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SWEATOPEDIA

Sweatopedia is a leading source of comprehensive, objective, and accurate information on hyperhidrosis.

Antiperspirant

Antiperspirants for the Face and Groin

By Katie Crissman /

Primary focal hyperhidrosis can affect many body parts, and some are more easily treated than others. For some locations, like the hands, there are several treatment options available. Anything from antiperspirants to iontophoresis for palmar hyperhidrosis can be utilized to treat hyperhidrotic skin. Unfortunately, other areas, especially the face and groin, are harder to treat because of the sensitive nature of the skin on those parts of the body. These areas also present a challenge because they are so important to human functioning. Any treatments used to treat the skin of the face and groin must not cause too much further discomfort because those areas are crucial to daily function, and because they can be easily damaged. This is why it is so important for patients to understand their treatment options and the products available to them. For those who suffer from craniofacial hyperhidrosis and excessive groin sweat, there are antiperspirants and other treatments available that are able to reduce sweating without causing damage to sensitive skin.

The Ingredients in Over-the-Counter Antiperspirants and How They Affect Skin

Over-the-counter topical treatments for hyperhidrosis are the first-line options for both craniofacial and groin sweating.[1] However, finding an antiperspirant that is both effective and appropriate for sensitive skin can be a challenge. It is important to remember that before applying any antiperspirant to a sensitive area, it is a good idea to manage hyperhidrosis with a doctor and get their approval before trying a new treatment, even if it is over-the-counter. Before trying any new product on sensitive skin, test it on another area of the body to make sure no allergic reactions or irritation occur as a result.

It is important to understand the different kinds of antiperspirants available on the market before discussing specific products. The most common types of antiperspirants used to treat hyperhidrosis contain aluminum chloride or aluminum chloride hexahydrate. Aluminum is thought to work by obstructing eccrine sweat gland ducts so that sweat productions is limited. The metal ions in the aluminum interact with other molecules in the skin in such a way that the epithelial cells in sweat glands are damaged and form a sort of plug. It is highly effective at reducing sweat production. Some studies have found that aluminum chloride can be quite irritating, making it tricky to use on sensitive areas. Doctors may recommend using 1% hydrocortisone cream to treat irritation caused by aluminum chloride. Antiperspirants with aluminum chloride hexahydrate are usually clinical strength. These may be necessary if aluminum chloride alone is not effective. In order to make products with these ingredients work more effectively, it is important for users to apply them at night to allow a plug to form.[1]

One of the drawbacks of using aluminum chloride or aluminum chloride hexahydrate is that they can be very irritating. One study found that when mixed with salicylic acid, aluminum chloride hexahydrate produced much less irritation and still effectively reduced sweating. Some products now use both of these ingredients together in order to reduce side effects.[1]

Newer, clinical strength over-the-counter antiperspirants often use an ingredient called aluminum zirconium trichlorohydrex or aluminum chlorohydrate to reduce sweating associated with hyperhidrosis. These products have been shown to provide more sweat protection and cause less irritation than aluminum chloride products. Aluminum zirconium trichlorohydrex blocks sweat ducts in a similar way to aluminum chloride, but at a more superficial level. It also produces much less HCl, the chemical that causes skin irritation, than typical aluminum chloride formulations. These newer products may provide a solution for people with sweating in more sensitive areas.[1]

Another active ingredient called aluminum sesquichlorohydrate is now being used in some of the newest antiperspirants on the market. It is said to cause less irritation but still effectively reduces sweating. Currently there are no major studies corroborating its effectiveness although these may come in the future.

