Hyperhidrosis, or excessive sweating, is a common skin condition which can lead to psychological distress and negative self-view. Primary hyperhidrosis is defined as excessive sweating of certain body areas without psychological reasons. Hyperhidrotic patients report a high rate of psychological strain and impaired quality of life due to the social and psychological implications of primary hyperhidrosis. This article will review a 2014 study which aims to investigate the relationship between hyperhidrosis and different psychological/physiological aspects of chronic stress as a cofactor for the etiology of depression. This study compares 40 hyperhidrotic subjects to 40 age- and sex-matched healthy control subjects. Tools used in this study to measure responses are the Tier Inventory of Chronic Stress (TICS), the Beck Depression Inventory (BDI-II) and the Screening for Somatoform Disorders (SOMS-2). The cortisol awakening response of each patient was also analyzed as a psychological stress correlate. Below is a summary of the study results:
Hyperhidrosis Impact Questionnaire
47.5% of subjects reported the onset of their hyperhidrosis at an age between 12-17 years. 35% were over 17 years old, 10% were between 6-11 years old, and 7.5% were below the age of 6 at onset of disease. The body regions most frequently affected were the armpits (50%), palms (25%), and the face (17.5%).
Tier Inventory of Chronic Stress (TICS)
The hyperhidrotic group of patients showed significantly higher values for “lack of social recognition”. 4 other scales, uncorrected, showed “social overload”, “excessive demands from work”, and “chronic worrying” reflected a trend towards more chronic stress in the hyperhidrotic patients.
Beck Depression Inventory
As measured by the beck depression inventory, 24 out of 40 hyperhidrotic patients (60%) reached total sum scores equal or greater than 9, which represents the screening’s cut-off for an indication of depression. In comparison, 4 out of 40 (10%) of healthy control subjects provided a sum of 9 or greater. Overall, the hyperhidrosis showed a significantly increased risk and prevalence of depression. Comparing only axillary hyperhidrotics to the control group produces even larger differences: without correction, axillary hyperhidrotics would have a higher BDI-II sum score than other hyperhidrotics, illustrating that axillary hyperhidrosis can often be the most psychologically debilitating location.
Screening for Somatoform Disorders
No significant differences found.
Cortisol Levels
No significant differences found.
Resources:
1) Gross KM, Schote AB, Schneider KK, Schulz A, Meyer J. Elevated social stress levels and depressive symptoms in primary hyperhidrosis. PLoS One. 2014;9(3):e92412. Published 2014 Mar 19. doi:10.1371/journal.pone.0092412
Hyperhidrosis is a condition marked by excessive sweating, caused by the overstimulation of cholinergic receptors on eccrine glands. This condition results in perspiration that exceeds the body's needs for regulating temperature. Eccrine glands, which are densely located in the armpits, palms, soles, and face, are most often linked with hyperhidrosis. Research indicates that about 3% of people in the United States are affected by this disorder. The impact of hyperhidrosis extends beyond physical symptoms, leading to significant emotional, psychological, social, and professional challenges.
Primary hyperhidrosis typically begins in childhood, affecting between 0.6% and 1% of the population. A hereditary form with autosomal dominant inheritance has been identified, with some families showing a link to an abnormality on chromosome 14q. The criteria for diagnosing hyperhidrosis include excessive sweating lasting at least six months without a clear cause, and meeting at least two of the following conditions: daily activity impairment, bilateral and relatively symmetrical sweating at least once per week, onset before the age of 25, cessation of focal sweating during sleep, or a positive family history. Secondary hyperhidrosis, on the other hand, can be triggered by drugs (such as sertraline), toxins (like acrylamide), systemic illnesses (including endocrine and metabolic disorders, neoplasms, spinal cord lesions), or congenital conditions such as familial dysautonomia (Riley-Day syndrome).
The pathophysiology of hyperhidrosis involves the overactivity of eccrine sweat glands, which are regulated by the sympathetic nervous system through cholinergic fibers. These fibers transmit impulses as a physiological response to control core body temperature during physical exertion or psychological stress. The hypothalamus, acting as the thermoregulatory center, oversees this sympathetic innervation to the sweat glands. When muscarinic receptors are stimulated by cholinergic activity, sweating is induced. In hyperhidrosis, there is excessive activation of the sympathetic nervous system, leading to an abnormal release of acetylcholine from nerve endings. This overproduction of acetylcholine causes the body to produce more sweat than necessary for cooling. It is believed that this condition may stem from a malfunctioning negative feedback mechanism in the hypothalamus, resulting in disproportionate sweating. This pathological response can also be triggered by medications that increase acetylcholine release or by systemic medical conditions that enhance sympathetic nervous system activity.
The treatment options for hyperhidrosis include a range of topical and systemic therapies. First-line therapy often involves the use of over-the-counter aluminum chloride hexahydrate 20%, applied for 3 to 4 nights. Another option is topical glycopyrronium tosylate, available as a pre moistened cloth containing 2.4% glycopyrronium solution, which has been approved for treating excessive sweating. These agents work by denaturing keratin, thereby blocking the pores of the sweat glands and reducing perspiration.
For patients who do not respond to topical treatments or exhibit more generalized symptoms, oral anticholinergic medications can be considered. These include oxybutynin, administered at doses of 5 mg to 10 mg daily, or topical glycopyrrolate at concentrations of 0.5% to 2.0%. While effective, these anticholinergic medications can cause side effects such as dry eyes, dry mouth, urinary retention, and constipation.
If both topical and oral drug therapies are ineffective, other treatment modalities may be explored. Iontophoresis, performed 2 to 3 times weekly, and botulinum toxin A injections, administered every 3 to 4 weeks, are additional options for managing hyperhidrosis. These treatments offer alternative strategies for patients seeking relief from excessive sweating. Botulinum toxin is a highly effective treatment for hyperhidrosis, though it is costly and necessitates repeated sessions. Some specialists advise combining botulinum toxin with lidocaine for axillary injections to enhance comfort and effectiveness. The mechanism of action for botulinum toxin A involves cleaving the SNAP-25 protein, which disrupts the presynaptic fusion and binding of acetylcholine vesicles to the nerve terminal, thereby inhibiting the release of acetylcholine. This makes it an optimal choice for patients who have not achieved adequate results with topical antiperspirants and oral anticholinergics.
