Dermatologic Therapy, Vol. 28, 2015, 267–268 Printed in the United States All rights reserved
C 2015 Wiley Periodicals, Inc. V
DERMATOLOGIC THERAPY ISSN 1396-0296
THERAPEUTIC HOTLINE: LETTERS Supression of sweating in palmar hyperhydrosis with 5% strontium chloride hexahydrate MelI_ h Akyol, Sibel Berksoy Hayta, RukI_ye Yasak € ¸elI_k & Sedat Ozc Dermatology Department, Cumhuriyet University School of Medicine, Sivas, Turkey
A 18-year-old boy who complained palmoplantar hyperhydrosis was admitted to our clinic. He had hyperhydrosis for 3 years. He had been used some topical medications and antiperspirants, including aluminium chlorohydrate. He expressed that he used a topical product composed of strontium chloride hexahydrate R Nocicept dysesthesia cream, Gelis € h. Ltd. ¸im Mu (V S¸ti, Sivas, Turkey) to calm his pruritus due to insect bite on his hand and that this product decreased his palmar hyperhydrosis. To test the effect of strontium chloride hexahydrate (Sigma) on sweating, we made an iodine-starch test in our patient. His right hand in tap water and his left hand in a solution with 5% strontium chloride hexahydrate were kept for 15 minutes and iodine-starch test was made. A decrease of sweating on the hands treated 5% strontium chloride hexahydrate was detected (FIG. 1). The case was invited once again to make a gravimetric test for his hyperhydrosis. Gravimetric test was made after 15 minutes’ rest in sitting position in standardized temperature (24–25 C) and humidity 15–17%. After drying the surface, a preweighed filter paper was applied to the palms Address correspondence and reprint requests to: Melih Akyol, MD, Dermatology Department, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey, or e-mail: [email protected]
and plantars for a period of 1 minute. The paper was then weighed and the rate of sweat production was calculated in mg/min (1). Gravimetric intensity of sweating in this case prior to any topical application was 82 and 73 mg/min for right and left palms (respectively) and 67 and 55 mg/min right and left plantars (respectively). We recommended him to use a topical preparation including 5% strontium chloride hexahyR Nocicept dysesthesia cream) twice a day drate (V for 2 weeks period. Eight hours after the last use of topical preparation, gravimetric test was carried out again. The intensity of sweating was 30 and 33 mg/min for right and left palms, respectively, and 35 and 28 mg/min for right and left plantars, respectively. Strontium salts (e.g., chloride, nitrate) block the activation of cutaneous type C nociceptors and can effectively suppress sensory irritation and pruritus (2). Depending on their effects, R Nocicept dysstrontium chloride hexahydrate (V esthesia cream) can be used in dermatological diseases accompanied by pruritus and irritation as an adjunctive therapy agent. Topical aluminium chloride hexahydrate is a well-established therapy for hyperhidrosis and the mechanism of action of aluminum chloride hexahydrate is the blockage of the distal acrosyringium, which leads to functional and structural degeneration of the
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FIG. 1. Iodine-starch test.
eccrine acini (3). We think that strontium salts may have similar effect on sweating. That still low sweating rate after 8 hours the last topical application with 5% strontium chloride hexahydrate in our case suggest that idea. However, we know that increased cytoplasmic calcium, due to the transient and sustained acethylcoline phases, through the activation of inositol 1,4,5-triphosphate (IP3), stimulates chloride channels in the apical (luminal) membrane of ecrine sweat glands. The rise in cytoplasmic calcium is reportedly the key factor in the activation of potassium channels. Calcium-activated potassium channels, which are gated by intracellular calcium, result in the coupling of intracellular calcium levels and membrane potential. Chloride enters the secretory cell via either a Na-2Cl-K or Na-Cl cotransport system, and leaves the cells by diffusion into the lumen of the sweat duct (4–6). Strontium is very similar to calcium in its physiological behavior, but it can act as an imperfect surrogate for calcium (7). Therefore, strontium salts may prevent hyperhydrosis by reducing cytoplasmic calcium influx and other train of sweating events indirectly, but the calcium influx-related effect of strontium salts on sweating should be very short lived.
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Further studies are warranted to display the efficacy and mechanism of strontium salts in the treatment of localized hyperhydrosis.
References 1. Stefaniak TJ, Proczko M. Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals. Clin Auton Res 2013: 23: 197–200. 2. Hahn GS. Strontium is a potent and selective inhibitor of sensory irritation. Dermatol Surg 1999: 25: 689–694. 3. Woolery-Lloyd H, Valins W. Aluminum chloride hexahydrate in a salicylic acid gel: a novel topical agent for hyperhidrosis with decreased irritation. J Clin Aesthet Dermatol 2009: 2: 28–31. 4. Ko WH, Chan HC, Wong PY. Anion secretion induced by capacitative Ca21 entry through apical and basolateral membranes of cultured equine sweat gland epithelium. J Physiol 1996: 497: 19–29. 5. Brayden DJ, Pickles RJ, Cuthbert AW. Ion transport in cultured epithelia from human sweat glands: comparison of normal and cystic fibrosis tissues. Br J Pharmacol 1991: 102: 57–64. 6. Elwary SMA, Headley K, Schallreuter KU. Calcium homeostasis influences epidermal sweating in patients with vitiligo. Br J Dermatol 1997: 137: 81–85. 7. Concise International Chemical Assessment Document 77. Strontium and strontium compounds. WHO, 2010.
