Clinical Briefs

By Louis Kuritzky, MD

US Prevalence and Impact on Axillary Hyperhidrosis

The diagnosis of hyperhidrosis, or excessive sweating, is achieved by clinical inquiry rather than laboratory testing, though quantitative metrics are available for clinical research. Primary hyperhidrosis (HHD) can be manifest on the palms and soles, face, axillae, and other areas, and is felt to be secondary to sympathetic overactivity. Of course, persons who are anxious about, or embarrassed by, their HHD, tend to magnify their sweating because of further increases in sympathetic tone, heightening the intensity of their problematic symptoms.

The demographics of HHD are only weakly established, with most literature resources citing a single unpublished pilot study from the 1970s. Using data from a consumer survey, screening information from 150,000 US households was obtained. HHD was sought whether formally defined by a clinician, or simply fitting clinical criteria as described by the screening instrument.

The HHD prevalence was deter-mined to be 2.9%, which would equate to almost 8 million individuals in the United States adult population. No gender predilection was found, and average age of onset was 25. Half of HHD sufferers had axil- lary HHD. Only one-third had dis- cussed the condition with their physician. Approximately one-third said that HHD was barely tolerable- intolerable; this same proportion reported frequent, relentless life interference with daily activities caused by HHD.

Numerous effective treatments for HHD are available, hence there is ample room for enhanced clinician communication with HHD sufferers.

Strutton DR, et al. J Am Acad Dermatol 2004;51:241-248.

Effects of Extended Outpatient Rehabilitation After Hip Fracture

For senior citizens who do not succumb to the sequelae of hip fracture (HFX), the long-term consequences remain daunting for most. Insurers may provide coverage sufficient only to sustain a patient to the point of being independently ambulatory, despite continued partial disabilities which may incur risk of future falls. Whether a high-intensity, long-term (6 months) rehabilitation program, including resistance training, provides better outcomes for HFX sufferers than a low-intensity, short-term program was studied in this report. All subjects (n=90) had undergone surgical treatment of a proximal femur fracture within the prior 16 weeks, and had completed a course of standard physical therapy.

The high intensity regimen included progressive resistance exercises for the upper and lower body; exercise sessions were scheduled 3 times weekly.

Persons in the control group were provided a home exercise protocol, guided by a single session in which they received instruction on how to perform the exercises at home (also recommended 3 times weekly).

The primary end point, physical performance and degree of disabili- ty, was significantly better for par- ticipants in the high intensity regimen. Although traditional exercise programs at home help HFX victims maintain functional status, long-term, high intensity regimens provide more favorable outcomes.

Binder EF, et al JAMA. 2004;292: 837-846.

Mortality and Incidence of Cancer During 10-Year Follow-Up of the Scandinavian Simvastatin Survival Study (4S)

Although the value of statins for both primary and secondary prevention of cardiovascular events is widely accepted, inconsistent background signals of disproportionate cancer risk have sporadically surfaced. For instance, prospective epidemiologic surveys have sometimes noted an increased cancer mortality risk in persons with the lowest cholesterol levels. Similarly, animal studies (rodents) sometimes show increases in cancer risk subsequent to cholesterol lowering. In 2 separate pravastatin trials (CARE and PROSPER), breast cancer and total cancer, respectively, were increased in statin recipients.

Reassuringly, metanalyses from larger trials, including the Heart Protection Study (n = 20,000), do not demonstrate any increased cancer risk, but skeptics maintain a degree of circumspection due to the relatively short duration of lipid trials, generally 3-5 years in length.

The 4S trial was originally concluded in 1994, and Strandberg and colleagues now report on data at the conclusion of an extended follow-up. At a mean of 10.4 years, there was no suggestion of increased cancer risk. In fact, a trend towards lower cancer deaths in simvastatin recipients narrowly missed being statistically significant. Long-term follow-up confirms both the continued cardiovascular benefits, as well as neutral (trending towards favorable) effects on cancer mortality.

Strandberg TE, et al. Lancet. 2004; 364:771-777.

Dr. Kuritzky, Clinical Assistant Professor, University of Florida, Gainesville, is Associate Editor of Internal Medicine Alert.