Hyperhidrosis is a condition that extends beyond physical discomfort, significantly impacting various aspects of a person's life. The excessive sweating associated with hyperhidrosis can lead to social embarrassment, emotional and psychological distress, and can even cause disabilities related to work or school. Despite the availability of treatments such as topical agents, oral medications, iontophoresis, and botulinum toxin injections, managing hyperhidrosis effectively requires a tailored approach to address the unique needs of each patient. By understanding the profound effects of this condition and exploring the range of treatment options, healthcare providers can better support individuals in achieving relief and improving their quality of life.
Brackenrich, J. (2022, October 3). Hyperhidrosis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459227/#:~:text=Hyperhidrosis%20is%20a%20disorder%20of%20excessive%20sweating%20due,the%20body%20uses%20for%20homeostatic%20temperature%20regulation.%20
Lakraj, A.-A. D., Moghimi, N., & Jabbari, B. (2013, April 23). Hyperhidrosis: Anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705293/
Mayo Foundation for Medical Education and Research. (2022, September 16). Hyperhidrosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/diagnosis-treatment/drc-20367173
Hyperhidrosis, or excessive sweating, is a medical condition that can have a significant impact on a person's quality of life. While sweating is a normal bodily function that helps regulate body temperature, people with hyperhidrosis produce sweat in amounts far greater than is necessary for cooling. This can lead to feelings of embarrassment, anxiety, and isolation, as well as physical discomfort and skin problems. Understanding the psychosocial impact of hyperhidrosis is crucial for providing effective treatment and support for those affected by this condition.
One of the most common psychosocial effects of hyperhidrosis is embarrassment. Excessive sweating can lead to visible sweat stains on clothing, particularly in the underarm area, which can be embarrassing and make individuals feel self-conscious in social situations. This can lead to a reluctance to participate in activities that may cause sweating, such as exercise or social events, which can further impact their quality of life. In addition to embarrassment, hyperhidrosis can also lead to feelings of anxiety and low self-esteem. The constant worry about sweating can cause individuals to feel anxious in social situations, leading to avoidance behaviors and a reduced quality of life. This can also impact relationships, as individuals may avoid intimacy or close physical contact due to their sweating. Hyperhidrosis can also have a significant impact on a person's social life and relationships. The fear of sweating can lead to social withdrawal and isolation, as individuals may avoid social situations where sweating may occur. This can lead to feelings of loneliness and depression, further impacting their mental health and well-being.
Hyperhidrosis can also have a physical impact on a person's skin. Excessive sweating can lead to skin irritation, rashes, and fungal infections, particularly in areas where sweat tends to accumulate, such as the armpits, groin, and feet. This can cause discomfort and further impact a person's quality of life.
In terms of treatment, there are several options available for hyperhidrosis, including antiperspirants, medication, and in severe cases, surgery. Antiperspirants containing aluminum chloride are often the first line of treatment and can be effective for many people. However, for those with more severe cases of hyperhidrosis, other treatments such as oral medications or botulinum toxin injections may be necessary.
It is important for healthcare providers to recognize the psychosocial impact of hyperhidrosis and provide appropriate support and treatment options for those affected by this condition. This may include counseling or therapy to help individuals cope with the emotional effects of hyperhidrosis, as well as education and support groups to help them manage their condition.
References:
www.aad.org/public/diseases/a-z/hyperhidrosis-overview.
Hyperhidrosis is a medical condition characterized by excessive sweating beyond what is necessary for the regulation of body temperature. People with hyperhidrosis may sweat profusely even when the body doesn't need cooling, and this can significantly impact their daily activities and quality of life. The condition can affect various parts of the body, including the armpits, hands, feet, face, and other areas. There are two main types of hyperhidrosis, primary focal and secondary generalized. Primary focal hyperhidrosis affects specific areas of the body, such as the hands, feet, or armpits. It usually starts in childhood or adolescence and is not typically associated with other medical conditions. Secondary Generalized Hyperhidrosis is more generalized, involving the entire body or larger areas. It is often a symptom of an underlying medical condition, such as diabetes, hyperthyroidism, or certain infections. Treatment options for hyperhidrosis may include topical antiperspirants, medications, and in some cases, procedures like Botox injections or surgery. The choice of treatment depends on the severity of symptoms and the areas affected.
Patients with hyperhidrosis report that pharmacological therapy alone may not address all their needs. There is a profound physical and mental social impact on patients. There are many barriers to treatment. One significant barrier to treating hyperhidrosis is the lack of patients seeking out medical care. This could be due to the lack of awareness of treatment options or the fact that some insurance and medical companies do not see hyperhidrosis as a medical condition. Many patients report that there is a lack of literature and awareness of the treatment options offered. Due to the lack of literature, some patients do not even realize their hyperhidrosis is a sweating disorder, they try to modify their lifestyle and adapt to the problem independently without seeking medical help. “Sixty four percent of patients reported unmet healthcare needs such as a lack of access, inadequacy of information, and paucity of psychological support in dealing with HH [7]. One third of participants said that information on HH is inadequate and worry that healthcare practitioner knowledge and public awareness are limited [7]” (1).
In addition to the physical and mental impact, managing hyperhidrosis is time consuming. Patients report spending an extra 10 to 60 minutes in their daily routine to compensate for their side effects.
A qualitative study done in 2011, (published in 2017), investigated the impact of hyperhidrosis on the daily life of patients. “Seventeen major themes capturing the impacts of hyperhidrosis were identified; these covered all areas of life including daily life, psychological well-being, social life, professional /school life, dealing with hyperhidrosis, unmet health care needs and physical impact” (2). Nearly three-quarters of the study participants reported an impact on lifestyle. Their choices in footwear and fashion heavily revolved around their profound sweating. They also based their vacation choices on the climate, avoiding hot climates that only exacerbated their sweating. Various types of hobbies: physical and non physical activities were also avoided due to the direct result of sweating as well as a secondary consequence of avoidance of embarrassing situations.
The American Academy of Dermatology urges those with excessive sweating in a certain area of the body at times when it's not normal to be sweating to talk to a board certified dermatologist. New treatment options for hyperhidrosis are starting to emerge and seeking help from a dermatologist can help them manage their condition and improve their quality of life.
