Preliminary Experience With Transdermal Oxybutynin Patches for Hyperhidrosis

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On examination a band of thinner skin without hair follicles was found at both temples. Both erythema and follicular hypererkeratosis were evident at the forehead and top of the head." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Ormaechea-Pérez, A. López-Pestaña, J. Zubizarreta-Salvador, A. Jaka-Moreno, A. Panés-Rodríguez, A. Tuneu-Valls" "autores" => array:6 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Ormaechea-Pérez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Pestaña" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Zubizarreta-Salvador" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Jaka-Moreno" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Panés-Rodríguez" ] 5 => array:2 [ "nombre" => "A." 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Bergón-Sendín, A. Pulido-Pérez, L.C. Sáez-Martín, R. Suárez-Fernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Bergón-Sendín" "email" => array:1 [ 0 => "Mbergon1@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Pulido-Pérez" ] 2 => array:2 [ "nombre" => "L.C." "apellidos" => "Sáez-Martín" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Suárez-Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia inicial con oxibutinina transdérmica en el tratamiento de la hiperhidrosis" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 1071 "Tamanyo" => 59679 ] ] ] ] "textoCompleto" => "IntroductionHyperhidrosis (HH) is a condition in which the patient sweats more than is necessary to regulate body temperature. HH can be classed as primary and secondary. In primary HH (PHH), there is no underlying disease that accounts for the excessive sweating, whereas in the secondary form, excessive sweating can be attributed to various causes (eg, abnormalities of the endocrine and nervous systems, cancer, and treatment with drugs).<a class="elsevierStyleCrossRef" href="#bib0120">1</a>PHH is defined as the presence of excessive sweating for at least 6 months with no justifiable cause (major criterion) and 2 or more of the following minor criteria: (1)bilateral and symmetrical distribution; (2)at least 1 episode of excessive sweating per week; (3)interference with daily activities; (4)cessation of sweating during sleep; (5)onset before age 25 years; and (6)family history of PHH.<a class="elsevierStyleCrossRef" href="#bib0125">2</a> The most frequently involved sites are the axillas and palms, followed by the soles and facial region. PHH often affects various sites in the same patient (multifocal) and may even be generalized.<a class="elsevierStyleCrossRef" href="#bib0130">3</a>PHH is thought to affect approximately 2%-3% of the population, and even though it is not considered a severe disease, its effect on the patient's quality of life is very significant. According to various quality of life rating scales, its effect is equivalent to that of much more severe conditions, such as diabetes.<a class="elsevierStyleCrossRef" href="#bib0135">4</a>PHH can be managed using various therapeutic options, including drugs (topical and systemic), nonsurgical interventions (eg, iontophoresis and botulinum toxin), and surgery (selective sympathectomy and excisional surgery).<a class="elsevierStyleCrossRef" href="#bib0140">5</a>Oxybutynin is an anticholinergic drug whose efficacy in the control of PHH is well-documented, although its use in this disease is off-label.<a class="elsevierStyleCrossRefs" href="#bib0145">6–9</a> It is important to note that none of the systemic options used for PHH are currently authorized for treatment of the disease in Spain. HH responds well to treatment with oral oxybutynin; however, adverse effects are common (mainly dry mouth and throat), prove uncomfortable for the patient, and can lead to discontinuation of treatment.In 2014, a transdermal patch formulation of oxybutynin was marketed in Spain. According to the summary of product characteristics, it was indicated for the treatment of overactive bladder (as with the oral formulation). The transdermal patch avoids the first stage of liver metabolism, thus—in theory—reducing adverse effects and the possibility of drug interactions.<a class="elsevierStyleCrossRef" href="#bib0165">10</a>Our hypothesis was that PHH could be improved by minimizing the adverse effects of oral oxybutynin. Therefore, we proposed a pilot study in which we applied transdermal oxybutynin patches in patients with PHH. The primary objective of this study was to evaluate the effectiveness of the transdermal patch; the secondary objective was to describe its tolerance profile.Material and MethodsWe performed a prospective study from February to September 2015. We included 25 patients whose PHH could not be suitably controlled with topical treatments and excluded patients who had received botulinum toxin during the previous 2 years or who had undergone surgery for PHH (selective sympathectomy or excisional surgery). All patients were given exhaustive information about the transdermal oxybutynin patch and alternative treatments and about the conditions of the study. They all gave their written informed consent. The effectiveness of treatment was measured using 2 subjective scales: a visual analog scale (VAS), in which sweating was graded from 1 to 10 (with 10 as the maximum degree of sweating and 1 the minimum); and the validated Hyperhidrosis Disease Severity Scale (HDSS)<a class="elsevierStyleCrossRef" href="#bib0170">11</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Treatment with transdermal oxybutynin patches (Kentera, Gebro Pharma) was administered for 10 weeks. Patients applied 2 patches (36mg each) per week, rotating between the thighs, hips, and abdomen. The interval of 10 weeks was based on findings for long-term oral oxybutynin, in which a lack of response at 6 weeks of treatment is considered therapeutic failure.<a class="elsevierStyleCrossRef" href="#bib0145">6</a>The study comprised 3 visits. At the initial visit (visit1), patients were informed about the study and gave their informed consent, a baseline evaluation of HH was made using the VAS and HDSS, and treatment was started at the dose described above. Visit 2 was 6 weeks after the start of treatment and visit 3 at 10 weeks. Treatment was maintained until visit 3. The HDSS and VAS were applied at visits 2 and 3, and any adverse effects were recorded. At visit3, patients evaluated how well treatment had controlled their disease, classifying the outcome as no improvement, slight nonsignificant improvement, or significant improvement.The demographic characteristics of the patients included in the study and the sites affected by PHH are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>ResultsWe included 25 patients (16 women and 9 men) with a mean age of 28years (18-42 years). They had all received treatment for HH (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).Control of symptoms was evaluated using the VAS and HDSS after 10 weeks of treatment (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Symptoms did not worsen in any patients during the study.The VAS score decreased for all patients (1 point in 3 patients, 2 points in 5 patients, 3 points in 10 patients, 4 points in 6 patients, and 5 points in 1 patient).The HDSS score decreased by 3 points in 1 patient, 2 points in 5 patients, and 1 point in 9 patients; the HDSS score remained unchanged in 10 patients after treatment.No variations in the scores for these scales were recorded between week 6 (visit2) and week 10 (visit3).As for the general evaluation at visit 3, no patients defined the response as no improvement, 8 patients (32%) considered it a slight nonsignificant improvement, and 17 (68%) patients considered it a significant improvement.Adverse effects were reported in 2 patients (8%). In both cases, the adverse effect was irritation at the site where the patch was placed. This was classed as mild (erythema and desquamation) in patient 17 and moderate (erythema, edema, and desquamation) in patient 22. The adverse effect did not lead either of the 2 patients to discontinue treatment, since it was controlled by applying the patch at another site (patient 17) and with application of low-potency topical corticosteroids (patient 22).DiscussionThe basic function of sweating is to regulate body temperature in response to various stimuli, such as heat and exercise. The sweat glands are activated by the sympathetic nervous system: thermoregulatory signals from the hypothalamus are transmitted via sympathetic preganglionic and postganglionic nerve endings to the sweat glands. The main neurotransmitter involved in this process is acetylcholine, which acts via the nicotinic receptors (preganglionic and postganglionic fibers) and muscarinic receptors (sweat glands). PHH is the result of an autonomic nervous system dysfunction without morphologic or quantitative abnormalities in the sweat glands.<a class="elsevierStyleCrossRef" href="#bib0140">5</a>No therapeutic algorithm has been agreed upon for management of PHH, and the best option should be decided on a case-by-case basis. Therefore, it is important to take into account the individual characteristics of the patient and disease, the safety profile of the various treatments, and the resources available and their cost, starting with the least expensive treatments and/or treatments with fewer potential adverse effects. Consequently, the approaches considered first-line are topical products that act directly on the sweat gland, mainly aluminum salts.<a class="elsevierStyleCrossRef" href="#bib0175">12</a>Topical anticholinergic drugs, mainly glycopyrrolate, have also been used.<a class="elsevierStyleCrossRefs" href="#bib0180">13–16</a> This active ingredient is no longer marketed in Spain, although it can be obtained as a foreign medication. Glycopyrrolate has been used at various concentrations (0.5%-4%) and in various vehicles (solution, gel, and cream), with results that vary according to the location of PHH and the concentration of the active ingredient.<a class="elsevierStyleCrossRef" href="#bib0200">17</a> Adverse effects resulting from systemic absorption of the drug have been reported when it is used on more extensive areas of the body.<a class="elsevierStyleCrossRef" href="#bib0205">18</a>Oxybutynin is marketed abroad as a topical formulation (gel) for the treatment of bladder conditions, although there are no references in the literature on the use of this formulation for the management of PHH.Of all the systemic options, the best results have been achieved with anticholinergic drugs, and broad experience has been accumulated with oral methantheline bromide, oxybutynin, and glycopyrrolate. Most studies have been performed with oxybutynin.<a class="elsevierStyleCrossRefs" href="#bib0165">10,11,13,14</a>Oral oxybutynin is metabolized in the liver by isoenzyme CYP3A4 of cytochrome P450; therefore, it can react with other drugs that inhibit this system (eg, azole antifungal agents and macrolides). Its main limitation in the treatment of PHH is the frequency of adverse effects, which, although not generally severe, are uncomfortable and can lead the patient to discontinue treatment. The most common adverse effect is dry mouth and throat, followed by gastrointestinal complaints, headache, dizziness, and blurred vision.<a class="elsevierStyleCrossRef" href="#bib0210">19</a>Transdermal oxybutynin (Kentera, Gebro Pharma) is sold as patches with a surface area of 39cm2 that contain 36mg of oxybutynin and release the active ingredient at a nominal amount of 3.9mg every 24hours The dose recommended in the summary of product characteristics is 2 patches per week, which are applied in rotation on the thigh, abdomen, and hip.The results of our study show that the symptoms of PHH improve during treatment with transdermal oxybutynin in an acceptable percentage of patients and that adverse effects are infrequent.In the assessment of the severity of the symptoms of PHH, subjective scales are considered more appropriate than objective methods, since the effect on quality of life not only depends on the severity of HH in quantitative terms, but also on the degree to which each patient adapts to this severity.<a class="elsevierStyleCrossRef" href="#bib0215">20</a> HDSS has been validated in English (not in Spanish) and is scored on a scale of 1 to 4 depending on the intensity of sweating and its interference with daily activities. However, given that the scale has only 4 points, it could lack sensitivity for detecting slight modifications; therefore, it may not reflect some variations in symptoms.<a class="elsevierStyleCrossRef" href="#bib0220">21</a> Solish et al.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> calculated that a 1-point improvement on the HDSS would correspond to an approximately 50% decrease in sweating and that a 2-point improvement would correspond to an 80% decrease. Therefore, we decided to complement the HDSS with a VAS in which the patient grades the intensity of HH on a scale of 1 to 10 (minimum grade, 1; maximum grade 10) in order to provide a more accurate appreciation of the improvement and thus increase the sensitivity of the evaluation of the response to treatment. Analysis of the results of our study shows that patients whose HDSS score did not change did in fact improve according to the VAS. This finding is consistent with the belief that decreases in sweating of up to 50% will not be recorded by the HDSS.In our study, the HDSS score improved in 60% of patients during treatment, as follows: 1 point, 60%; 2 points, 33.3%; and 3 points, 6.6%. In their prospective placebo-controlled trial involving 62 patients with PHH treated with oral oxybutynin at 7.5mg/d, Schollhammer et al.