Topical Anticholinergics May Be Effective for Hyperhidrosis
Primary axillary hyperhidrosis affects approximately 2% of the population. It is most prevalent between 18 and 54 years of age and in females. Treatment typically progresses from antiperspirants, iontophoresis, botulinum toxin type A injections, to lasers or surgical retrodermal axillary curettage or thoracoscopic sympathectomy for resistant cases. Oral anticholinergics have been used off-label to treat hyperhidrosis, but have systemic effects. Topical anticholinergic agents, such as glycopyrrolate sprays, have been reported to be useful in various parts of the body affected by hyperhidrosis. However, their relative effectiveness and ease of use when compared to other treatments has not been demonstrated for axillary hyperhidrosis.
A recent study compared efficacy and side effects of using different concentrations of topically applied glycopyrrolate spray to Botulinum toxin type A injections for the treatment of axillary hyperhidrosis. Forty patients with localized primary axillary hyperhidrosis were allocated to one of the four study groups: 1% glycopyrrolate spray applied topically to axillae twice daily; 2% glycopyrrolate spray, applied topically to axillae twice daily; a single session of subcutaneous Botulinum toxin type A injections; or no treatment. Forty control patients were also recruited. Each patient underwent two evaluations, one at the start and one after six weeks of treatment. All three treatment groups showed a significant improvement in their overall symptoms of axillary hyperhidrosis at 6 weeks of treatment based on the results of the Hyperhidrosis Severity Disease Scoring. No treatment group reduced the hyperhidrosis to a level similar to those without hyperhidrosis. The spray formulation of topical glycopyrrolate reduced the symptoms of axillary hyperhidrosis on patient subjective evaluation at 6 weeks after starting treatment. There was a clear rank order in the effect of glycopyrrolate 1%, glycopyrrolate 2% and botulinum toxin.
The authors state that due to the minimal and inferior effect 1% glycopyrrolate spray has on managing the physical and psychological effects of axillary hyperhidrosis, they would not recommend its use. However, this study demonstrates that 2% topical glycopyrrolate spray is a safe and effective treatment for axillary hyperhidrosis in the short-term, while also reducing the influence of psychological associated factors.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: January 17, 2017
Source: Wiley Online Library
Adapted from the original article.