Hyperhidrosis Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 4, 2011
 

Medication Summary

The goals of pharmacotherapy for hyperhidrosis are to reduce morbidity and prevent complications. Control of palmar hyperhidrosis with a new dry-type iontophoretic device has been described.[54] Dry-type iontophoresis may reduce palmar sweating more conveniently than other conventional methods.

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Aldehydes

Class Summary

These agents reduce perspiration by denaturing keratin and thereby occluding the pores of the sweat glands. They have a short-lasting effect. Contact sensitization is increased, especially with formalin. Aldehydes are used to treat the palms and soles; they are not as effective in the axillae.

Glutaraldehyde solution

 

2% as Cidex. Not as effective but less staining. 20-50% solution can be diluted to 10% (more effective, especially for feet, but still staining occurs).

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Aluminum Compounds

Class Summary

These agents are antiperspirants that are used in the management of hyperhidrosis.

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Aluminum chloride topical (20% Drysol)

 

Certin-Dri and Xerac are over-the-counter products at low concentrations. Work best if applied to a dry area and covered with plastic overnight. Should be washed off in the morning. Effect should be noted within 1 mo.

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Anticholinergic Agents

Class Summary

The use of these agents is usually avoided because they are poorly tolerated at the required doses when given systemically. Acetylcholine is the preglandular neurotransmitter for sweat secretion. These drugs inhibit the binding of acetylcholine to the cholinergic receptor. Clinical effects usually occur within days.

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Propantheline (Pro-Banthine)

 

Blocks action of acetylcholine at postganglionic parasympathetic receptor sites.

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Glycopyrrolate (Robinul)

 

Acts in smooth muscle, CNS, and secretory glands to blocks action of acetylcholine at parasympathetic sites.

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Benztropine (Cogentin)

 

Blocks striatal cholinergic receptors; may help balance cholinergic and dopaminergic activity in striatum.

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Oxybutynin (Ditropan)

 

Inhibits action of acetylcholine on smooth muscle and has direct antispasmodic effect on smooth muscles.

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Neuromuscular Blocking Agents

Class Summary

These agents inhibit the transmission of nerve impulses at the neuromuscular junction of skeletal muscle and/or autonomic ganglia.

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OnabotulinumtoxinA (BOTOX®)

 

Prevents calcium-dependent release of acetylcholine and produces a state of denervation at the neuromuscular junction and postganglionic sympathetic cholinergic nerves in the sweat glands.

Each injection produces an area of anhydrosis approximately 1.2 cm in diameter. Reportedly results in anhydrosis lasting 4-12 mo.

Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Rachel Altman, MD  Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School

Rachel Altman, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi

Disclosure: Nothing to disclose.

George Kihiczak, MD  Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Altman RS, Schwartz RA. Emotionally induced hyperhidrosis. Cutis. May 2002;69(5):336-8. [Medline].

  2. Ruchinskas R. Hyperhidrosis and anxiety: chicken or egg?. Dermatology. 2007;214(3):195-6. [Medline].

  3. Esen AM, Barutcu I, Karaca S, et al. Peripheral vascular endothelial function in essential hyperhidrosis. Circ J. Jun 2005;69(6):707-10. [Medline].

  4. Yamashita N, Tamada Y, Kawada M, Mizutani K, Watanabe D, Matsumoto Y. Analysis of family history of palmoplantar hyperhidrosis in Japan. J Dermatol. Dec 2009;36(12):628-31. [Medline].

  5. Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. Jul 1977;186(1):34-41. [Medline].

  6. Cloward RB. Hyperhydrosis. J Neurosurg. May 1969;30(5):545-51. [Medline].

  7. Cloward RB. Treatment of hyperhidrosis palmaris (sweaty hands); a familial disease in Japanese. Hawaii Med J. Mar-Apr 1957;16(4):381-7. [Medline].

  8. Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. Jul 1995;33(1):78-81. [Medline].

  9. Saglam M, Esen AM, Barutcu I, et al. Impaired left ventricular filling in patients with essential hyperhidrosis: an echo-Doppler study. Tohoku J Exp Med. Apr 2006;208(4):283-90. [Medline].

  10. Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients. Clin Auton Res. Feb 1999;9(1):17-22. [Medline].

  11. Moon SY, Shin DI, Park SH, Kim JS. Harlequin syndrome with crossed sympathetic deficit of the face and arm. J Korean Med Sci. Apr 2005;20(2):329-30. [Medline].

  12. Karaca S, Emul M, Kulac M, et al. Temperament and character profile in patients with essential hyperhidrosis. Dermatology. 2007;214(3):240-5. [Medline].

  13. Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol. Feb 17 2011;[Medline].

  14. Rodrigues Masruha M, Lin J, Arita JH, DE Castro Neto EF, Scerni DA, Cavalheiro EA, et al. Spontaneous periodic hypothermia and hyperhidrosis: a possibly novel cerebral neurotransmitter disorder. Dev Med Child Neurol. Dec 17 2010;[Medline].

  15. Martín AF, Figueroa SC, Merino Mde L, Hurlee AD. Hyperhidrosis in association with efavirenz. AIDS Patient Care STDS. Mar 2009;23(3):143-5. [Medline].

  16. Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S. Unilateral hyperhidrosis with accompanying contralateral anhidrosis. Clin Exp Dermatol. Dec 2009;34(8):e544-6. [Medline].

  17. López V, Pinazo I, Santonja N, Jordá E. Eccrine angiomatous hamartoma in a child. Pediatr Dermatol. Sep-Oct 2010;27(5):548-9. [Medline].

  18. Shelley WB, Laskas JJ, Satanove A. Effect of topical agents on planter sweating. AMA Arch Derm Syphilol. Jun 1954;69(6):713-6. [Medline].