<a class="elsevierStyleCrossRef" href="#bib0220">21</a> recorded a 60% improvement in the HDSS score (1 point, 28%; 2 points, 61%; 3 points, 11%). Adverse effects were recorded in a considerable percentage of patients and included dry mouth (43%), blurred vision (13%), gastrointestinal complaints (9%), headache (3%), asthenia (3%), and difficulty urinating (3%). Although the rates of improvement with transdermal oxybutynin were not as high as those reported for the oral formulation in our study, the adverse effect profile was better, with only 8% of patients affected (mild to moderate irritant contact dermatitis).We must take into account that the doses generally used for treatment of PHH with oral oxybutynin in the literature range from 2.5mg to 10mg per day.<a class="elsevierStyleCrossRef" href="#bib0210">19</a> The dose of transdermal oxybutynin that is released is calculated to be 3.9mg per day, which, while within the appropriate range, can be considered low. Compared with studies based on larger doses of oral oxybutynin, the low dose of the transdermal patch formulation could lead to a poorer response in the case of excessive sweating, although, even so, our data indicate that efficacy is acceptable with the “low dose” released by the patches. Studies on management of overactive bladder in which higher doses are administered (1 daily patch or 2-3 patches applied simultaneously with 2 changes per week) report better control of symptoms and a favorable safety profile.<a class="elsevierStyleCrossRefs" href="#bib0225">22,23</a> If these data are extrapolated, we could consider increasing the dose of the drug in cases of PHH that are not controlled with lower doses, although intensifying treatment in this way would likely lead to an increase in the incidence of adverse effects.The monthly cost of aluminum salts, which are marketed in various formulations, is €12-18. The treatment is not covered by the Spanish National Health System. The monthly cost of transdermal oxybutynin is €40.59 compared with €4.40 for the oral formulation (at a dose of 10mg per day). Both formulations are covered, albeit for different indications.The main limitations of this study are the number of cases included and the lack of a control group with which to compare the results of treatment.An exhaustive review of the literature revealed no other reports of cases of PHH treated with transdermal oxybutynin.Although the experience we report here is limited and broader placebo-controlled studies are necessary to confirm or refute our data, the preliminary findings we present indicate that transdermal oxybutynin has an excellent safety profile for the management of PHH and can be considered a valid option for treatment.Ethical DisclosuresProtection of humans and animalsThe authors declare that no tests were carried out in humans or animals for the purposes of this study.Confidentiality of dataThe authors declare that they have followed their insitutional protocols on publication of patient data.Right to privacy and informed consentThe authors declare that no private patient data appear in this article.Conflicts of InterestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres762930" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres762932" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec764403" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres762931" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec764404" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 9 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of humans and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-12" "fechaAceptado" => "2016-07-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec764403" "palabras" => array:3 [ 0 => "Hyperhidrosis" 1 => "Oxybutynin" 2 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec764404" "palabras" => array:3 [ 0 => "Hiperhidrosis" 1 => "Oxibutinina" 2 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveHyperhidrosis is very common and has a considerable impact on patients’ quality of life. While oral oxybutynin is associated with good response rates, adverse effects are common and frequently cause patients to stop treatment. Following the recent launch of oxybutynin in a transdermal patch formulation in Spain, we undertook a preliminary study to assess treatment response and adverse effects in patients with hyperhidrosis. Material and methodsThis prospective study of 25 patients treated twice weekly with transdermal oxybutynin patches over 10 weeks assessed treatment response on 2 subjective scales: the Hyperhidrosis Disease Severity Scale (HDSS) and a visual analog scale (VAS) for sweating. ResultsSixty percent of patients showed an improvement in HDSS scores. VAS scores improved in all cases, and 68% of patients achieved a reduction of 3 points or more. Just 2 patients (8%) experienced treatment-related adverse effects (irritant dermatitis at the patch application site in both cases). ConclusionsAlthough our results are based on a small sample, they suggest that transdermal oxybutynin could be a useful option for the treatment of hyperhidrosis and that it has an excellent safety and tolerability profile." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa hiperhidrosis (HH) es una condición muy prevalente que supone una repercusión importante en la calidad de vida. Entre las opciones terapéuticas disponibles, la oxibutinina oral consigue buenas tasas de respuesta aunque con frecuentes efectos secundarios que condicionan en muchas ocasiones el abandono del tratamiento. Tras la comercialización en nuestro país de la oxibutinina en presentación transdérmica, realizamos un estudio preliminar para valorar el control de la HH y el perfil de efectos secundarios de este tratamiento. Material y métodosSe realizó un estudio prospectivo con 25 pacientes que recibieron tratamiento con 2 parches semanales de oxibutinina transdérmica durante 10 semanas. La respuesta terapéutica se valoró mediante 2 escalas subjetivas: Hyperhidrosis Disease Severity Scale (HDSS) y escala analógica visual (EAV). ResultadosUn 60% de los pacientes consiguieron una reducción en la puntuación de la HDSS. Todos los casos obtuvieron una disminución en la puntuación de la EAV, siendo esta de 3 puntos o superior en el 68% de los pacientes. Solo 2 pacientes (8%) presentaron efectos adversos relacionados con el tratamiento, en ambos casos en forma de dermatitis irritativa en la zona de aplicación del parche. ConclusionesAunque se trata de una experiencia limitada, los resultados de nuestro estudio sugieren que la oxibutinina transdérmica podría tener utilidad en el manejo de la HH, con un excelente perfil de seguridad y tolerancia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Bergón-Sendín M, Pulido-Pérez A, Sáez-Martín LC, Suárez-Fernández R. Experiencia inicial con oxibutinina transdérmica en el tratamiento de la hiperhidrosis. Actas Dermosifiliogr. 2016;107:845–850." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient's Response \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">My sweating is never noticeable and never interferes with my daily activities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">My sweating is tolerable but sometimes interferes with my daily activities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">My sweating is barely tolerable and frequently interferes with my daily activities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">My sweating is intolerable and always interferes with my daily activities \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260354.