Sweat induction, added exposure improves efficacy of targeted alkali thermolysis patches

Key takeaways:

• Participants assigned to the heated room for sweat induction experienced higher quality-of-life results, researchers found.
• Of total participants, 60% had improved hydrolysis severity scores.

ORLANDO — The efficacy of targeted alkali thermolysis patches for excess sweating may be improved with sweat induction prior to application via a heated room or exercise and with increased exposure times, according to study results.

The single-use disposable targeted alkali thermolysis, or TAT, patch (Brella, Candesant Biomedical), contains elemental sodium, which combines with the water in sweat to create an exothermic reaction. This heat damages the underarm sweat glands to reduce sweating for approximately 3 to 4 months, according to researchers.

“There are issues, however, in that hyperhidrosis or excessive sweating patients do not seem to sweat evenly or predictably,” Stacy R. Smith, MD, dermatologist at the California Dermatology & Clinical Research Institute, said during a presentation at the American Society for Dermatologic Surgery Annual Meeting. “If we can improve the consistency of how they sweat, maybe we can get better results, since sweating is required for the treatment to work.”

Smith and colleagues were also motivated to investigate the effect of increased exposure time on TAT patch efficacy, which was previously limited to 3 minutes for maximum safety during an early phase study.

The researchers enrolled patients with excessive sweating who were randomly assigned to exercise (5-minute brisk walk outside clinic) or a heated room (15 minutes in 90) prior to the patch application. These sweat induction methods were purposefully selected because they do not overuse clinic resources, are easy to perform and do not require excessive time, according to the researchers.

They also assigned patients to stepped cohorts based on maximum exposure time of 5 minutes for the first cohort and 7.5 minutes for the second cohort. The patch was removed at the maximum exposure time or if the patient reported pain greater than a seven out of 10.

Smith and colleagues evaluated the patch efficacy using the Hyperhidrosis Disease Severity Scale (HDSS) score and the “bothered” and “impact” portions of a quality-of-life survey; safety was assessed based on local skin reactions and systematic adverse events.

The researchers found that 70% of patients in cohort 1 made it to the maximum application time of 5 minutes, two-thirds of whom were assigned to the exercise group. Those who did not make it to the maximum time had their patch removed due to pain.

Within cohort 2, 60% of patients reached the maximum patch application time, all of whom were in the heated room group. Again, those with reduced exposure time stopped due to pain.

Further, the researchers found that 60% of participants experienced HDSS score improvement, with similar results between the heated room and exercise groups. Additionally, 55% to 70% of participants exhibited improved results in the “bother” portion of the survey, and the “impact” portion improved in 66% to 80%, with heated room participants having significantly better quality-of-life results.

Smith and colleagues observed no related systematic adverse events.

Half of the exercise group and 10% of the heated room group experienced local skin reactions. Those in the exercise group were mostly erosions, all of which healed in 2 to 4 days.

Researchers found no correlation between exposure time and local skin reaction incidence.

“The efficacy of TAT patched can be improved by sweat induction and by increasing the exposure time,” Smith said.

The heated room may be the preferred sweat induction method, with a similar efficacy to the exercise method but improved safety and well-controlled time exposure, Smith said, adding that patient pain response may be used to adjust TAT patch exposure time going forward.