Original article
Systemic therapy for primary hyperhidrosis: A retrospective study of 59 patients treated with glycopyrrolate or clonidine

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Background

Data regarding systemic medications in the management of hyperhidrosis (HH) are limited.

Objective

The goal of this study was to provide evidence for the safety and efficacy of systemic medications for primary HH.

Methods

A retrospective chart review was conducted of patients seen at an academic dermatology department prescribed systemic medications for primary HH.

Results

A total of 71 patients were prescribed systemic agents. Twelve patients (17%) were lost to follow-up and were excluded from further analysis. A total of 59 patients with at least 2 months of follow-up data (mean age 28.9 ± 12.0 years; 37 women, 22 men; mean follow-up 19.5 months) were included in the analysis. Palmoplantar and/or axillary HH was most common (42/59; 71%); followed by generalized (9/59; 15%) and craniofacial (8/59; 14%) HH. Glycopyrrolate (generally 1-2 mg once or twice daily) was prescribed to 45 patients, with response rate of 67% (30/45). Fifteen treatment failures included 6 nonresponders and 9 with adverse effects, including xerostomia and gastrointestinal disturbance. Clonidine (0.1 mg twice daily) was prescribed to 13 patients, with a response rate of 46% (6/13). Seven treatment failures included 3 nonresponders and 4 with adverse effects, all relating to decreased blood pressure. One patient responded to oxybutynin at 5 mg twice daily. There were no significant differences in efficacy (P = .21; odds ratios 0.43, 95% confidence interval 0.12-1.5) or adverse effects (P = .46; odds ratios 1.78, 95% confidence interval 0.44-7.1) in comparing glycopyrrolate versus clonidine.

Limitations

This was a retrospective study from a single, university-based population.

Conclusion

Systemic therapy with glycopyrrolate or clonidine can be effective for HH. Nearly two-thirds responded to therapy, and less than a quarter had treatment-limiting adverse effects, all of which were self-limited and nonserious.

Section snippets

Methods

Institutional review board approval was obtained from the university’s human subjects committee to conduct a retrospective chart review. Charts were systematically reviewed for all dermatologic visits from 1993 to 2005 for all patients encountered for the International Classification of Diseases, Ninth Revision code corresponding to primary HH. Clinical data were reviewed to ensure that all patients met diagnostic criteria for primary HH,7 including at least 4 of the following 7 features:

Results

The retrospective chart review identified a total of 71 patients who were treated with oral medications for a diagnosis of primary HH. Of these 12 (17%) were lost to follow-up and were excluded from further analysis. The remaining 59 patients were included in the analysis, and had at least 2 months of follow-up data. Demographic and clinical characteristics are shown (Table I). The mean age was 28.9 years, with a female:male ratio of 1.7:1. The palms, soles, and/or axillae were primarily

Discussion

Only limited data are available regarding use of oral medications in the management of HH. The HH disease severity scale defines moderate HH as sweating that is tolerable but sometimes interferes with daily activities, and severe HH as sweating that is barely tolerable to intolerable, that frequently to always interferes with daily activities.8 A 2007 practice guideline correctly states that “compelling evidence is lacking for the safety and efficacy of systemic anticholinergic agents” for the

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Funding sources: None.

Conflicts of interest: None declared.

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