Hyperhidrosis is a common medical condition characterized by excessive sweating. A recent systematic literature review investigated the efficacy and safety of several common Hyperhidrosis therapies.
Hyperhidrosis is a chronic autonomic disorder characterized by excessive sweating that affects approximately 4.8% of the United States population. The condition can significantly reduce the quality of life by negatively affecting interpersonal relationships, hygiene, daily activities, and career progress. Rapid and effective treatment of hyperhidrosis is a top priority for healthcare professionals and their patients. The condition can be classified into two subgroups, namely primary (idiopathic) and secondary hyperhidrosis. Primary hyperhidrosis is thought to be caused by the overstimulation of the eccrine glands, following activation of sympathetic nerves, while secondary hyperhidrosis is a consequence of underlying medical conditions including endocrine, metabolic and cardiac disturbances, neurological and psychiatric disorders, or drug intake.
Christine Hosp and Henning Hamm conducted a systematic literature review of the PubMed library to investigate the efficacy and side-effects of different therapeutic strategies for hyperhidrosis. The results were published in the journal Expert Opinion on Drug Safety. The review investigated several therapies including topical treatments, oral anticholinergics, and botulinum toxins.
Topical therapies, including aluminum salts and topical glycopyrrolates, were shown to be efficacious, with only mild side-effects like a dry mouth and headaches. The use of aluminum metal is concerning, however; because it may increase the risk of tumors, breast cancers, Alzheimer’s disease, and Parkinson’s disease. Although these concerns are yet to be experimentally validated, they also can not be dismissed, and caution must be taken when using these therapies. Other topical treatments, like Oxybutynin, Umeclidinium bromide, and Botulinum toxin A containing gels are still being investigated.
Another class of anti-hyperhidrosis drugs are oral anticholinergics, including Methantheline bromide, Propantheline bromide, Glycopyrronium bromide (glucopyrrolate), Oxybutynin, and Bornaprine. There is plentiful evidence to suggest that Methantheline bromide and Oxybutynin are effective in treating hyperhidrosis, with only mild complications like a dry mouth, nausea, and constipation. In contrast, the efficacy of the remaining oral therapies is founded primarily based on anecdotal evidence, with no randomized placebo-controlled trials.Thus, it is important to investigate these therapies more carefully before they are readily prescribed by clinicians. Furthermore, it is important to note that oral anticholinergics must be taken with caution, particularly in elderly patients. Elder patients often take more than one medication for chronic conditions; therefore, the combination of anticholinergics with other medication could potentially increase the risk of cognitive impairment and central nervous system complications. Additionally, these drugs must not be prescribed to pregnant women due to the lack of empirical studies investigating safety profiles in this population.
Botulinum toxin, a neurotoxin produced by the gram-positive Clostridium botulinum bacteria, is commonly used for medicinal and cosmetic purposes. The two types of botulinum toxins that are used as therapeutics are botulinum toxin A and botulinum toxin B. The current review demonstrated that both type A and B toxins are effective in treating hyperhidrosis, with some side-effects including pain at the injection site, formication, swelling and hematomas.
In conclusion, there are several different options available for the treatment of hyperhidrosis, each with varying efficacies, side-effects, and specificity for the location of sweating. It is important to identify the type of hyperhidrosis, the location, and severity, before deciding on the appropriate therapeutic strategy. In addition, further research is warranted to test the efficacy of the different strategies in more susceptible populations, like pregnant women and the elderly. It is also imperative to continually study the potential long-term effects of these therapeutic strategies.
Written by Haisam Shah, BSc
Hosp, C., & Hamm, H. (2017). Safety of available and emerging drug therapies for hyperhidrosis. Expert Opinion on Drug Safety, (just-accepted).