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Hyperhidrosis Disease Severity Scale." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: HDSS, Hyperhidrosis Disease Severity Scale; VAS, visual analog scale." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Area Affected \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Previous treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VAS Week 0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VAS Week 10 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Improvement in VAS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDSS Week 0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDSS Week 10 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Improvement in HDSS Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adverse Effects \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Head \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Head \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, botulinum toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Head \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, botulinum toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, mild eczema \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Head \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, moderate eczema \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, iontophoresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, botulinum toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aluminum salts, botulinum toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260353.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic Characteristics and Outcome." ] ] 2 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 1071 "Tamanyo" => 59679 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of hyperhidrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.B. 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Preliminary Experience With Transdermal Oxybutynin Patches for Hyperhidrosis

Experiencia inicial con oxibutinina transdérmica en el tratamiento de la hiperhidrosis

M. Bergón-Sendín

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Mbergon1@yahoo.es

Corresponding author.

, A. Pulido-Pérez, L.C. Sáez-Martín, R. Suárez-Fernández

Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España

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    "titulo" => "Preliminary Experience With Transdermal Oxybutynin Patches for Hyperhidrosis"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hyperhidrosis &#40;HH&#41; is a condition in which the patient sweats more than is necessary to regulate body temperature&#46; HH can be classed as primary and secondary&#46; In primary HH &#40;PHH&#41;&#44; there is no underlying disease that accounts for the excessive sweating&#44; whereas in the secondary form&#44; excessive sweating can be attributed to various causes &#40;eg&#44; abnormalities of the endocrine and nervous systems&#44; cancer&#44; and treatment with drugs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">PHH is defined as the presence of excessive sweating for at least 6 months with no justifiable cause &#40;major criterion&#41; and 2 or more of the following minor criteria&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41;<span class="elsevierStyleHsp" style=""></span>bilateral and symmetrical distribution&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41;<span class="elsevierStyleHsp" style=""></span>at least 1 episode of excessive sweating per week&#59; &#40;<span class="elsevierStyleItalic">3</span>&#41;<span class="elsevierStyleHsp" style=""></span>interference with daily activities&#59; &#40;<span class="elsevierStyleItalic">4</span>&#41;<span class="elsevierStyleHsp" style=""></span>cessation of sweating during sleep&#59; &#40;<span class="elsevierStyleItalic">5</span>&#41;<span class="elsevierStyleHsp" style=""></span>onset before age 25 years&#59; and &#40;<span class="elsevierStyleItalic">6</span>&#41;<span class="elsevierStyleHsp" style=""></span>family history of PHH&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> The most frequently involved sites are the axillas and palms&#44; followed by the soles and facial region&#46; PHH often affects various sites in the same patient &#40;multifocal&#41; and may even be generalized&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">PHH is thought to affect approximately 2&#37;-3&#37; of the population&#44; and even though it is not considered a severe disease&#44; its effect on the patient&#39;s quality of life is very significant&#46; According to various quality of life rating scales&#44; its effect is equivalent to that of much more severe conditions&#44; such as diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PHH can be managed using various therapeutic options&#44; including drugs &#40;topical and systemic&#41;&#44; nonsurgical interventions &#40;eg&#44; iontophoresis and botulinum toxin&#41;&#44; and surgery &#40;selective sympathectomy and excisional surgery&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Oxybutynin is an anticholinergic drug whose efficacy in the control of PHH is well-documented&#44; although its use in this disease is off-label&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6&#8211;9</span></a> It is important to note that none of the systemic options used for PHH are currently authorized for treatment of the disease in Spain&#46; HH responds well to treatment with oral oxybutynin&#59; however&#44; adverse effects are common &#40;mainly dry mouth and throat&#41;&#44; prove uncomfortable for the patient&#44; and can lead to discontinuation of treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2014&#44; a transdermal patch formulation of oxybutynin was marketed in Spain&#46; According to the summary of product characteristics&#44; it was indicated for the treatment of overactive bladder &#40;as with the oral formulation&#41;&#46; The transdermal patch avoids the first stage of liver metabolism&#44; thus&#8212;in theory&#8212;reducing adverse effects and the possibility of drug interactions&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our hypothesis was that PHH could be improved by minimizing the adverse effects of oral oxybutynin&#46; Therefore&#44; we proposed a pilot study in which we applied transdermal oxybutynin patches in patients with PHH&#46; The primary objective of this study was to evaluate the effectiveness of the transdermal patch&#59; the secondary objective was to describe its tolerance profile&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We performed a prospective study from February to September 2015&#46; We included 25 patients whose PHH could not be suitably controlled with topical treatments and excluded patients who had received botulinum toxin during the previous 2 years or who had undergone