The pharmacological treatment and management of hyperhidrosis

ABSTRACT

Introduction

Idiopathic hyperhidrosis is a dysfunctional disorder involving eccrine sweat glands, and its impact on patients’ daily quality of life is well known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options.

Areas covered

The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatment flow chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar, and craniofacial hyperhidrosis.

Expert opinion

Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis, can be an added therapeutic option for patients with insufficient response to topical treatment. Until the pathophysiological mechanisms underlying hyperhidrosis are clear and the etiological therapeutic approach becomes realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms,

KEYWORDS:

• Focal hyperhidrosis
• pharmacological treatments
• Axillary hyperhidrosis
• palmoplantar hyperhidrosis
• craniofacial hyperhidrosis

Article highlights

• Hyperhidrosis is an idiopathic disorder characterized by excessive sweating not related to heat or physical exercise, whose impact on patients’ quality of life can be so great as to compromise the relationship life up to complete social isolation.

• Different therapeutic options are available (topical antiperspirants, topical anticholinergics, botulinum toxins, oral anticholinergics) according to body site involvement and disease severity

• Axillary hyperhidrosis is the most easily managed form of hyperhidrosis through a stepwise incremental therapeutic approach based on antiperspirants, topical anticholinergics, botulinum toxins, and oral anticholinergics.

• Palmoplantar hyperhidrosis is still a therapeutic challenge owing to its impact on patients’ quality of life and the efficacy–safety ratio of available treatments.

• Craniofacial hyperhidrosis remains one of the less investigated forms of hyperhidrosis, and its treatment represents a great challenge, although promising topical anticholinergics are incoming.

This box summarizes key points contained in the article.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.