Antiperspirants for the Face and Groin

There are several antiperspirant options for people with craniofacial hyperhidrosis and for people who experience excessive groin sweating. When choosing an antiperspirant for facial sweating there are two options: to use an antiperspirant originally designed for another part of the body, or to use an antiperspirant designed specifically for the face. There have been no official studies on the effectiveness of antiperspirants in the treatment of craniofacial hyperhidrosis.[3] However, antiperspirants are effectively used by many to manage facial sweating. The skin around the groin area can be just as sensitive as the skin of the face. There are no products that are currently marketed specifically for use in the perineal region, but listed below are antiperspirants that can be safely used on both the face and the groin. Before trying any of these products, speak to a dermatologist. Finding the right antiperspirant may require trial and error, but it can make a big difference in a person’s quality of life. Antiperspirants on one of the most effective ways to reduce and stop excessive face sweating and groin sweating, so it is worth the effort to find the right one.

There is a product on the market that claims to specifically reduce facial sweating. It is marketed towards women who wear makeup, as a way to prevent sweat from ruining their look. They can, however, be useful for anyone who struggles with a sweaty face. Here is a look:

  • Neat Feat 3B Face Saver Antiperspirant Gel for Facial Perspiration and Shine - This product is available on Amazon. It is specifically designed for use on the face and it’s active ingredient is 17.5% aluminum zirconium trichlorohydrex glycine. This would fall into the category of the newer, clinical strength antiperspirants previously mentioned.
  • This is a list of antiperspirants that can be safely used on the face on the face or groin. These antiperspirants are marketed for sensitive skin and contain active ingredients that have scientifically shown to be effective:

  • Duradry PM 10.5mL Gel Unscented - This product has an active ingredient called aluminum chloride hexahydrate mixed with salicylic acid. As mentioned above, this combination can reduce irritation caused by aluminum chloride hexahydrate.
  • Carpe Lotion - This product uses Aluminum Sesquichlorohydrate, a newer formulation that is said to reduce irritation and be effective for treating excessive sweating. It is not specifically marketed for use on the face, but it is sold as being appropriate for sensitive skin.
  • ZeroSweat Lotion Antiperspirant - This is marketed on Amazon as usable for facial sweating, but this does not appear in writing on the bottle. This product also uses Aluminum Sesquichlorohydrate to minimize irritation and reduce sweating.
  • SweatBlock Antiperspirant - Clinical Strength - This product uses aluminum chloride hexahydrate. It is marketed as a “strong antiperspirant”. It doesn’t contain anything to reduce irritation from the active ingredient, so it should only be tried after using other, less irritating products. This may be helpful for those who suffer from more severe sweating who are trying one more OTC product before moving on to other treatment options.
  • A new type of antiperspirant application has recently hit the market, specifically, companies are using antiperspirant wipes to help people apply antiperspirant more easily. Carpe antiperspirant wipes, in particular, are made to be safe for sensitive skin and could be beneficial for those who have excessive sweating on the face or groin. The wipes make the product easier to apply and it leaves less residue than other types of antiperspirants. Carpe antiperspirant wipes use 15% aluminum chlorohydrate which is a newer generation antiperspirant that is thought to produce less irritation than older active ingredients.[1][4]

    Sweating on either the face or groin can cause sufferers to experience the anxiety that often accompanies hyperhidrosis. While these antiperspirants are not perfect, they may allow sweat sufferers to find quick relief from a non invasive and safe source. If over-the-counter antiperspirants do not provide enough relief, then patients should look into trying some of the other medical treatment options that are available, as well as incorporating anxiety reduction techniques that can reduce sweating into their routine. Choosing clothes that are lightweight and breathable can also help, and there are specific clothes that are best for dealing with excessive sweat. Most people can find relief, it often just a matter of experimenting and finding the product that works.[4]

    If you are wondering why you sweat from your face so much, there may be several reasons. The same is true for groin sweating. Read up on the causes of these conditions to get a better understanding of why you are struggling.

