Elsevier

Dermatologic Clinics

Volume 32, Issue 4, October 2014, Pages 485-490
Dermatologic Clinics

Topical Therapies in Hyperhidrosis Care

https://doi.org/10.1016/j.det.2014.06.008Get rights and content

Section snippets

Key points

  • 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.

  • Topical agents are a useful adjunct to other treatments such as onabotulinumtoxinA.

  • Antiperspirants are most effective when applied to thoroughly dried skin at night.

  • Many insurance companies consider treatment of hyperhidrosis with iontophoresis or onabotulinumtoxinA medically necessary only when topical

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

First page preview

First page preview
Click to open first page preview

References (24)

  • L.P. Stolman

    Treatment of hyperhidrosis

    Dermatol Clin

    (1998)
  • J.R. Davidson et al.

    Hyperhidrosis in social anxiety disorder

    Prog Neuropsychopharmacol Biol Psychiatry

    (2002)
  • J.W. White

    Treatment of primary hyperhidrosis

    Mayo Clin Proc

    (1986)
  • J.L. Atkins et al.

    Hyperhidrosis: a review of current management

    Plast Reconstr Surg

    (2002)
  • R. Böni

    Generalized hyperhidrosis and its systemic treatment

    Curr Probl Dermatol

    (2002)
  • H.W. Walling et al.

    Treatment options for hyperhidrosis

    Am J Clin Dermatol

    (2011)
  • E. Hölzle

    Pathophysiology of sweating

    Curr Probl Dermatol

    (2002)
  • R.G. Glogau

    Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox

    Dermatol Surg

    (1998)
  • M.K. Naumann et al.

    Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial

    Br J Dermatol

    (2002)
  • Strutton DR, Kowalski J, Glaser DA, et al. Impact of daily activities in the US for individuals with axillary...
  • R. Adar et al.

    Palmar hyperhidrosis and its surgical treatment: a report of 100 cases

    Ann Surg

    (1977)
  • E. Hölzle

    Topical pharmacological treatment

    Curr Probl Dermatol

    (2002)
  • Cited by (35)

    • The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options

      2019, Journal of the American Academy of Dermatology
      Citation 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 Dermatology
    • Thiolated polymers: Bioinspired polymers utilizing one of the most important bridging structures in nature

      2019, Advanced Drug Delivery Reviews
      Citation 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].

    View all citing articles on Scopus

    Disclosure: Dr D.M. Pariser has been an investigator for Allergan, Dermira, and Watson Laboratories. Ms A. Ballard has no disclosures.

    View full text