References:
Parashar, K., Adlam, T., & Potts, G. (2023). The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature. American journal of clinical dermatology, 24(2), 187–198. https://doi.org/10.1007/s40257-022-00743-7
Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. S. (2017). The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health and quality of life outcomes, 15(1), 121. https://doi.org/10.1186/s12955-017-0693-x
Hyperhidrosis is a medical condition characterized by excessive sweating beyond what is necessary to regulate body temperature. This condition can significantly impact an individual's quality of life, causing embarrassment, discomfort, and social withdrawal. Understanding the causes, symptoms, and treatment options for hyperhidrosis is essential for effectively managing this condition.
There are two primary types of hyperhidrosis: primary focal hyperhidrosis and secondary generalized hyperhidrosis. Primary focal hyperhidrosis, the most common form, typically affects specific areas of the body, such as the palms, soles, underarms, or face, and is thought to result from overactive sweat glands. Secondary generalized hyperhidrosis, on the other hand, is usually caused by an underlying medical condition or medication and can affect larger areas of the body.
The exact cause of primary focal hyperhidrosis remains unclear, but it is believed to involve a combination of genetic and environmental factors. Triggers such as stress, anxiety, heat, and certain foods or beverages may exacerbate symptoms. Secondary generalized hyperhidrosis can be caused by various medical conditions, including hormonal imbalances, neurological disorders, infections, or metabolic diseases, as well as medications such as antidepressants or antipyretics.
The symptoms of hyperhidrosis can vary in severity but often include persistent and uncontrollable sweating, even in cool or relaxed environments. Individuals with hyperhidrosis may experience damp or sweaty palms, excessive sweating in the underarms or feet, and noticeable sweating that soaks through clothing. Beyond the physical discomfort, hyperhidrosis can also have significant psychological and social effects, leading to embarrassment, low self-esteem, and avoidance of social situations.
Treatment options for hyperhidrosis depend on the severity of symptoms and their impact on daily life. For mild cases, lifestyle modifications such as wearing breathable clothing, using antiperspirants, and practicing stress management techniques may provide relief. Antiperspirants containing aluminum chloride are particularly effective in reducing sweat production when applied to affected areas regularly.
In more severe cases, medical interventions may be necessary. Topical treatments such as prescription antiperspirants or medications containing aluminum chloride hexahydrate can be applied to affected areas to inhibit sweat gland activity. Oral medications such as anticholinergics may also help reduce sweating by blocking nerve signals that stimulate sweat production. However, these medications may cause side effects such as dry mouth, blurred vision, or constipation.
For individuals with refractory or severe hyperhidrosis, procedural interventions may be recommended. Botulinum toxin injections can temporarily block the nerve signals that stimulate sweat glands, providing relief for several months before requiring repeat treatments. In extreme cases, surgical options such as sweat gland removal (sympathectomy) or sweat gland removal (curettage) may be considered, although these procedures carry risks and potential complications.
It is essential for individuals with hyperhidrosis to consult with a healthcare professional to determine the most appropriate treatment approach based on their specific symptoms and medical history. With proper management, many individuals with hyperhidrosis can experience significant improvement in their symptoms and regain confidence in their daily activities and social interactions.
Sweating is a vital physiological mechanism that contributes to thermoregulation by dissipating heat through the evaporation of sweat on the skin. “Normal” sweating occurs in response to factors such as physical activity, high ambient temperature, emotional stress, and illness. Hyperhidrosis is a common medical condition characterized by excessive sweating beyond what is necessary for thermoregulation. Overstimulation of cholinergic receptors on eccrine glands and impairment of the acetylcholine negative feedback loop in hyperhidrosis lead to sweating even in non-stressful conditions and low ambient temperatures. Eccrine glands are concentrated in areas such as the underarms, palms of the hands, soles of the feet, and face; therefore, these areas are most commonly associated with hyperhidrosis. Hyperhidrosis can result in emotional, psychological, social, and occupational impairment for those affected.
Hyperhidrosis is classified into two main types, primary (idiopathic) or secondary. The etiology of primary hyperhidrosis is not well understood; however, genetic predisposition and hyperactivity of the sympathetic nervous system, causing excessive release of acetylcholine, are proposed mechanisms. On the other hand, secondary hyperhidrosis has numerous known causes including various medical conditions (diabetes mellitus, hyperthyroidism, menopause, neurological disorders, and infections) and certain medications (antidepressants such as SSRIs, insulin, antipsychotics, antipyretics, and some antimicrobials). Although hyperhidrosis is not typically associated with cancer, excessive sweating can be a symptom of certain cancers or an adverse effect to chemotherapy or hormonal therapy agents. Certain cancers such as non-Hodgkin and Hodgkin lymphomas, carcinoid tumors, and advanced medullary thyroid cancer may present with hyperhidrosis as part of the constellation of symptoms. Patients with advanced cancer of any kind may experience increased sweating, although the true incidence in this population is unknown. Breast and prostate cancer are the two cancers most commonly associated with hyperhidrosis, usually presenting as an adverse effect related to changes in hormone levels. Hyperhidrosis in breast cancer is often attributed to estrogen deficiency, and certain treatments may induce a menopausal state, resulting in symptoms such as hot flashes and sweating. Medications such as letrozole, anastrozole, raloxifene and tamoxifen may further exacerbate these symptoms. Similarly, approximately 75% of male patients with prostate cancer experience hot flashes and sweating, commonly linked to androgen ablation therapy. The severity and duration of sweating varies based on prescribed treatment regimens; nevertheless, hyperhidrosis in these patients contributes to the overall burden of treatment-related side effects.
Treatment options are similar for primary and secondary hyperhidrosis; however, treatment of the underlying disorder or discontinuation of the suspected medication (if medically feasible) is recommended in addition to regular therapy if a secondary cause is suspected. First-line therapy for hyperhidrosis includes over the counter or prescription-strength antiperspirants containing aluminum chloride (e.g., Drysol). Skin irritation can occur with these products, and patients often become intolerant with long-term use. A topical anticholinergic agent, glycopyrronium cloths (Qbrexza), or oral anticholinergic, oxybutynin, may be considered; use of these should be avoided in medical conditions such as glaucoma, ulcerative colitis, etc. Other treatment options with proven efficacy are typically reserved for patients resistant to conservative therapy. Iontophoresis, which involves low-level electrical currents to affected areas, has demonstrated efficacy but therapy is long-term, and effects are mild. Botulinum toxin injections are an expensive but effective option, with decreased perspiration lasting from 6 to 24 months. Finally, sympathectomy appears to be somewhat permanent, but may lead to compensatory sweating, Horner syndrome, pain, and intercostal neuralgia. Lifestyle modifications such as wearing breathable clothing, managing stress through relaxation techniques, and identifying and avoiding triggers can also contribute significantly to symptom control. A comprehensive approach often involves a combination of these treatment options and nonpharmacological strategies tailored to the specific needs and circumstances of the individual.