    Sources
    1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
    2. Wollery-Lloyd, H., MD, & Valins, W. (2009). Aluminum Chloride Hexahydrate in a Salicylic Acid Gel: A Novel Topical Agent for Hyperhidrosis with Decreased Irritation. Clinical Aesthetic Dermatology, 2(6). Retrieved September 17, 2018.
    3. Nicholas, R., Quddus, A., & Baker, D. M. (2015). Treatment of Primary Craniofacial Hyperhidrosis: A Systematic Review. American Journal of Clinical Dermatology, 16(5), 361-370. doi:10.1007/s40257-015-0136-6
    4. Innovation Counter. (2018). Final Product Profile Carpe Antiperspirant Wipes [Brochure]. North Carolina: Author.
    5. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.
    Hyperhidrosis Treatments

    Glycopyrrolate for Sweating

    By Katie Crissman /

    If you’ve been thinking about taking medication to help you stop sweating excessively you may have heard about a drug called glycopyrrolate. Both glycopyrrolate and its cousin oxybutynin are medications that can be taken in pill form and can significantly reduce sweating. 

    Many of the most popular treatments for hyperhidrosis (a condition that causes someone to sweat too much) are local. This means that they are used on a specific spot on the body. However, meditations like glycopyrrolate and oxybutynin are often used in conjunction with localized treatments to tackle sweat.

    General Information About These Medications:

    • Glycopyrrolate and Oxybutynin are both anticholinergic medicines used to treat hyperhidrosis, a skin condition that causes excessive sweating
    • You have to have a prescription to get these medications. 
      • Ideally, you will *manage your hyperhidrosis with a dermatologist before you start taking these medications.
    • Neither Glycopyrrolate or oxybutynin are specifically approved by the FDA for the treatment of excessive sweating. They are used off label.[1]

    What You Need to Know About Each Individual Medication

     

    Glycopyrrolate

    Glycopyrrolate (sold under the brand name Robinul) is one of the anticholinergics used most often in the treatment of hyperhidrosis, although this varies widely between doctors and studies. Here’s what you should know about glycopyrrolate:

    • Patients are usually given glycopyrrolate in pill form and instructed to take 1 to 2 mg twice a day. 
      • The normal dosage range is usually between 1 and 8 mgs per day.
      • This is not medical advice and you should always follow your doctor’s instructions.
    • Many times patients are limited in the amount of glycopyrrolate they are able to take due to side effects that increase as the dose increases. 
    • There are several possible side effects, which include:
      • Dry mouth (the most common side effect) 
      • Dry eyes
      • Constipation
      • Nausea 
      • Many others
      • You can drink more water, use mints, take eye-drops and increase fiber consumption to fight address side effects.[1]
    • Glycopyrrolate has a high cost for those without insurance.[2]

    The effectiveness of glycopyrrolate is often related to the dose a patient is able to handle. One study on the effectiveness of glycopyrrolate found that out of 19 patients 80% responded to treatment. However, one third of the patients had to stop treatment due to side effects.[1] 

    Other studies have found that the drug is effective in reducing sweating but that side effects often hinder treatment. Glycopyrrolate is often chosen as a second, or third line therapy for hyperhidrosis that causes excessive sweating of the palms, soles, and armpits. It is one of the first line treatments for craniofacial hyperhidrosis.[3] Many times, using glycopyrrolate in conjunction with other therapies increases the success rate.[1]

    Oxybutynin


    Oxybutynin (brand name Ditropan) is the other most commonly used anticholinergic used in the treatment of hyperhidrosis. Here’s what you need to know about it:

    • When being used orally to treat hyperhidrosis, oxybutynin is typically prescribed in 5 to 10 mg doses and taken daily. It can be used in amounts of 15 to 20 mgs a day if needed. 
      • It is also available as a topical gel, slow-release tablet, and as a transdermal patch. 
    • Oxybutynin has similar side effects when compared to glycopyrrolate. However, it is able to penetrate into the central nervous system (CNS) more easily so it can also have some added CNS side effects.[1] 
    • The side effects include:
      • Constipation
      • Drowsiness
      • Confusion
      • Others[4]
    • It is relatively inexpensive.[2]

    Oxybutynin is found to be effective in treating the symptoms of hyperhidrosis but, like other anticholinergic drugs, side effects often get in the way. One study of 50 patients using oxybutynin to treat palmar and axillary hyperhidrosis found that 70% of patients reported improvements in those areas. Interestingly, 90% of the patients also reported improvement of plantar sweating. Side effects were noted as moderate to severe in 35% of the patients by the six week mark of the study.[1] This indicates that oxybutynin is effective in reducing sweat production, but that, when used orally it can be limited by the side effects it can cause. 