surgery for PHH &#40;selective sympathectomy or excisional surgery&#41;&#46; All patients were given exhaustive information about the transdermal oxybutynin patch and alternative treatments and about the conditions of the study&#46; They all gave their written informed consent&#46; The effectiveness of treatment was measured using 2 subjective scales&#58; a visual analog scale &#40;VAS&#41;&#44; in which sweating was graded from 1 to 10 &#40;with 10 as the maximum degree of sweating and 1 the minimum&#41;&#59; and the validated Hyperhidrosis Disease Severity Scale &#40;HDSS&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment with transdermal oxybutynin patches &#40;Kentera&#44; Gebro Pharma&#41; was administered for 10 weeks&#46; Patients applied 2 patches &#40;36<span class="elsevierStyleHsp" style=""></span>mg each&#41; per week&#44; rotating between the thighs&#44; hips&#44; and abdomen&#46; The interval of 10 weeks was based on findings for long-term oral oxybutynin&#44; in which a lack of response at 6 weeks of treatment is considered therapeutic failure&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The study comprised 3 visits&#46; At the initial visit &#40;visit<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; patients were informed about the study and gave their informed consent&#44; a baseline evaluation of HH was made using the VAS and HDSS&#44; and treatment was started at the dose described above&#46; Visit 2 was 6 weeks after the start of treatment and visit 3 at 10 weeks&#46; Treatment was maintained until visit 3&#46; The HDSS and VAS were applied at visits 2 and 3&#44; and any adverse effects were recorded&#46; At visit<span class="elsevierStyleHsp" style=""></span>3&#44; patients evaluated how well treatment had controlled their disease&#44; classifying the outcome as <span class="elsevierStyleItalic">no improvement</span>&#44; <span class="elsevierStyleItalic">slight nonsignificant improvement</span>&#44; or <span class="elsevierStyleItalic">significant improvement</span>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The demographic characteristics of the patients included in the study and the sites affected by PHH are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We included 25 patients &#40;16 women and 9 men&#41; with a mean age of 28<span class="elsevierStyleHsp" style=""></span>years &#40;18-42 years&#41;&#46; They had all received treatment for HH &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Control of symptoms was evaluated using the VAS and HDSS after 10 weeks of treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Symptoms did not worsen in any patients during the study&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The VAS score decreased for all patients &#40;1 point in 3 patients&#44; 2 points in 5 patients&#44; 3 points in 10 patients&#44; 4 points in 6 patients&#44; and 5 points in 1 patient&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The HDSS score decreased by 3 points in 1 patient&#44; 2 points in 5 patients&#44; and 1 point in 9 patients&#59; the HDSS score remained unchanged in 10 patients after treatment&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">No variations in the scores for these scales were recorded between week 6 &#40;visit<span class="elsevierStyleHsp" style=""></span>2&#41; and week 10 &#40;visit<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">As for the general evaluation at visit 3&#44; no patients defined the response as <span class="elsevierStyleItalic">no improvement</span>&#44; 8 patients &#40;32&#37;&#41; considered it a <span class="elsevierStyleItalic">slight nonsignificant improvement</span>&#44; and 17 &#40;68&#37;&#41; patients considered it a <span class="elsevierStyleItalic">significant improvement</span>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Adverse effects were reported in 2 patients &#40;8&#37;&#41;&#46; In both cases&#44; the adverse effect was irritation at the site where the patch was placed&#46; This was classed as mild &#40;erythema and desquamation&#41; in patient 17 and moderate &#40;erythema&#44; edema&#44; and desquamation&#41; in patient 22&#46; The adverse effect did not lead either of the 2 patients to discontinue treatment&#44; since it was controlled by applying the patch at another site &#40;patient 17&#41; and with application of low-potency topical corticosteroids &#40;patient 22&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The basic function of sweating is to regulate body temperature in response to various stimuli&#44; such as heat and exercise&#46; The sweat glands are activated by the sympathetic nervous system&#58; thermoregulatory signals from the hypothalamus are transmitted via sympathetic preganglionic and postganglionic nerve endings to the sweat glands&#46; The main neurotransmitter involved in this process is acetylcholine&#44; which acts via the nicotinic receptors &#40;preganglionic and postganglionic fibers&#41; and muscarinic receptors &#40;sweat glands&#41;&#46; PHH is the result of an autonomic nervous system dysfunction without morphologic or quantitative abnormalities in the sweat glands&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">No therapeutic algorithm has been agreed upon for management of PHH&#44; and the best option should be decided on a case-by-case basis&#46; Therefore&#44; it is important to take into account the individual characteristics of the patient and disease&#44; the safety profile of the various treatments&#44; and the resources available and their cost&#44; starting with the least expensive treatments and&#47;or treatments with fewer potential adverse effects&#46; Consequently&#44; the approaches considered first-line are topical products that act directly on the sweat gland&#44; mainly aluminum salts&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Topical anticholinergic drugs&#44; mainly glycopyrrolate&#44; have also been used&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#8211;16</span></a> This active ingredient is no longer marketed in Spain&#44; although it can be obtained as a foreign medication&#46; Glycopyrrolate has been used at various concentrations &#40;0&#46;5&#37;-4&#37;&#41; and in various vehicles &#40;solution&#44; gel&#44; and cream&#41;&#44; with results that vary according to the location of PHH and the concentration of the active ingredient&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> Adverse effects resulting from systemic absorption of the drug have been reported when it is used on more extensive areas of the body&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Oxybutynin is marketed abroad as a topical formulation &#40;gel&#41; for the treatment of bladder conditions&#44; although there are no references in the literature on the use of this formulation for the management of PHH&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Of all the systemic options&#44; the best results have been achieved with anticholinergic drugs&#44; and broad experience has been accumulated with oral methantheline