Safety of available and emerging drug therapies for hyperhidrosis

ABSTRACT

Introduction: Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available.

Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute.

Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.

KEYWORDS:

• Hyperhidrosis
• aluminum salts
• anticholinergics
• botulinum toxin
• safety

Article highlights

• Hyperhidrosis has frequently a negative impact on quality of life.

• Numerous potent treatment modalities are available with overall good safety profiles in suggested doses.

• Aluminum salts in antiperspirants are suspected to cause breast cancer and Alzheimer disease although scientific proof is missing.

• Stepwise up-titration of oral anticholinergics prescribed for hyperhidrosis is needed to reduce the risk of severe systemic effects.

• Botulinum toxins temporarily interfere with signal transduction of sympathetic nerve fibers stimulating sweat glands. Depending on the treated site anhidrotic effects last from 3 to more than 12 months. Injection pain is the most often reported complaint.

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Declaration of interest

Christine Hosp was investigator in a clinical hyperhidrosis trial sponsored by Riemser Pharma GmbH, Greifswald-Insel Riems, Germany. Henning Hamm was principal investigator and investigator in clinical hyperhidrosis trials sponsored by Allergan Co., High Wycombe, United Kingdom, Ipsen Pharma GmbH, Ettlingen, Germany, and Riemser Pharma GmbH. He received a research grant and speaker’s honoraria from Allergan Co., United Kingdom, and Pharm-Allergan GmbH, Frankfurt am Main, Germany. The authors have no other 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 apart from those disclosed.

Additional information

Funding

This paper has not been funded.