References
Bombatch C, Veverka A, Tasnif Y, et al. “Chapter 39: common skin conditions,” 2024 NAPLEX Course Book. UWorld, RxPrep. 2023 May.
Brackenrich J, Fagg C. Hyperhidrosis [updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023 Jan. https://www.ncbi.nlm.nih.gov/books/NBK459227/
Cole KM, Clemons M, Alzahrani M, et al. Vasomotor symptoms in early breast cancer – a “real world” exploration of the patient experience. Support Care Cancer. 2022 May;30(5):4437-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8809216/
Collercandy N, Thorey C, Diot E, et al. When to investigate for secondary hyperhidrosis: data from a retrospective cohort of all causes of recurrent sweating. Ann Med. 2022 Dec;54(1):2089-101. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9455328/
Frisk J. Managing hot flushed in men after prostate cancer – a systemic review. Maturitas. 2010 Jan;65(1):15-22. https://www.maturitas.org/article/S0378-5122(09)00398-3/fulltext
Mcconaghy JR, Fosselman D. Hyperhidrosis: management options. Am Fam Physician. 2018 Jun;97(11):729-34. https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
Stefanopoulou E, Yousaf O, Grunfeld EA, Hunter MS. A randomized controlled trial for men who have hot flushed following prostate cancer treatment (MANCAN). Psycooncology. 2015 Sep;24(9):1159-66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006840/
Hyperhidrosis is a condition where your body produces more sweat than normal even when your body has already regulated its temperature. Excessive sweating may occur at rest, in cold temperatures, and when you don’t expect it. This medical condition is common, and it may influence a person’s mental health by causing embarrassment and avoiding activities or people. There are two types of hyperhidrosis, primary focal and secondary generalized. Primary focal hyperhidrosis is caused by a genetic mutation that can be inherited from your biological family. This is the most common type of hyperhidrosis and affects your armpits, hands, feet, and face, and can start before age twenty-five. Secondary generalized hyperhidrosis is caused by a trigger such as a disease condition or it can be medication-induced. Generalized hyperhidrosis may also occur when a person is sleeping. The main symptoms of hyperhidrosis are feelings of wetness on the skin, damp clothing, and beads of fluid dripping from your cheeks or forehead. If this condition is not treated, long-term symptoms can occur such as inflammation when the sweat irritates the skin, body odor when the bacteria combine with the sweat particles, and cracked or peeling skin on your feet. Symptoms vary based on severity and how well you manage them.
The reason behind the excessive sweating is overactive glands or eccrine glands. These glands release sweat to cool down your body but in hyperhidrosis, sweat is produced even when your body has regulated its temperature. Triggers of hyperhidrosis are emotional situations involved with stress, anxiety, fear, or nervousness. Exercise, humidity, and spicy foods are also considered triggers. Medications are another trigger and are known as a side effect of the drug. Some include albuterol, bupropion, insulin, levothyroxine, lisinopril, naproxen, omeprazole, and sertraline. It is not recommended to abruptly stop taking the medication to avoid additional side effects. Speaking with your healthcare provider and discussing any other medications the patient is taking is crucial to rule out any other causes of hyperhidrosis. Medical conditions that cause excessive sweating are cancer, diabetes, heart disease, and hyperthyroidism to name a few.
There is no cure for hyperhidrosis. Medications and treatment can help reduce symptoms and improve the patient’s overall quality of life. Treating the underlying cause of generalized hyperhidrosis can help rid the excessive sweating altogether if the disease or side effect of the medication is managed. Self-treatments can be over-the-counter (OTC) antiperspirants and deodorants with aluminum-based products. Aluminum precipitates with the sweat molecules and damages the epithelial cells that plug the eccrine glands, blocking the sweat production. Other self-treatments are wearing breathable clothing, showering more often, and changing your routine to triggers if possible. Medications that your doctor can prescribe are aluminum chloride gel, beta-blockers for preventing triggers that cause excessive sweating, and anticholinergic agents such as glycopyrrolate or oxybutynin. These two drugs are used as off-label according to the FDA. Overall, focal and generalized hyperhidrosis can affect a person’s mental health and should monitored by a healthcare provider to help improve a patient’s overall quality of life.
References:
Cleveland Clinic medical. (n.d.). Why do I sweat so much?. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis
U.S. National Library of Medicine. (n.d.). Hyperhidrosis: Medlineplus medical encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/007259.htm
HYPERHIDROSIS
Sweating is a natural body function that happens to everyone, however, excessive sweating is an insecurity that many people have. Hyperhidrosis is a condition where one sweats excessively, without heat or exercise. Primary hyperhidrosis takes place in focal points, specifically, in the palms, feet, and armpits. It is not caused by underlying conditions, however, the exact cause and mechanism are not known. With the increased sweating and moisture buildup, there is an increased risk of infections. These patients are more at risk of athlete's foot, bacterial infections, and ringed keratolysis. Secondary hyperhidrosis is caused by medications, diseases, and issues with the CNS or endocrine system. Causes include alcohol use, menopause, narcotic withdrawal, congestive heart failure, and chronic pulmonary diseases. Medications that cause hyperhidrosis include sulfonylureas, insulin, tamoxifen, sildenafil, and SSRIs (Fluoxetine, Citalopram, Sertraline, Paroxetine).
There are two types of glands affecting sweating, eccrine and apocrine. The eccrine gland releases fluids and electrolytes that maintain temperature. This allows the body to cool down when exercising or in heat. Apocrine glands are located in the armpits, pubic areas, and ear canal. They release proteins, pheromones, and steroids. In addition, the odor emitting from sweat originates from the apocrine gland. Acetylcholine is a neurotransmitter that controls the function of the eccrine gland, signaling when the body needs to cool down. Catecholamines are neurotransmitters that induce sweating from both glands in response to stimuli of the environment, metabolism, temperature, and emotion. The main gland causing hyperhidrosis are eccrine glands, however, apocrine glands may be causes of hyperhidrosis of the armpits.