bromide&#44; oxybutynin&#44; and glycopyrrolate&#46; Most studies have been performed with oxybutynin&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#44;11&#44;13&#44;14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Oral oxybutynin is metabolized in the liver by isoenzyme CYP3A4 of cytochrome P450&#59; therefore&#44; it can react with other drugs that inhibit this system &#40;eg&#44; azole antifungal agents and macrolides&#41;&#46; Its main limitation in the treatment of PHH is the frequency of adverse effects&#44; which&#44; although not generally severe&#44; are uncomfortable and can lead the patient to discontinue treatment&#46; The most common adverse effect is dry mouth and throat&#44; followed by gastrointestinal complaints&#44; headache&#44; dizziness&#44; and blurred vision&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Transdermal oxybutynin &#40;Kentera&#44; Gebro Pharma&#41; is sold as patches with a surface area of 39<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> that contain 36<span class="elsevierStyleHsp" style=""></span>mg of oxybutynin and release the active ingredient at a nominal amount of 3&#46;9<span class="elsevierStyleHsp" style=""></span>mg every 24<span class="elsevierStyleHsp" style=""></span>hours The dose recommended in the summary of product characteristics is 2 patches per week&#44; which are applied in rotation on the thigh&#44; abdomen&#44; and hip&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The results of our study show that the symptoms of PHH improve during treatment with transdermal oxybutynin in an acceptable percentage of patients and that adverse effects are infrequent&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the assessment of the severity of the symptoms of PHH&#44; subjective scales are considered more appropriate than objective methods&#44; since the effect on quality of life not only depends on the severity of HH in quantitative terms&#44; but also on the degree to which each patient adapts to this severity&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> HDSS has been validated in English &#40;not in Spanish&#41; and is scored on a scale of 1 to 4 depending on the intensity of sweating and its interference with daily activities&#46; However&#44; given that the scale has only 4 points&#44; it could lack sensitivity for detecting slight modifications&#59; therefore&#44; it may not reflect some variations in symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> Solish et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> calculated that a 1-point improvement on the HDSS would correspond to an approximately 50&#37; decrease in sweating and that a 2-point improvement would correspond to an 80&#37; decrease&#46; Therefore&#44; we decided to complement the HDSS with a VAS in which the patient grades the intensity of HH on a scale of 1 to 10 &#40;minimum grade&#44; 1&#59; maximum grade 10&#41; in order to provide a more accurate appreciation of the improvement and thus increase the sensitivity of the evaluation of the response to treatment&#46; Analysis of the results of our study shows that patients whose HDSS score did not change did in fact improve according to the VAS&#46; This finding is consistent with the belief that decreases in sweating of up to 50&#37; will not be recorded by the HDSS&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our study&#44; the HDSS score improved in 60&#37; of patients during treatment&#44; as follows&#58; 1 point&#44; 60&#37;&#59; 2 points&#44; 33&#46;3&#37;&#59; and 3 points&#44; 6&#46;6&#37;&#46; In their prospective placebo-controlled trial involving 62 patients with PHH treated with oral oxybutynin at 7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#44; Schollhammer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> recorded a 60&#37; improvement in the HDSS score &#40;1 point&#44; 28&#37;&#59; 2 points&#44; 61&#37;&#59; 3 points&#44; 11&#37;&#41;&#46; Adverse effects were recorded in a considerable percentage of patients and included dry mouth &#40;43&#37;&#41;&#44; blurred vision &#40;13&#37;&#41;&#44; gastrointestinal complaints &#40;9&#37;&#41;&#44; headache &#40;3&#37;&#41;&#44; asthenia &#40;3&#37;&#41;&#44; and difficulty urinating &#40;3&#37;&#41;&#46; Although the rates of improvement with transdermal oxybutynin were not as high as those reported for the oral formulation in our study&#44; the adverse effect profile was better&#44; with only 8&#37; of patients affected &#40;mild to moderate irritant contact dermatitis&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">We must take into account that the doses generally used for treatment of PHH with oral oxybutynin in the literature range from 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg to 10<span class="elsevierStyleHsp" style=""></span>mg per day&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> The dose of transdermal oxybutynin that is released is calculated to be 3&#46;9<span class="elsevierStyleHsp" style=""></span>mg per day&#44; which&#44; while within the appropriate range&#44; can be considered low&#46; Compared with studies based on larger doses of oral oxybutynin&#44; the low dose of the transdermal patch formulation could lead to a poorer response in the case of excessive sweating&#44; although&#44; even so&#44; our data indicate that efficacy is acceptable with the &#8220;low dose&#8221; released by the patches&#46; Studies on management of overactive bladder in which higher doses are administered &#40;1 daily patch or 2-3 patches applied simultaneously with 2 changes per week&#41; report better control of symptoms and a favorable safety profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">22&#44;23</span></a> If these data are extrapolated&#44; we could consider increasing the dose of the drug in cases of PHH that are not controlled with lower doses&#44; although intensifying treatment in this way would likely lead to an increase in the incidence of adverse effects&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The monthly cost of aluminum salts&#44; which are marketed in various formulations&#44; is &#8364;<span class="elsevierStyleHsp" style=""></span>12-18&#46; The treatment is not covered by the Spanish National Health System&#46; The monthly cost of transdermal oxybutynin is &#8364;<span class="elsevierStyleHsp" style=""></span>40&#46;59 compared with &#8364;<span class="elsevierStyleHsp" style=""></span>4&#46;40 for the oral formulation &#40;at a dose of 10<span class="elsevierStyleHsp" style=""></span>mg per day&#41;&#46; Both formulations are covered&#44; albeit for different indications&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The main limitations of this study are the number of cases included and the lack of a control group with which to compare the results of treatment&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">An exhaustive review of the literature revealed no other reports of cases of PHH treated with transdermal oxybutynin&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Although the experience we report here is limited and broader placebo-controlled studies are necessary to confirm or refute our data&#44; the preliminary findings we present indicate that transdermal oxybutynin has an excellent safety profile for the management of PHH and can be considered a valid option for treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of humans and animals</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purposes of this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their insitutional protocols on publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        9 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of humans and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of Interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-03-12"
