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When used correctly, topical treatments for primary focal hyperhidrosis can provide significant benefit and, with patient education on usage, skin irritation can be limited and tolerable.
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Topical agents are a useful adjunct to other treatments such as onabotulinumtoxinA.
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Antiperspirants are most effective when applied to thoroughly dried skin at night.
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Many insurance companies consider treatment of hyperhidrosis with iontophoresis or onabotulinumtoxinA medically necessary only when topical
Topical Therapies in Hyperhidrosis Care
Section snippets
Key points
The Nature of the Problem
Hyperhidrosis, also known as excessive sweating, is a dermatologic disorder characterized by sweating that is beyond what is anticipated or necessary for thermoregulation in the person’s environment.1 Primary, or idiopathic, hyperhidrosis and secondary hyperhidrosis are the chief categories of the condition.2 Primary hyperhidrosis (hyperhidrosis that is not caused by another medical condition or as a side effect of medication) presents in approximately 3% of the population.3 The excessive
Patient evaluation overview
The first step when evaluating a patient presenting with hyperhidrosis is a detailed clinical history with a focus on features of primary hyperhidrosis in order to support the diagnosis of primary focal hyperhidrosis (Box 1). It is also critical to know the patient’s medical and surgical history as well as any medications, supplements, or complementary therapies that have been used. Review of systems should focus on the endocrine and neurologic systems. Physical examination includes an
Topical options for hyperhidrosis treatment
Because of the history of safety, cost-effectiveness, and ease of use and access of topical therapies, and because many patients obtain symptom relief from them, topical treatments are often the first line of treatment of primary focal hyperhidrosis (Fig. 1).3 Topical antiperspirants are most effective for axillary sweating but may also be used for the palms of the hands, soles of the feet, and on the craniofacial area. Aluminum chloride is the most commonly used topical agent.3
Aluminum salts
Aluminum chloride is the partially neutralized form used in cosmetic antiperspirants, whereas aluminum chloride hexahydrate is used in prescription products and is among the most effective antiperspirants available.11 Newer over-the-counter (OTC) clinical-strength antiperspirants are also available and are discussed later in this article.
With regard to mechanism of action, several studies have shown that aluminum salts cause an obstruction of the distal eccrine sweat gland ducts.12 The
Topical glycopyrrolate
Glycopyrrolate is an anticholinergic agent that is used off-label systemically for the treatment of hyperhidrosis. Topical glycopyrrolate may also be effective for focal hyperhidrosis. A topical application of 0.5% or 1% glycopyrrolate was studied in 16 patients with Frey syndrome (gustatory hyperhidrosis) and was effective and free of adverse effects.18 In another study of 25 patients with craniofacial sweating, all the patients had half their foreheads treated with 2% glycopyrrolate and the
Clinical-strength OTC products
A new generation of OTC antiperspirants includes aluminum zirconium trichlorohydrex and may be an option for nonaxillary as well as axillary hyperhidrosis. These products provide more sweat-reduction benefits than traditional OTC products with less reported irritation to the skin than prescription topical therapies.23 In a study of 20 male participants published in 2012, researchers found that sweat reduction caused by the use of an OTC clinical-strength antiperspirant product was more
References (24)
Treatment of hyperhidrosis
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Treatment options for hyperhidrosis
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(2002)Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox
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Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial
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(2002) - Strutton DR, Kowalski J, Glaser DA, et al. Impact of daily activities in the US for individuals with axillary...
Palmar hyperhidrosis and its surgical treatment: a report of 100 cases
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Topical pharmacological treatment
Curr Probl Dermatol
Cited by (35)
Primary palmar hyperhidrosis
2023, PielA novel lotion formulation of 20% oxybutynin hydrochloride for the treatment of primary palmar hyperhidrosis: A randomized, placebo-controlled, double-blind, phase III study
2023, Journal of the American Academy of DermatologyThe etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options
2019, Journal of the American Academy of DermatologyCitation Excerpt :ACH applications should be repeated every 24 to 48 hours until anhidrosis is attained.15 Clinical efficacy in many cases is noted in 1 to 2 weeks.11 After symptom relief, maintenance therapy can be tailored individually depending upon the resultant effect, side effects, and events anticipated by the patient to entail excessive perspiration.
Epidemiology of hyperhidrosis in 2 population-based health care databases
2018, Journal of the American Academy of DermatologyThiolated polymers: Bioinspired polymers utilizing one of the most important bridging structures in nature
2019, Advanced Drug Delivery ReviewsCitation Excerpt :Accordingly, the development of aluminium-free antiperspirants is of great commercial interest. A promising alternative to aluminium salts are thiomers, as they crosslink with the mucus of sweat glands via disulfide bond formation instead of just ionically crosslinking as aluminium does leading to a mechanical obstruction of the ducts [431]. For this purpose thiolated polyacrylates and thiolated polyethyleneimines were already tested [26].
Disclosure: Dr D.M. Pariser has been an investigator for Allergan, Dermira, and Watson Laboratories. Ms A. Ballard has no disclosures.