Hyperhidrosis is usually prevalent in patients 19 to 39 years old. This condition can lead to a lower quality of life, due to its social and professional impacts. From handshakes to hugs, excessive sweating can be insecurity. People with hyperhidrosis must endure multiple showers a day, increased deodorant and antiperspirant use, multiple changes of clothes, and extra sets of towels used. In a Brazilian study, "Of 23 patients diagnosed with primary hyperhidrosis, 11 reported a poor or very poor QOL" (Lenefsky). People with hyperhidrosis walk around with worry and anxiety about their odor or if their sweat leaked through their clothing. Treatment of Hyperhidrosis is dependent on severity. The first-line treatment across all severities is topical 20% aluminum chloride (Drysol). The aluminum inhibits the function of eccrine glands, inhibiting sweat secretion. This may cause skin irritation as a side effect. For craniofacial hyperhidrosis, topical 2% glycopyrrolate is used. For palms and soles, iontophoresis can be used as a first or second-line treatment. Botox can be used in the armpits, palms, soles, or face. the botox blocks acetylcholine release from eccrine glands.
Arora G, Kassir M, Patil A, Sadeghi P, Gold MH, Adatto M, Grabbe S, Goldust M. Treatment of Axillary hyperhidrosis. J Cosmet Dermatol. 2022 Jan;21(1):62-70. doi: 10.1111/jocd.14378. Epub 2021 Aug 20. PMID: 34416078.
Lenefsky M, Rice ZP. Hyperhidrosis and its impact on those living with it. Am J Manag Care. 2018 Dec;24(23 Suppl):S491-S495. PMID: 30589248.
McConaghy JR, Fosselman D. Hyperhidrosis: Management Options. Am Fam Physician. 2018 Jun 1;97(11):729-734. PMID: 30215934.
Hyperhidrosis
Hyperhidrosis, a medical condition characterized by excessive sweating beyond what is necessary for regulating body temperature, affects millions of people worldwide. It can significantly impact an individual's quality of life, causing physical discomfort, social embarrassment, and emotional distress. Hyperhidrosis can occur in specific areas of the body, such as the palms, soles of the feet, underarms, and face, or it may be generalized, affecting multiple regions simultaneously. Understanding the causes, symptoms, and available treatment options for hyperhidrosis is crucial in effectively managing this condition and improving the lives of those affected.
The exact cause of hyperhidrosis is not fully understood, but it is believed to be related to overactive sweat glands or dysregulation in the autonomic nervous system, which controls involuntary bodily functions. The condition can be classified into two main types: primary hyperhidrosis and secondary hyperhidrosis. Primary hyperhidrosis, also known as focal hyperhidrosis, is the most common form, accounting for approximately 90% of cases. It typically begins during childhood or adolescence and often affects the palms, soles, and armpits. Unlike secondary hyperhidrosis, primary hyperhidrosis is not associated with any underlying medical conditions or medications. It tends to run in families, suggesting a genetic predisposition to the condition. Secondary hyperhidrosis is less common and occurs as a result of an underlying medical condition or as a side effect of certain medications. Conditions that can cause secondary hyperhidrosis include menopause, thyroid disorders, infections, diabetes, and certain neurological disorders. Medications like antidepressants and some antibiotics may also trigger excessive sweating as a side effect.
S ymptoms of hyperhidrosis can be debilitating, leading to social withdrawal, reduced self-esteem, and interference with daily activities. Individuals with hyperhidrosis often find it challenging to shake hands, hold objects, or engage in activities that require physical contact, leading to social and professional limitations. Fortunately, several treatment options are available to manage hyperhidrosis and improve the quality of life for affected individuals. These treatments can be divided into conservative measures and more advanced medical interventions. Some of the conservative measures include using antipirsperants, wearing loose clothing, or avoiding triggers. Some over-the-counter antipirsperants contain aluminum chloride which can temporarily block the sweat ducts and can be applied to areas prone to excessive sweating, such as the underarms, palms, and soles. Wearing loose-fitting, breathable clothing made from natural fibers can help improve air circulation and reduce sweating. Identifying and avoiding triggers that exacerbate sweating, such as spicy foods, caffeine, and stress, can be helpful for some individuals.Come of the medical interventions include, iontophoresis, botulinum toxin (Botox) injections, oral medications, and even surgical procedures. Iontophoresis is a non-invasive procedure that involves immersing the affected body part in water while a low electrical current is passed through the skin. Botox injections can help in localized hyperhidrosis because the toxin blocks the release of acetylcholine, a chemical that stimulates sweat glands, reducing sweating in the treated area. Doctors can also prescribe anticholinergic drugs which can reduce sweating systemically. Lastly, surgical interventions such as, endoscopic thoracic sympathectomy (ETS) may be considered. This procedure involves cutting or clamping the sympathetic nerves that stimulate sweat glands. However, ETS carries risks and should be carefully considered after exhausting other treatment options.
References:
Strutton, D., Kowalski, J. W., & Glaser, D. A. (2004). US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. Journal of the American Academy of Dermatology, 51(2), 241-248.
Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. S. (2017). The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health and Quality of Life Outcomes, 15(1), 1-9.
Hyperhidrosis, also known as excessive sweating, is a condition affecting many and is normally unrelated to body temperature or exercise. It can often be treated with over-the-counter products, but there is often confusion on which product to purchase since there are so many varieties and claims. Since most people experience hyperhidrosis in the underarm region, the most common product people think about is deodorant, but we have to see that there is a difference between deodorant and antiperspirant.
One of the main reasons that individuals are bothered by hyperhidrosis is the smell that comes associated with excessive sweating. Body odor develops when the bacteria on the skin mixes with the chemicals in the sweat. This is why people often go for deodorants in order to combat the smell, but this doesn’t entirely solve the issue as the sweat will continue to come out. Anti-perspirants on the other hand, block the release of sweat. The main difference between the two is that antiperspirants typically have a higher aluminum content than deodorants. The aluminum in both products can also mix with human sweat, forming a substance that can cause yellow staining on clothing which is harder to remove.
