Cogentin

Errata # 1

The Editors wish to apologize for omitting tables which should have accompanied Dr. Lewis P. Stolman's excellent article in the September/October issue of JDD, entitled "Treatment of Hyperhidrosis," (J Drugs Dermatol 2003; 2(5):521-527). The tables are reproduced here in their entirety.

Errata #2:

The July/August article "Current Trend in Ivermectin Usage for Scabies" (J Drugs Dermatol 2003; 2(4):397-401) referred to various dosages in milligrams and micrograms; throughout the text. The correct measurements were in micrograms: any references to milligrams were incorrect and should be read as micrograms.

Errata #3:

Andrew L Kaplan MD was the lead author of the July/August issues case report "Multiple Fixed Drug Eruption with Interferon/Ribavarin Combination Therapy for Hepatitis C Virus Infection" (J Drugs Dermatol 2003; 2(5):570-573), and should have been credited as such.

Table 1

Hyperhidrosis Generalized:

Heat, humidity & exercise

Febrile illnesses: acute & chronic infections

Neoplasia: Hodgkin's disease

Metabolic: carcinoid, diabetes mellitus, gout, hyperpituitarism, hypoglycemia, menopause, pheochromocytoma, thyrotoxicosis

Sympathetic discharge: shock & syncope, intense pain, alcohol & drug withdrawal

Neurologic: Riley-Day Syndrome. Ross syndrome, irritative hypothalamic lesions

Drugs: propanolol, physostigmine, pilocarpine, tricyclic antidepressants, venlafaxine

Table 2

Hyperhidrosis Localized:

Heat

Olfactory

Gustatory: citric acid, coffee, chocolate, peanut butter, spicy foods

Neurologic lesions/Frey's syndrome

Primary or focal hyperhidrosis

Table 3

Treatment of Hyperhidrosis

1) Medical

* Topical:

Antiperspirants: Drysol[R] (aluminum hexahydrate in alcohol)

2-5% Tannic acid solution

5-20% Formalin solution

10% Glutaraldehyde solution

Anticholinergics: 0.5% glycopyrrolate lotion

* Systemic:

Tranquilizers: Valium[R] (diazepam), Prozac[R] (fluoxetine) Anticholinergics: Banthine/Probanthine[R] (propantheline bromide), Pamine[R] (methscopolamine bromide), Robinul[R] (glycopyrrolate), Ditropan[R] (oxybutynin), Cogentin[R] (benztropine mesylate)

NSAIDS: Indocin[R] (indomethacin)

Calcium channel blockers: Cardizem[R] (diltiazem)

Catapres[R] (clonidine hydrochloride)

Botox[R] (botulinum toxin type A)

2) Surgical

Sympathectomy

Ablation of axillary sweat glands

3) Electrical

Iontophoresis

Table 4

Iontophoresis for Hyperhidrosis with the Fischer[TM] Galvanic Unit

A: Iontophoresis of hands using an assistant to control the unit

1) Fill the two plastic trays with tap water at room temperature to the top of the electrodes.

2) With the Fischer[TM] unit off, connect the trays to the unit's outputs with the supplied cords.

3) Make certain the patient removes all jewelry and any small cuts or abrasions are covered with Vaseline[TM] or some similar water-resistant material.

4) With the unit still off, have patient place one hand in each tray. The water level should be just above the skin of the tops of the fingers and hands. Remind the patient to keep hands in the water for the duration. Removing the hands or touching the electrodes during the treatment may result in a small shock. Since the intensity of the current flow is greatest at that part of the hand that is closest to the electrodes, instruct the patient to rotate their hands using a sliding motion away from the electrodes to avoid any unusual discomfort.

5) Turn unit on with meter scale set from 0-50 and "Intensity" knob at zero; gradually increase the amperage using the "Intensity" knob to the therapeutic range of 15 to 18 milliamps and treat for 10 minutes. Note: If the red "Active" light does not illuminate when you begin to increase current flow, return to zero and check all connections.

6) At the end of the 10 minutes decrease current flow gradually to zero.

7) When the meter indicates the flow is zero and the "Active" light goes out, switch the direction of current flow at the unit by removing plug, rotating it 180 degrees, and reinserting.

8) Repeat steps 5) and 6) for 10 minutes. The total treatment duration will be 20 minutes.

Note: If the feet and not the hands are being treated, the patient--once--taught may adjust the controls him/her self (see Table 5).

Table 5

Iontophoresis for Hyperhidrosis with the Fischer[TM] Galvanic Unit

B: Iontophoresis of the hands and feet without an assistant

Note: This technique allows one hand to be free so that the patient can control the unit The total duration of the treatment is increased from 20 to 40 minutes. however with 20 minutes for each hand-and-foot combination

1) Place one tray on a table and the second on the floor.

2) Place one hand in one tray and a that in the second.

3) Follow instructions 5) to 8) above.

4) Remove treated hand and foot, insert untreated hand and foot, and repeat 5) to 8) above.

Notes:

1) If the mineral content of the tap water is low, current flow is reduced and the desired amperage (15 to 18 milliamps) may not be achieved. A teaspoonful of baking soda added and dissolved in each tray should remedy the problem.

2) Patients need treatments every 2 to 3 days for 5 to 10 sessions before an effect is observed. Once euhidrosis is achieved the interval between treatments may be stretched out. Some patients need only treat themselves once every 2 to 4 weeks

3) Avoid treating patient who are pregnant or have pacemakers.

4) Patients who fail to respond to simple tap water iontophoresis may benefit from the addition of an anticholinergic to the water e.g. Robinul Forte[TM] 2 mg crushed and dissolved in each tray.

5) Some patients experience irritation along the waterline following treatment. 1% hydrocortisone cream is usually sufficient to relieve this.

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2004 Gale Group