Hyperhidrosis of the Residual Limb in Patients with Amputations: Developing a Treatment Approach
Abstract
Excessive sweating in the residual (amputated) limb of amputees leads to slipping and sliding of the prosthetic limb, skin irritation and discomfort, and reduced quality of life. The objective of this study is to develop a management approach for the treatment of this common problem. In order for an amputee to successfully use a prosthetic limb, there must be a stable connection between the prosthesis and the residual limb. Sweat is unable to evaporate on the part of the leg that is covered by the prosthesis, which leads to excessive moisture accumulation. This may cause not only skin irritation and discomfort, but it also negatively affects how well the prosthesis fits and functions. Excessive sweating decreases an amputee s satisfaction with their prosthesis. Dermatologists follow a well-researched protocol to treat excessive sweating in the axilla (armpits), palms, soles of the feet, and other areas of the body. Unfortunately this protocol has not been rigorously studied in amputees. The ultimate goal of this research project is to apply this dermatology protocol to the problem of excessive sweating in amputees. Our first step will be to test a method of identifying the area(s) of the limb that has excessive sweating (the iodine-starch test). Second, we will test a topical, prescription-strength antiperspirant (aluminum chloride 20%), to determine its effectiveness. Third, we will take those amputees who do not respond to the topical treatment and treat them with botulinum toxin A injections into the skin, which can reduce sweating for up to 9 months. This follows the common treatment protocol used by dermatologists. This research will benefit any person living with an amputation who uses a prosthesis. There are approximately 1.6 million amputees living in the United States at this time, and that number is projected to double by 2050. Our research has shown that 66% suffer from excessive sweating that interferes with their daily activities. This project will have direct clinical application to reduce the burden of excessive sweating in amputees. Treating this problem can improve prosthetic fit and function, leading to improved activity and ability to perform daily tasks and recreational activities. Benefits also include reduced skin irritation of the residual limb. Risks are relatively low, but may include irritation of the skin, allergic reaction, and spread of the botulinum toxin to other parts of the body. This project will have immediate application to patients. As soon as this project is completed, we will be able to share if the iodine-starch test is a valid method to identify sweating in an amputee. We will be able to share the effectiveness of the topical aluminum chloride treatment, and also identify any possible adverse effects. This will also identify the subset of patients who may need to be treated with botulinum toxin. The information from the botulinum toxin trial will support the need for larger studies over the next 5 years. This project will directly benefit Service members and U.S. Veterans living with amputation, as well as their families and caregivers. Appropriate evaluation and treatment of excessive sweating will reduce the secondary health consequences of prosthetic use, such as skin irritation and breakdown, and will lead to improved prosthetic fit and function, and improved quality of life. Ultimately, effective management of this problem will allow Service members, Veterans, and civilians with amputations to maintain their desired activities in work, recreation, and daily life.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Aug 07, 2017
- Source ID
- W81XWH1710053
Entities
People
- Colby Hansen
Organizations
- United States Army
- University of Utah