    "fechaAceptado" => "2016-07-05"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec764403"
          "palabras" => array:3 [
            0 => "Hyperhidrosis"
            1 => "Oxybutynin"
            2 => "Treatment"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec764404"
          "palabras" => array:3 [
            0 => "Hiperhidrosis"
            1 => "Oxibutinina"
            2 => "Tratamiento"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background and objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hyperhidrosis is very common and has a considerable impact on patients&#8217; quality of life&#46; While oral oxybutynin is associated with good response rates&#44; adverse effects are common and frequently cause patients to stop treatment&#46; Following the recent launch of oxybutynin in a transdermal patch formulation in Spain&#44; we undertook a preliminary study to assess treatment response and adverse effects in patients with hyperhidrosis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This prospective study of 25 patients treated twice weekly with transdermal oxybutynin patches over 10 weeks assessed treatment response on 2 subjective scales&#58; the Hyperhidrosis Disease Severity Scale &#40;HDSS&#41; and a visual analog scale &#40;VAS&#41; for sweating&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sixty percent of patients showed an improvement in HDSS scores&#46; VAS scores improved in all cases&#44; and 68&#37; of patients achieved a reduction of 3 points or more&#46; Just 2 patients &#40;8&#37;&#41; experienced treatment-related adverse effects &#40;irritant dermatitis at the patch application site in both cases&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Although our results are based on a small sample&#44; they suggest that transdermal oxybutynin could be a useful option for the treatment of hyperhidrosis and that it has an excellent safety and tolerability profile&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hiperhidrosis &#40;HH&#41; es una condici&#243;n muy prevalente que supone una repercusi&#243;n importante en la calidad de vida&#46; Entre las opciones terap&#233;uticas disponibles&#44; la oxibutinina oral consigue buenas tasas de respuesta aunque con frecuentes efectos secundarios que condicionan en muchas ocasiones el abandono del tratamiento&#46; Tras la comercializaci&#243;n en nuestro pa&#237;s de la oxibutinina en presentaci&#243;n transd&#233;rmica&#44; realizamos un estudio preliminar para valorar el control de la HH y el perfil de efectos secundarios de este tratamiento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo con 25 pacientes que recibieron tratamiento con 2 parches semanales de oxibutinina transd&#233;rmica durante 10 semanas&#46; La respuesta terap&#233;utica se valor&#243; mediante 2 escalas subjetivas&#58; <span class="elsevierStyleItalic">Hyperhidrosis Disease Severity Scale</span> &#40;HDSS&#41; y escala anal&#243;gica visual &#40;EAV&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un 60&#37; de los pacientes consiguieron una reducci&#243;n en la puntuaci&#243;n de la HDSS&#46; Todos los casos obtuvieron una disminuci&#243;n en la puntuaci&#243;n de la EAV&#44; siendo esta de 3 puntos o superior en el 68&#37; de los pacientes&#46; Solo 2 pacientes &#40;8&#37;&#41; presentaron efectos adversos relacionados con el tratamiento&#44; en ambos casos en forma de dermatitis irritativa en la zona de aplicaci&#243;n del parche&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Aunque se trata de una experiencia limitada&#44; los resultados de nuestro estudio sugieren que la oxibutinina transd&#233;rmica podr&#237;a tener utilidad en el manejo de la HH&#44; con un excelente perfil de seguridad y tolerancia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Berg&#243;n-Send&#237;n M&#44; Pulido-P&#233;rez A&#44; S&#225;ez-Mart&#237;n LC&#44; Su&#225;rez-Fern&#225;ndez R&#46; Experiencia inicial con oxibutinina transd&#233;rmica en el tratamiento de la hiperhidrosis&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;845&#8211;850&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient&#39;s Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">My sweating is never noticeable and never interferes with my daily activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">My sweating is tolerable but sometimes interferes with my daily activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">My sweating is barely tolerable and frequently interferes with my daily activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">My sweating is intolerable and always interferes with my daily activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1260354.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hyperhidrosis Disease Severity Scale&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; HDSS&#44; Hyperhidrosis Disease Severity Scale&#59; VAS&#44; visual analog scale&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Patient</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Area Affected</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Previous treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">VAS Week 0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">VAS Week 10</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Improvement in VAS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">HDSS Week 0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">HDSS Week 10</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Improvement in HDSS Score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Adverse Effects</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&#44; soles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&#44; soles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; botulinum toxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; botulinum toxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; mild eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&#44; soles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; moderate eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palms&#44; soles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; iontophoresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; botulinum toxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aluminum salts&#44; botulinum toxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                            0 => "A&#46;B&#46; Stashak"