  19. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol. May 1989;20(5 Pt 1):713-26. [Medline].

  20. Streker M, Reuther T, Verst S, Kerscher M. [Axillary hyperhidrosis--efficacy and tolerability of an aluminium chloride antiperspirant. Prospective evaluation on 20 patients with idiopathic axillary hyperhidrosis]. Hautarzt. Feb 2010;61(2):139-44. [Medline].

  21. Klaber M, Catterall M. Treating hyperhidrosis. Anticholinergic drugs were not mentioned. BMJ. Sep 16 2000;321(7262):703. [Medline].

  22. Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol. Dec 2009;34(8):e990-1. [Medline].

  23. Bouman HD, Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. Jun 1952;31(3):158-69. [Medline].

  24. Karakoç Y, Aydemir EH, Kalkan MT, Unal G. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. Sep 2002;41(9):602-5. [Medline].

  25. Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ. Sep 16 2000;321(7262):702-3. [Medline].

  26. Sato K, Ohtsuyama M, Samman G. Eccrine sweat gland disorders. J Am Acad Dermatol. Jun 1991;24(6 Pt 1):1010-4. [Medline].

  27. Abell E, Morgan K. The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis. Br J Dermatol. Jul 1974;91(1):87-91. [Medline].

  28. Fujita M, Mann T, Mann O, Berg D. Surgical pearl: use of nerve blocks for botulinum toxin treatment of palmar-plantar hyperhidrosis. J Am Acad Dermatol. Oct 2001;45(4):587-9. [Medline].

  29. Moraru E, Voller B, Auff E, Schnider P. Dose thresholds and local anhidrotic effect of botulinum A toxin injections (Dysport). Br J Dermatol. Aug 2001;145(2):368. [Medline].

  30. Naumann M. Evidence-based medicine: botulinum toxin in focal hyperhidrosis. J Neurol. Apr 2001;248 Suppl 1:31-3. [Medline].

  31. Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. Sep 15 2001;323(7313):596-9. [Medline].

  32. Shelley WB, Talanin NY, Shelley ED. Botulinum toxin therapy for palmar hyperhidrosis. J Am Acad Dermatol. Feb 1998;38(2 Pt 1):227-9. [Medline].

  33. Swartling C, Farnstrand C, Abt G, Stalberg E, Naver H. Side-effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study. Eur J Neurol. Sep 2001;8(5):451-6. [Medline].

  34. Schnider P, Binder M, Auff E, Kittler H, Berger T, Wolff K. Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol. Apr 1997;136(4):548-52. [Medline].

  35. Vadoud-Seyedi J, Simonart T. Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study. Br J Dermatol. May 2007;156(5):986-9. [Medline].

  36. Flanagan KH, King R, Glaser DA. Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis. J Drugs Dermatol. Mar 2008;7(3):221-7. [Medline].

  37. Woolery-Lloyd H, Elsaie ML, Avashia N. Inguinal hyperhidrosis misdiagnosed as urinary incontinence: treatment with botulinum toxin A. J Drugs Dermatol. Mar 2008;7(3):293-5. [Medline].

  38. Naumann M, So Y, Argoff CE, et al. Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. May 6 2008;70(19):1707-14. [Medline].

  39. Gregoriou S, Rigopoulos D, Chiolou Z, Papafragkaki D, Makris M, Kontochristopoulos G. Treatment of bromhidrosis with a glycine-soja sterocomplex topical product. J Cosmet Dermatol. Mar 2011;10(1):74-7. [Medline].

  40. Kumagai K, Kawase H, Kawanishi M. Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg. Aug 2005;80(2):461-6. [Medline].

  41. Kotzareff A. Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale. Rev Med Suisse Romande. 1920;40:111-3.

  42. Chen HJ, Lu K, Liang CL. Transthoracic endoscopic T-2, 3 sympathectomy for facial hyperhidrosis. Auton Neurosci. Oct 8 2001;93(1-2):91-4. [Medline].

  43. Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. Oct 2001;136(10):1115-7. [Medline].

  44. Kim BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH. Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. Am J Surg. Jun 2001;181(6):540-2. [Medline].

  45. Panhofer P, Zacherl J, Jakesz R, Bischof G, Neumayer C. Improved quality of life after sympathetic block for upper limb hyperhidrosis. Br J Surg. May 2006;93(5):582-6. [Medline].

  46. Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. Jul 1997;41(1):110-3; discussion 113-5. [Medline].

  47. Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery. Mar 2009;64(3):511-8; discussion 518. [Medline].

  48. Chou SH, Kao EL, Li HP, Lin CC, Huang MF. T4 sympathectomy for palmar hyperhidrosis: an effective approach that simultaneously minimzes compensatory hyperhidrosis. Kaohsiung J Med Sci. Jul 2005;21(7):310-3. [Medline].

  49. Heckmann M. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. Jun 1998;42(6):1403-4. [Medline].

  50. Li X, Tu YR, Lin M, Lai FC, Chen JF, Miao HW. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg. Feb 2009;87(2):427-31. [Medline].

  51. Kim WO, Kil HK, Yoon KB, Yoon DM. Topical glycopyrrolate for patients with facial hyperhidrosis. Br J Dermatol. May 2008;158(5):1094-7. [Medline].

  52. Goldman A, Wollina U. Subdermal Nd-YAG laser for axillary hyperhidrosis. Dermatol Surg. Jun 2008;34(6):756-62. [Medline].

  53. Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. Jul 1990;8(3):479-82. [Medline].

  54. Na GY, Park BC, Lee WJ, Park DJ, Kim do W, Kim MN. Control of palmar hyperhidrosis with a new "dry-type" iontophoretic device. Dermatol Surg. Jan 2007;33(1):57-61. [Medline].

 
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