Systemic Treatment of Hyperhidrosis

Abstract

Until quite recently, clinical guidelines and reviews on the treatment of hyperhidrosis advised against the use of systemic therapies based on their unacceptable adverse effects and a lack of evidence of usefulness. Numerous studies published over the past few years, however, have shown that, when used appropriately, these treatments are effective and in general have a favorable tolerability profile, making them an additional option for the treatment of hyperhidrosis, particularly for disease that is widespread, multifocal, or resistant to other treatments. In this review, the first of its kind, we examine the systemic therapies available for hyperhidrosis, including antihypertensives, psychoactive agents, and in particular oral anticholinergics, although none of these drugs are currently approved for this indication. Tratamiento sistémico de la hiperhidrosisResumen Hasta hace pocos años las guías clínicas y revisiones sobre tratamientos de la hiperhidrosis consideraban que no existía evidencia de la utilidad de los tratamientos sistémicos, y que se asociaban a un perfil intolerable de efectos adversos, siendo desaconsejados. Sin embargo, en los últimos años diferentes estudios han ido mostrando la eficacia de los mismos, asociándose a un perfil de efectos adversos por lo general aceptable cuando se usan de forma apropiada, convirtiéndose en una alternativa terapéutica más en el tratamiento de la hiperhidrosis, de especial relevancia en casos de hiperhidrosis generalizada, multifocal o resistente a otros tratamientos. Mediante esta revisión, la primera centrada en este tema, se repasarán los diferentes tratamientos sistémicos actualmente disponibles para la hiperhidrosis, incluyendo antihipertensivos, psicofármacos y, fundamentalmente, los anticolinérgicos orales, aunque ninguno tiene indicación aprobada en el tratamiento de la hiperhidrosis.

Initial study of transdermal oxybutynin for treating hyperhidrosis

“…10 In Spain, transdermal oxybutynin is marketed at a price of approximately €42 for eight patches; thus, for a dose of two patches/week, the annual cost would be €546. 10 In Spain, transdermal oxybutynin is marketed at a price of approximately €42 for eight patches; thus, for a dose of two patches/week, the annual cost would be €546.…”

“…At our specialist outpatient clinic, oral oxybutynin is employed as first-line systemic therapy and oral glycopyrrolate as second-line treatment. 10 In Spain, transdermal oxybutynin is marketed at a price of approximately €42 for eight patches; thus, for a dose of two patches/week, the annual cost would be €546. Accordingly, its cost is intermediate between that of oral oxybutynin and oral glycopyrrolate, with annual costs of €36 and €1600, respectively.…”

“…Accordingly, its cost is intermediate between that of oral oxybutynin and oral glycopyrrolate, with annual costs of €36 and €1600, respectively. 10 In view of the absence of previous reports in this field, our evaluation is based on the above data and on the results described.…”

Survival study of treatment adherence by patients given oral oxibutynin for hyperhidrosis

“…1,2 Various forms of treatment have been approved for HH, 3 according to the part of the body affected, but in many cases good control of the condition is not achieved, either due to its intensity or because it affects various locations and cannot be addressed in a comprehensive way. In recent years, studies have demonstrated the effectiveness and safety of oral anticholinergics 4,5 and especially of oral oxybutynin (OOx), which has been corroborated by clinical trials. [6][7][8] Most studies in this respect, however, do not conduct follow-up for more than 1 year and only evaluate effectiveness and adverse effects.…”

Adjusting oral oxybutynin medication for hyperhidrosis to reflect seasonal temperature variations

“…Oral oxybutynin (OOx) is an anticholinergic medication that is indicated for the treatment of urge incontinence and/or increased urinary frequency, at doses of up to 20 mg/day in adults, dispensed in 5 mg tablets (Del Boz, ). The anticholinergic effect is derived from its binding to muscarinic receptors located in the eccrine sweat glands, and so it also alleviates hyperhidrosis (HH).…”