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                        "tituloSerie" => "Clin Cosmet Investig Dermatol&#46;"
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                        "volumen" => "7"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25378942"
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              "identificador" => "bib0125"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Hornberger"
                            1 => "K&#46; Grimes"
                            2 => "M&#46; Naumann"
                            3 => "D&#46;A&#46; Glaser"
                            4 => "N&#46;J&#46; Lowe"
                            5 => "H&#46; Naver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2003.12.029"
                      "Revista" => array:6 [
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                        "volumen" => "51"
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                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en hiperhidrosis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Callejas"
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                            2 => "E&#46; Cladellas"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "U&#46; Janlert"
                            3 => "C&#46; Brulin"
                            4 => "E&#46; Nylander"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.13291"
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                        "tituloSerie" => "J Dermatol&#46;"
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              "identificador" => "bib0140"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperhidrosis&#58; Anatomy&#44; pathophysiology and treatment with emphasis on the role of botulinum toxins"
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                        0 => array:2 [
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                          "autores" => array:3 [
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Toxins &#40;Basel&#41;&#46;"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Wolosker"
                            1 => "M&#46;P&#46; Teivelis"
                            2 => "M&#46; Krutman"
                            3 => "P&#46;R&#46; de Paula"
                            4 => "P&#46; Kauffman"
                            5 => "J&#46;R&#46; de Campos"
                          ]
                        ]
                      ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.avsg.2013.12.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Vasc Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24512855"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of uncommon sites of focal primary hyperhidrosis&#58; Experience with pharmacological therapy using oxybutynin"
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                        0 => array:2 [
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                          "autores" => array:6 [
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                            1 => "N&#46; Wolosker"
                            2 => "M&#46; Krutman"
                            3 => "P&#46; Kauffman"
                            4 => "J&#46; Ribas"
                            5 => "P&#46; Puech-Leao"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "paginaInicial" => "608"
                        "paginaFinal" => "614"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25318092"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis"
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                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2011.12.039"
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                        "tituloSerie" => "J Vasc Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "1696"
                        "paginaFinal" => "1700"
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                0 => array:1 [
                  "referenciaCompleta" => "Kentera Summary of Product Characteristics &#91;accessed September 6&#44; 2014&#93;&#46; Available at&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR__Product_Information/human/000532/WC500040171.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;&#95;Product&#95;Information&#47;human&#47;000532&#47;WC500040171&#46;pdf</a>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comprehensive approach to the recognition&#44; diagnosis and severity-based treatment of focal hyperhidrosis&#58; Recommendations of the Canadian Hyperhidrosis Advisory Committee"
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                        0 => array:2 [
                          "etal" => true
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Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2016.09.013

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Year/Month	Html	Pdf	Total

2024 November	5	9	14
2024 October	94	64	158
2024 September	108	36	144
2024 August	148	66	214
2024 July	119	42	161
2024 June	115	38	153
2024 May	97	51	148
2024 April	93	32	125
2024 March	92	32	124
2024 February	106	35	141
2024 January	69	38	107
2023 December	70	19	89
2023 November	84	25	109
2023 October	71	26	97
2023 September	72	35	107
2023 August	48	23	71
2023 July	52	48	100
2023 June	53	33	86
2023 May	61	39	100
2023 April	42	25	67
2023 March	51	31	82
2023 February	49	28	77
2023 January	40	37	77
2022 December	70	43	113
2022 November	32	30	62
2022 October	30	39	69
2022 September	23	42	65
2022 August	42	36	78
2022 July	20	47	67
2022 June	26	36	62
2022 May	42	37	79
2022 April	41	28	69
2022 March	38	45	83
2022 February	41	22	63
2022 January	68	35	103
2021 December	55	37	92
2021 November	71	54	125
2021 October	73	57	130
2021 September	61	43	104
2021 August	83	39	122
2021 July	56	21	77
2021 June	63	25	88
2021 May	56	42	98
2021 April	107	90	197
2021 March	101	29	130
2021 February	71	31	102
2021 January	39	17	56
2020 December	39	21	60
2020 November	37	22	59
2020 October	33	14	47
2020 September	32	18	50
2020 August	43	24	67
2020 July	33	15	48
2020 June	38	29	67
2020 May	37	16	53
2020 April	33	22	55
2020 March	34	19	53
2020 February	9	0	9
2020 January	4	0	4
2019 December	8	0	8
2019 November	4	0	4
2019 September	4	0	4
2019 August	4	0	4
2019 July	4	0	4
2019 June	7	0	7
2019 May	5	0	5
2019 April	2	4	6
2019 March	4	0	4
2019 February	3	0	3
2019 January	8	0	8
2018 December	1	0	1
2018 November	3	0	3
2018 October	4	0	4
2018 September	3	0	3
2018 February	18	0	18
2018 January	60	15	75
2017 December	48	10	58
2017 November	47	13	60
2017 October	45	10	55
2017 September	37	2	39
2017 August	39	8	47
2017 July	46	5	51
2017 June	56	15	71
2017 May	44	11	55
2017 April	43	16	59
2017 March	37	8	45
2017 February	40	17	57
2017 January	29	10	39
2016 December	74	49	123
2016 November	27	34	61
2016 October	2	6	8

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