C 2015 Wiley Periodicals, Inc. V
DERMATOLOGIC THERAPY ISSN 1396-0296
THERAPEUTIC HOTLINE: LETTERS Supression of sweating in palmar hyperhydrosis with 5% strontium chloride hexahydrate MelI_ h Akyol, Sibel Berksoy Hayta, RukI_ye Yasak € ¸elI_k & Sedat Ozc Dermatology Department, Cumhuriyet University School of Medicine, Sivas, Turkey
A 18-year-old boy who complained palmoplantar hyperhydrosis was admitted to our clinic. He had hyperhydrosis for 3 years. He had been used some topical medications and antiperspirants, including aluminium chlorohydrate. He expressed that he used a topical product composed of strontium chloride hexahydrate R Nocicept dysesthesia cream, Gelis € h. Ltd. ¸im Mu (V S¸ti, Sivas, Turkey) to calm his pruritus due to insect bite on his hand and that this product decreased his palmar hyperhydrosis. To test the effect of strontium chloride hexahydrate (Sigma) on sweating, we made an iodine-starch test in our patient. His right hand in tap water and his left hand in a solution with 5% strontium chloride hexahydrate were kept for 15 minutes and iodine-starch test was made. A decrease of sweating on the hands treated 5% strontium chloride hexahydrate was detected (FIG. 1). The case was invited once again to make a gravimetric test for his hyperhydrosis. Gravimetric test was made after 15 minutes’ rest in sitting position in standardized temperature (24–25 C) and humidity 15–17%. After drying the surface, a preweighed filter paper was applied to the palms Address correspondence and reprint requests to: Melih Akyol, MD, Dermatology Department, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey, or e-mail: [email protected]
and plantars for a period of 1 minute. The paper was then weighed and the rate of sweat production was calculated in mg/min (1). Gravimetric intensity of sweating in this case prior to any topical application was 82 and 73 mg/min for right and left palms (respectively) and 67 and 55 mg/min right and left plantars (respectively). We recommended him to use a topical preparation including 5% strontium chloride hexahyR Nocicept dysesthesia cream) twice a day drate (V for 2 weeks period. Eight hours after the last use of topical preparation, gravimetric test was carried out again. The intensity of sweating was 30 and 33 mg/min for right and left palms, respectively, and 35 and 28 mg/min for right and left plantars, respectively. Strontium salts (e.g., chloride, nitrate) block the activation of cutaneous type C nociceptors and can effectively suppress sensory irritation and pruritus (2). Depending on their effects, R Nocicept dysstrontium chloride hexahydrate (V esthesia cream) can be used in dermatological diseases accompanied by pruritus and irritation as an adjunctive therapy agent. Topical aluminium chloride hexahydrate is a well-established therapy for hyperhidrosis and the mechanism of action of aluminum chloride hexahydrate is the blockage of the distal acrosyringium, which leads to functional and structural degeneration of the
267
AQ1
Akyol et al.
FIG. 1. Iodine-starch test.
eccrine acini (3). We think that strontium salts may have similar effect on sweating. That still low sweating rate after 8 hours the last topical application with 5% strontium chloride hexahydrate in our case suggest that idea. However, we know that increased cytoplasmic calcium, due to the transient and sustained acethylcoline phases, through the activation of inositol 1,4,5-triphosphate (IP3), stimulates chloride channels in the apical (luminal) membrane of ecrine sweat glands. The rise in cytoplasmic calcium is reportedly the key factor in the activation of potassium channels. Calcium-activated potassium channels, which are gated by intracellular calcium, result in the coupling of intracellular calcium levels and membrane potential. Chloride enters the secretory cell via either a Na-2Cl-K or Na-Cl cotransport system, and leaves the cells by diffusion into the lumen of the sweat duct (4–6). Strontium is very similar to calcium in its physiological behavior, but it can act as an imperfect surrogate for calcium (7). Therefore, strontium salts may prevent hyperhydrosis by reducing cytoplasmic calcium influx and other train of sweating events indirectly, but the calcium influx-related effect of strontium salts on sweating should be very short lived.
268
Further studies are warranted to display the efficacy and mechanism of strontium salts in the treatment of localized hyperhydrosis.
References 1. Stefaniak TJ, Proczko M. Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals. Clin Auton Res 2013: 23: 197–200. 2. Hahn GS. Strontium is a potent and selective inhibitor of sensory irritation. Dermatol Surg 1999: 25: 689–694. 3. Woolery-Lloyd H, Valins W. Aluminum chloride hexahydrate in a salicylic acid gel: a novel topical agent for hyperhidrosis with decreased irritation. J Clin Aesthet Dermatol 2009: 2: 28–31. 4. Ko WH, Chan HC, Wong PY. Anion secretion induced by capacitative Ca21 entry through apical and basolateral membranes of cultured equine sweat gland epithelium. J Physiol 1996: 497: 19–29. 5. Brayden DJ, Pickles RJ, Cuthbert AW. Ion transport in cultured epithelia from human sweat glands: comparison of normal and cystic fibrosis tissues. Br J Pharmacol 1991: 102: 57–64. 6. Elwary SMA, Headley K, Schallreuter KU. Calcium homeostasis influences epidermal sweating in patients with vitiligo. Br J Dermatol 1997: 137: 81–85. 7. Concise International Chemical Assessment Document 77. Strontium and strontium compounds. WHO, 2010.
