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      • Record: found
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      Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics

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          Abstract

          Background

          Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate.

          Objective

          This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options.

          Methods

          We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH.

          Results

          The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate.

          Conclusion

          Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.

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          Most cited references39

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          Physiology of sweat gland function: The roles of sweating and sweat composition in human health

          Lindsay Baker (2019)
          ABSTRACT The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.
          Article 0 comments Cited 148 times – based on 0 reviews     Review now
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            The Etiology, Diagnosis and Management of Hyperhidrosis: A Comprehensive Review. Part II. Therapeutic Options

            Shiri Nawrocki, Jisun Cha (2019)
            Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
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              Treatment options for hyperhidrosis.

              Hobart Walling, Lance L. Swick (2011)
              Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Mehdi Farshchian: mfarshchian@mednet.ucla.edu
                Journal
                Journal ID (nlm-ta): Dermatol Ther (Heidelb)
                Journal ID (iso-abbrev): Dermatol Ther (Heidelb)
                Title: Dermatology and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8210
                ISSN (Electronic): 2190-9172
                Publication date (Electronic): 3 November 2022
                Publication date PMC-release: 3 November 2022
                Publication date Collection: December 2022
                Volume: 12
                Issue: 12
                Pages: 2705-2714
                Affiliations
                [1 ]GRID grid.254444.7, ISNI 0000 0001 1456 7807, Wayne State University School of Medicine, ; Detroit, MI USA
                [2 ]GRID grid.254444.7, ISNI 0000 0001 1456 7807, Department of Dermatology, , Wayne State University, ; Dearborn, MI USA
                [3 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Department of Medicine, Division of Dermatology, David Geffen School of Medicine, , University of California Los Angeles, ; Los Angeles, CA USA
                Article
                Publisher ID: 838
                DOI: 10.1007/s13555-022-00838-3
                PMC ID: 9674821
                PubMed ID: 36329359
                SO-VID: 8146dd31-daf1-4b68-9935-006d65f2af4c
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 31 August 2022
                Date accepted : 14 October 2022
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Dermatology
                Keywords: hyperhidrosis,topical anticholinergics,oxybutynin,sofpironium bromide,umeclidinium
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: hyperhidrosis, topical anticholinergics, oxybutynin, sofpironium bromide, umeclidinium

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