalysis. The groups given topical aluminum chloride solution showed significant, concentration-dependent decreases of the sweating amounts at the concentrations of 20% and 50% after 8 weeks. Subjective symptoms examined by HDSS and DLQI were also significantly improved after 2 weeks of external application. These results indicate that the topical 50% aluminum chloride solution applied to primary palmar hyperhidrosis decreased sweating significantly in comparison with patients treated with placebo. Irritant dermatitis on the skin adjacent to the sweating areas, such as on the interdigital area and dorsum of the hand other than the palm was locally observed as a concentration-dependent side effect, suggesting the necessity for a device to accurately apply the solution to only the affected area. Notably, the blood concentrations of aluminum chloride did not change in any of the patients, and no transfer inside the body was observed.
In October of 2011, a 30-year-old Japanese man was referred to Niigata Prefectural Shibata Hospital with severe facial swelling. Relevant history included some transient episodes of hand swelling since the age of 20 years; his mother and two brothers had also experienced similar episodes. In addition, in August of 2011 he had been admitted to our hospital for abdominal pain that was shown by computed tomography to be caused by edema of the small intestine although it had not been diagnosed. An infusion of corticosteroids and a H1 histamine receptor blocker had little effect on the facial swelling. Laboratory testing showed a low concentration of complement component 4, and low activity and amount of C1 inhibitor. A novel heterogeneous missense mutation was discovered on exon 3 of the C1 inhibitor gene by the Center of Research, Education and Treatment of Angioedema. The present case was definitively diagnosed with hereditary angioedema (HAE) type 1. The center will be useful because it provides genetic analysis for diagnosis of HAE and current knowledge about the disease.
Six cases of superficial digital arteriovenous malformations were treated at Department of Dermatology of Hyogo Cancer Center between 1993 and 2009 (five cases on fingers, one case on toe). The lesions were about 10 mm reddish macules consisting of red dots and linear erythema. In all cases, there was no specific history of trauma. Histopathologically, there were an increased number of branching irregularly-shaped blood vessels displaying variable thicknesses in the mid to deep dermis. Even in the same vessel, the vessel wall consisted of an uneven mixture of thin and thick-walled parts that did not exist in the normal tissue. With special and immuno-histochemical staining, neither the thickness of the smooth muscle of vessel walls nor the distribution of the elastic lamina were uniform, indicating that the thick-walled parts of vessel walls had arterial characteristics and the thin-walled parts, venous characteristics. No arteriovenous anastomoses could be found even in serial sections. These findings are essentially identical to the pathological features of cerebral arteriovenous malformation, indicating that the skin lesions may be also congenital and that post-traumatic acquired origin is unlikely. These lesions composed of anomalous vessels in the dermis of fingers or toes may be referred to as “superficial digital arteriovenous malformation”.