Which topical agents are used for the treatment of hyperhidrosis?

Updated: Mar 23, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Answer

Topical agents for hyperhidrosis therapy include topical anticholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization [27] ), glutaraldehyde, and methenamine. All of these agents are limited by staining, contact sensitization, irritancy, or limited effectiveness. These agents reduce perspiration by denaturing keratin and thereby occluding the pores of the sweat glands. They have a short-lasting effect.

The US Food and Drug Administration (FDA) approved glycopyrronium tosylate topical cloth in June 2018 for primary axillary hyperhidrosis in adults and children aged 9 years or older. It is an anticholinergic agent that inhibits the action of acetylcholine on sweat glands. Approval was based on results from two phase 3 clinical trials, ATMOS-1 and ATMOS-2 (n=697). Of these, 44 were pediatric patients aged 9-16 years. The proportions of patients experiencing a reduction of at least 50% in sweat production at 4 weeks for pediatric versus adult patients were 79.9% versus 74.3% of glycopyrronium tosylate–treated patients compared with 54.8% versus 53% of vehicle-treated patients, respectively. [28, 29]  Topical glycopyrronium tosylate has been judged as a cost-effective measure relative to prescription aluminum chloride. [30]

Contact sensitization is increased, especially with formalin. Aldehydes are used to treat the palms and soles; they are not as effective in the axillae. Glutaraldehyde solution 2% is sold as Cidex. It is not as effective but less staining. The 20-50% solution can be diluted to 10% (more effective, especially for feet, but still staining occurs).


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