There have also been many rumors linked to the usage of both products. For example, there are many who question whether or not deodorant is safe due to the parabens and fragrances present. These can cause cosmetic allergies for sensitive groups, which is something to keep in mind. There are also those who worry aluminum is bad for their health, as the mechanism is to prevent sweating. Sweating is essential for the human body to rid the body of toxins. When inhibiting the body’s ability to clear out these toxins, there is the question as to whether or not it is bad for the health. Additionally, there have been studies investigating whether or not aluminum is linked to cancer. Some studies support the link, finding that there are traces of aluminum present in breast tissue that can play a role in the development of breast cancer. However, there are also studies that found that an antiperspirant may actually protect against the development. It’s hard to come to a conclusion with so many conflicting studies.
When a patient comes asking for a recommendation, there are many things to consider before we can offer one. I believe the first thing to consider when offering a suggestion, is what is the primary problem that the patient is complaining about. If the smell is bothering them more than the excess sweating, then deodorant would be a better recommendation for them as they are more directed at combatting smell than amount. It is also worth considering that if the issue is the amount of sweat being produced, then an antiperspirant would effectively combat both issues. And if the patient is worried about the safety of both products, there are many “clean” products out there, but to effectively control hyperhidrosis, they may need more than what those clean products can provide. Non-pharmacologically, they should make sure to constantly wash the areas of excess sweat and dress in layers
Resources
“Are Deodorant and Antiperspirant the Same Thing?” Poison Control, www.poison.org/articles/are-deodorant-and-antiperspirant-the-same-thing.
Hyperhidrosis
Sweating is vital for thermal regulation and the natural way for the human body to cool itself. It also has a role in excretion and defense against microbes. Hyperhidrosis is a chronic autonomic disorder characterized by excessive sweating that is above the physiological needs of the body. This condition can lead to social anxiety that impacts one’s professional lifestyle and their mental health. Additionally, the constant moisture on the skin can lead to skin maceration which can increase the risk of skin conditions like athletes' foot or bacterial infections.
Hyperhidrosis affects approximately 4.3% of the United States population, with the majority of cases affecting the axillae. One third of patients report that the condition is intolerable and two thirds of patients report a family history. Primary hyperhidrosis is the result of an autosomal genetic mutation and usually affects those of ages 18-39 years old. Women are more likely to report symptoms to their doctor although prevalence among the sexes is about equal.
The axillae contains three types of sweat glands: eccrine, apocrine, and apoeccrine. Eccrine glands are located throughout the body. They gain function soon after birth and are innervated by cholinergic and sympathetic postganglionic unmyelinated C fibers under the control of the hypothalamus with acetylcholine as the primary neurotransmitter. Apocrine glands are located in specific areas of the body like the axillae and pubic area. They are innervated by sympathetic postganglionic sympathetic nerves with norepinephrine as the primary neurotransmitter. The sweat glands in the axillae are activated by emotional and thermal stimuli. Norepinephrine regulates both glands in emotional sweating. The cause of primary hyperhidrosis is not fully understood, but thought to be an increased sympathetic stimulation of eccrine sweat glands and abnormal control of emotional sweating. As sweating is increased, the enzyme that breaks down acetylcholine, acetylcholinesterase, is inhibited causing the lack of control.
Severity of hyperhidrosis can be measured using The Hyperhidrosis Disease Severity Scale (HDSS) which measures the frequency and tolerability of sweating. Treatment recommendations for all primary focal hyperhidrosis is a topical antiperspirant, aluminum chloride 20%. Aluminum chloride salts obstruct eccrine glands, destroy secretory epithelial cells, and plug the lumen. For craniofacial hyperhidrosis topical 2% glycopyrrolate can be used. One of the most studied treatments is botulinum toxin. This can be used in the axillae, soles of feet, face, and the palms. It works by blocking acetylcholine at the neuromuscular synapse. Other treatments include the use of devices. Microwave thermolysis is a new treatment used that destroys the eccrine sweat glands. Iontophoresis is another treatment that can be used for soles and palms. An electric current is applied and passes water through the skin. The exact mechanism of its effect is unknown but could be due to a decrease in pH, sympathetic nerve stimulation blockage, blockage of sweat secretion, and flow by a hyperkeratotic plug (Arora, et al.). There are several other emerging treatments for this condition.
Hyperhidrosis impacts peoples lives more than one may expect. Patients may experience anxiety or embarrassment when in social situations due to sweat showing on their clothes. They may have to avoid wearing certain colors or avoid certain foods that may make them sweat. Studies have shown an increased prevalence in anxiety and depression in those with hyperhidrosis compared to those without. An international study showed the prevalence of anxiety and depression was 21.3% and 27.2% respectively for patients with hyperhidrosis and 7.5% and 9.7% for those without (Lenefsky & Rice). This is a condition many people suffer with that can lead to several other conditions if left untreated. It is important for healthcare workers to provide a safe environment for patients to feel comfortable expressing their conditions.
Resources:
Arora, G., Kassir, M., Patil, A., Sadeghi, P., Gold, M. H., Adatto, M., Grabbe, S., & Goldust, M. (2022). Treatment of Axillary hyperhidrosis. Journal of cosmetic dermatology, 21(1), 62–70. https://doi.org/10.1111/jocd.14378
Lenefsky, M., & Rice, Z. P. (2018). Hyperhidrosis and its impact on those living with it. The American journal of managed care, 24(23 Suppl), S491–S495.
McConaghy, J. R., & Fosselman, D. (2018). Hyperhidrosis: Management Options. American family physician, 97(11), 729–734.
Hyperhidrosis
Sweating is an important function of the human body, helping to regulate body temperature, respond to emotional stress, and helping metabolism. There are 2 types of sweat glands in the human body: eccrine and apocrine glands. Eccrine glands are the most abundant, present throughout the body and are involved in temperature regulation. These glands release odorless fluid and electrolytes. Apocrine glands are found in the axillae, pubic area, and ear canal. They release sweat plus proteins and other chemicals like pheromones and steroids. This fluid from apocrine glands has a distinct odor due to bacteria-producing urea. Both the central nervous system and the autonomic nervous system are involved in regulating sweat secretion. Acetylcholine regulates thermal sweating and catecholamines like noradrenaline regulate emotional or stress-induced sweating. The autonomic nervous system can adjust the amount of sweating based on the environment, emotion or metabolism when functioning properly.
