Current and Emerging Medical Therapies for Primary Hyperhidrosis

Abstract

Hyperhidrosis is defined as the production of sweat beyond what is physiologically necessary to maintain thermal homeostasis. This disease state may (and typically does) have a significant impact on the patient’s quality of life. Medications including antiperspirants, anticholinergics, and botulinum toxin have been shown to be effective in the management of hyperhidrosis. Several medical device technologies have also proven to be effective. This review article will explore the current and emerging pharmacological and medical device treatments for hyperhidrosis and provide a framework for treating patients who suffer with primary forms of hyperhidrosis.

Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials

“…In primary hyperhidrosis, idiopathic sympathetic nerve hyperactivity triggers excess sweating, most commonly of the axillae, palms, soles, or craniofacial regions . Hyperhidrosis occurs in children and adults, with ~4.8% of the US population (~15.3 million people) affected . In an online survey of US teens, ~17.1% experienced excessive sweating, with a mean onset age of 11 years .…”

“…1 Hyperhidrosis occurs in children and adults, with~4.8% of the US population (~15.3 million people) affected. 1,2 In an online survey of US teens,~17.1% experienced excessive sweating, with a mean onset age of 11 years. 3 The substantial negative impact of hyperhidrosis on quality of life has been well established [4][5][6][7] and equated as comparable to, or greater than, the impact of psoriasis or eczema.…”

Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials

“…Hyperhidrosis, which is a condition characterized by sweat production exceeding that which is necessary to maintain normal thermal homeostasis, has an estimated prevalence in the United States of 4.8% (;15.3 million people). 1,2 The adverse impact of hyperhidrosis on quality of life has been well documented, [2][3][4][5][6] and a recent case-control study found that anxiety and depression are more than 3.5 times more prevalent among patients with hyperhidrosis than among those without it. 7 Hyperhidrosis treatments have included nonsurgical and surgical options that generally work to block sweat from reaching the skin surface (eg, antiperspirants), inhibit neuronal transduction to sweat glands (eg, onabotulinum toxinA or oral anticholinergic drugs), or destroy the sweat glands (eg, thermal ablation or surgical removal) or work via unknown mechanisms (eg, iontophoresis).…”

“…7 Hyperhidrosis treatments have included nonsurgical and surgical options that generally work to block sweat from reaching the skin surface (eg, antiperspirants), inhibit neuronal transduction to sweat glands (eg, onabotulinum toxinA or oral anticholinergic drugs), or destroy the sweat glands (eg, thermal ablation or surgical removal) or work via unknown mechanisms (eg, iontophoresis). 2,8,9 These treatments vary greatly with respect to effectiveness, invasiveness, and side effects and prior to 2018 only 2 had been approved by the US Food and Drug Administration (FDA) for axillary hyperhidrosis (onabotulinum toxin A and a microwave device for thermal ablation of sweat glands). Although treatment regimens may vary according to patient characteristics and symptom severity, 2 patients generally remain unsatisfied with the currently available treatment options.…”

“…2,8,9 These treatments vary greatly with respect to effectiveness, invasiveness, and side effects and prior to 2018 only 2 had been approved by the US Food and Drug Administration (FDA) for axillary hyperhidrosis (onabotulinum toxin A and a microwave device for thermal ablation of sweat glands). Although treatment regimens may vary according to patient characteristics and symptom severity, 2 patients generally remain unsatisfied with the currently available treatment options. 5,10,11 Patients with hyperhidrosis often delay or avoid seeking treatment, likely owing to a lack of recognition of hyperhidrosis as a medical condition, the social stigma of excessive sweating, and/ or low levels of satisfaction with or awareness of available treatments.…”