Hyperhidrosis is a condition in which patients sweat excessively, more than what is physiologically necessary. This condition affects approximately 2% of people in the United States. There are two types of hyperhidrosis: primary and secondary. Primary hyperhidrosis is idiopathic and bilaterally symmetric, affecting the axillae, palms, soles, or face. Secondary hyperhidrosis can be focal or generalized and is caused by a medical condition or medication use. In primary hyperhidrosis, the sympathetic stimulation of the eccrine glands leads to the increased sweating.
Hyperhidrosis affects patients’ quality of life by negatively impacting their self-esteem, relationships, productivity and emotional well-being.
Topical 20% aluminum chloride hexahydrate is the first-line treatment option for primary focal hyperhidrosis regardless of severity of the condition. It should be applied nightly to the affected areas for 6-8 hours and once improvement is seen, the patient can decrease to once or twice weekly, or as needed. Aluminum chloride hexahydrate works by obstructing the eccrine sweat glands and destroying the secretory cells. Adverse effects associated with this treatment include burning sensation, pruritus and skin irritation. If these skin irritations occur patients can opt for an over-the-counter antiperspirant containing aluminum zirconium trichlorohydrate which can decrease excessive sweating without as much irritation as the prescription product.
For facial hyperhidrosis, topical; 2% glycopyrrolate is used as first-line treatment. It is applied once every 2-3 days and has a low side effect profile with mild skin irritation as the main complaint.
For hyperhidrosis affecting the palms and soles, iontophoresis can be used as first or second-line treatment. This treatment involves passing an ionized substance like water through the skin by the application of electrical current. This treatment can be done at home for usually 3 days weekly until effects are observed and then decreased to once weekly as maintenance therapy. Adverse effects include erythema and tingling but are mild.
Botulinum toxin injection is another treatment option with consistent efficacy when used in the axillae and palms. The botulinum toxins bind to synaptic proteins and block the release of acetylcholine that activates the eccrine sweat glands. The toxin is administered intradermally in the affected area. The Minor starch-iodine test is used before injection to identify the exact areas where the sweat is most prominent. Treatment results last for 6-9 months. Adverse effects like injection site pain and decreased grip strength when injected into the palms have been reported.
Resources:
Lenefsky M, Rice Z. Hyperhidrosis and its impact on those living with it. AJMC. https://www.ajmc.com/view/hyperhidrosis-and-its-impact--on-those-living-with-it. Published December 19, 2018. Accessed March 25, 2022.
McConaghy JR, Fosselman D. Hyperhidrosis: Management options. American Family Physician. https://www.aafp.org/afp/2018/0601/p729.html. Published June 1, 2018. Accessed March 25, 2022.
Hyperhidrosis
Sweating is vital for the wellbeing of humans. It assists in thermoregulation, fluid/electrolyte balance and skin hydration. We have three types of sweat glands, eccrine, apocrine, and apoeccrine glands. The eccrine glands are responsible for regulating our body’s temperature; the evaporation from eccrine sweat results in a cooling effect. Eccrine glands are present substantially in the palms and soles and to a lesser extent the axillae. Our sweat secretion is modulated by our central and autonomic nervous system. The 2 main neurotransmitters involved are acetylcholine and catecholamines, such as noradrenaline. Acetylcholine regulates thermal sweating where heat stimuli causes sweating of the face, chest and back. Noradrenaline manages emotional or stress-induced sweating, causing sweating of the palms and soles. Thermal and emotional sweating are controlled by different parts of the brain. Thermal sweating is controlled by the hypothalamus while emotional sweating is regulated by the cerebral cortex.
Hyperhidrosis is the condition of excessive sweating beyond what is physiologically necessary. It can be classified as primary or secondary, based on the cause of sweating. The exact mechanism of primary hyperhidrosis is unknown but it is presumed to be an exaggerated response to sweating. It is not caused by external stimuli, body temperature, or disease. Symptoms are localized to the palms, soles, and axillae and generally develop in childhood or adolescence and persist for life. The diagnosis criteria consist of focal, visible excessive sweating for at least six months without an observable cause. Secondary hyperhidrosis can be due to medications, conditions and endocrine disturbances. The onset is usually after 25 years of age and presents as more generalized than focal.
Hyperhidrosis can have a negative impact on one’s quality of life. Patients suffering with axillary symptoms have reported staining of their clothes. Some have a fear of shaking other people’s hands due to their palmar hyperhidrosis. Patients sometimes have to take multiple daily showers, change clothes throughout the day, and have difficulty with simple tasks such as opening doors. All of this can lead to feelings of depression and anxiety which is why it is important we recognize their challenges and provide patients the care they need.
They are various types of treatment to combat hyperhidrosis. First line treatment for axillary hyperhidrosis include antiperspirants because they are highly accessible, inexpensive, and well-tolerated. Antiperspirants found in over the counter usually contain aluminum which physically blocks the opening of sweat gland ducts. However, there are also prescription strengths such as 20% aluminum chloride hexahydrate or 6.25% aluminum chloride hexahydrate for those who require it. Second-line therapy is botulinum toxin injections or microwave thermolysis. Botulin toxin injections have shown to improve axillary hyperhidrosis but can be painful and costly. Microwave energy is used to destroy the eccrine glands responsible for hyperhidrosis in the axilla. Systemic anticholinergics agents like oral glycopyrrolate can also be utilized but their adverse effects make it not a popular choice. Treatments for palmar and plantar hyperhidrosis are similar but iontophoresis has shown to be very effective. It uses electrical currents to temporarily block sweat glands. As healthcare providers, it is essential we validate our patients concerns and personalize their treatment in order to improve health outcomes.
References:
Lenefsky, Mary and Rice, Zakiya. “Hyperhidrosis and Its Impact on Those Living with It.” AJMC, Dec. 2018.
Smith, Christopher, and David Pariser. “Primary Focal Hyperhidrosis.” UpToDate, Jan. 2020.
Hyperhidrosis is a disorder of excessive sweating due to over-stimulation of cholinergic (nerve cells where acetylcholine (Ach) acts like the primary neurotransmitter) receptors on eccrine glands, which are the major sweat glands of the human body. This disorder manages to unfortunately be three disabilities all in one- a social, emotional and occupational disability which affects close to 3 % of the U.S. population. There are two different types of sweating that exist- thermoregulatory and emotional sweating. These two types of sweating are regulated by different centers in our body- thermoregulatory sweating is regulated primarily by the hypothalamus, which is the region of the forebrain below the thalamus and coordinates the autonomic system which has unconscious (involuntary) control over the body. Emotional sweating is regulated primarily by the limbic system, the part of our brain which is involved in regulating both the human body’s emotional and behavioral responses. The etiology of hyperhidrosis can also be categorized in two different ways. The first way is unknown albeit it’s thought to involve genetics and possibly deemed to be hereditary. The second way is much easier to identify as it can be easily associated with causative agents such as medications such as insulin, antipsychotics, and selective serotonin reuptake inhibitors (SSRIs). The cause for the second possible way can also be due to a patient’s past medical history (PMH) including his or her disease states/conditions (systemic disorders), including hyperthyroidism, Parkinson’s Disease, and diabetes mellitus.
The pathophysiology of excessive sweating is hyperactivity of the parasympathetic nervous system (our body’s “rest and digest” system) which causes an excess in the release of acetylcholine from the nerve endings. Acetylcholine (Ach) will then innervate the epidermal eccrine sweat glands as a physiologic response to our body’s core body temperature control, particularly in times of physical or psychological stress. In hyperhidrosis, it is postulated that the negative feedback ( a reaction that causes a decrease in function) mechanism to the hypothalamus may be impaired which then causes the body to sweat a lot more than what is needed to cool down the body's temperature.
Depending on the localization of hyperhidrosis, there are different types of treatment options. Local treatments include- aluminum chloride (AlCl) 15% to 25% concentration or antiperspirants, tap water iontophoresis for palmar/plantar sweating, and injections of botulinum toxin. AlCl works by reacting with proteins in the sweat duct and then subsequently forming a mechanical obstacle which prevents sweating. AlCl solutions should be applied on completely dry skin once a week or more, preferably when going to bed in order for it to work overnight. Iontophoresis is a type of electrical stimulation where the ions produced can physically block the sweat ducts in the stratum corneum, the outermost layer of the skin. Botulinum toxins are injected intradermally and inhibits the release of acetylcholine from the sudomotor synapses (anything that stimulates the sweat glands). Botox is considered to be the first-line therapy in treating compensatory hyperhidrosis, a common post-surgical complication of sympathetic surgery such as endoscopic thoracic sympathectomy (ETS) which is a type of surgery to treat hyperhidrosis.
References-
Schlereth, T, Dieterich, M, et al. Hyperhidrosis- Causes and Treatment of Enhanced Sweating. Dtsch Arztebl Int. 2009 Jan; 106(3): 32–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695293/
Rystedt, A, Brismar, K, et al. Hyperhidrosis- an unknown widespread “silent disorder.” Journal of Neurology & Neuromedicine. https://www.jneurology.com/articles/hyperhidrosis--an-unknown-widespread-silent-disorder.html
Brackenrich, J, Fagg, C. Hyperhidrosis. Statpearls. https://www.ncbi.nlm.nih.gov/books/NBK459227/
Excessive sweating is a medical condition known as Hyperhidrosis. Sweating is an important function of the body because it cools the body which prevents the body from overheating. Sweating in a person with hyperhidrosis occurs even the body does not need to be cooled down. Common areas in which people sweat when they have hyperhidrosis are from the palms, feet, underarms, or head. Hyperhidrosis is not the same as sweating after a workout or on a really summery day. It presents in different ways such as: visible sweating when not exerting or overworking yourself, sweating that interferes with day-to-day activities such as havening difficulty opening a doorknob, skin that turns soft and white similar to what happens when having your hands in the water for too long, and lastly skin infections. A person suffering with hyperhidrosis might experience skin infections frequently. These skin infections can include athlete’s foot and jock itch since those infections occur from moist being trapped in the skin.
Hyperhidrosis is not a contagious medical condition but it may be brought on due to another medical condition that a person has such as diabetes, a tumor, or even an injury that causes trauma to the body. The condition is caused due to the nerves being excited or overacting.
There are two different types of hyperhidrosis: primal focal and secondary hyperhidrosis. Primary focal hyperhidrosis usually occurs at a young age and it is not caused by another condition. A person with primary focal hyperhidrosis may experience sweating in one or more parts of the body, both side of the body, after waking up, and at least once a week. As opposed to Primary focal hyperhidrosis, secondary hyperhidrosis occurs due to an underlying cause such as another medical condition. A person with secondary hyperhidrosis might experience sweating throughout the entire body as well as sweating during sleep. It might seem humiliating in a public setting and decrease from a person’s quality of life when living with hyperhidrosis.
There are a few different treatment options that can be used for hyperhidrosis. Antiperspirants such as deodorant can be used as first-line treatment. It is affordable and helps your body to reduce the amount of sweat produced. Iontophoresis is another treatment option that may be used on the hands or feet. It is a machine that uses electric current to slow down the sweat glands temporarily. It is usually a 20 to 40 minutes treatment session and most patients require 6 to 10 treatments in order to shut down the sweat glands. Botulinum toxin injections are another form of treatment primarily to treat sweating in areas of the underarms. This is FDA approved treatment that temporarily blocks the chemical in the body from stimulating the sweat glands.
Another FDA approved treatment is the used of prescription cloth wipes which contain an ingredient called glypyrronium tosylate which can reduce underarm sweating. The brand name of this treatment is Qbrexza and it can be used in patients as young as 9 years old. It is a topical that is applied once daily. Many people might only need one cloth for both underarms that lasts them the whole day. Qbrexza is in a medication class called anticholinergics. Anticholinergics might cause side effects of experiencing dry mouth, dry skin, and other effects therefore when using Qbrexza, one must be careful with the use of other medications that are anticholinergics as well.
Anticholinergic medications are also available to be taken by mouth that are off-label use for the treatment of hyperhidrosis. The oral medications include oxybutynin, glycopyrrolate, and others. There are other treatment options as well such as surgery and a new treatment approved by the FDA which destroys the sweat glands. Treatment options and effectiveness are different and are individualized based on the patient. It is important to speak with a dermatologist for the best treatment possible.
“Hyperhidrosis: Overview.” American Academy of Dermatology, www.aad.org/public/diseases/a-z/hyperhidrosis-overview.
“Oral Medication.” The Hyperhidrosis Center at Thoracic Group, www.sweathelpnj.com/treatments/oral-medications/.
Qbrexza. Package Insert. Dermira, Inc; 2018