    Another study found that 60% of their patients showed improvement in their quality of life compared to only 27% in the placebo group, when low doses of oxybutynin were given.[4] If patients can find relief at lower doses then this can mitigate the drawbacks caused by side effects.

    What are Anticholinergic Medications? Here’s the Science Behind How They Work

    Anticholinergics agents comprise a group of medications that work by affecting how the body is able to use the neurotransmitter acetylcholine. A neurotransmitter is a type of chemical messenger the brain and spinal cord use to communicate. Specifically, anticholinergics interrupt acetylcholine from being used at certain receptors (muscarinic receptors) throughout the body by binding with it. 

    Muscarinic receptors are located throughout the autonomic nervous system (one of the peripheral nervous systems), and spread out over the whole body, which is why anticholinergics are responsible for such widespread effects.[1] The autonomic nervous system is the part of the nervous system that controls involuntary actions, like the movement of the GI tract muscle, breathing, heart rate, and many other functions.[5] It is also responsible for regulating sweat production, which is why anticholinergic medications can be useful in the treatment of hyperhidrosis.[1]

    There are several types of anticholinergics, although most are not used in the treatment of hyperhidrosis. Glycopyrrolate and Oxybutynin are the two most common anticholinergic medications used to treat excessive sweating. 

    Other types of anticholinergic medicines, like scopolamine and atropine, can cross the blood-brain barrier and cause more unwanted neurological side effects than glycopyrrolate. 

    While there are other anticholinergics that can be used to treat hyperhidrosis, they are not available in the United States. The most studied anticholinergic agent, other than glycopyrrolate and oxybutynin, is called methantheline bromide, and it has had some promising results in Germany.[1]

    Local Treatments that Use Glycopyrrolate and Oxybutynin


    All oral medications for hyperhidrosis will cause side effects that affect the whole body because of how they work. This can often make them less desirable treatment options. Sometimes, this is necessary, like in the case of a patient who has generalized all-over sweating instigated by a medication that causes hyperhidrosis as a side effect.[1] 

    However, both glycopyrrolate and oxybutynin are available in other forms that allow them to be used locally. Both drugs are available to be used in conjunction with an iontophoresis machine when being used to treat palmar and plantar hyperhidrosis. The electrical current from the iontophoresis machine aids the skin in absorbing the medications locally.[5] Topical creams are available containing both medications but their effectiveness is currently unclear as the medications may have trouble penetrating the skin barrier in this form. A new product called Qbrexza uses glycopyrrolate on a medicated wipe that can be used once a day to prevent sweating.[1]

    Future Uses in the Treatment of Hyperhidrosis

    There are various future treatments and research for hyperhidrosis that involve the use of both glycopyrrolate and oxybutynin. The most notable of these future treatments is the use of glycopyrrolate in a topical form which would be able to penetrate into eccrine glands. The cream would contain 1% or 2% glycopyrrolate. Oxybutynin is also being studied and potentially developed into a topical cream. Researchers are also looking into developing a glycopyrrolate pad to relieve sweating symptoms.[1]

    Recently, a product called Qbrexza (created by Dermira) was released and it uses Glycopyrronium Tosylate, a topical form of anticholinergic medication, on a wipe to reduce sweating. It is only marketed for underarm use, but it may have interesting implications for the future of hyperhidrosis treatment. For those who are interested in medicated antiperspirant wipes, but who don’t want to deal with prescription medications like Qbrexza, there are now over-the-counter antiperspirant wipes available from brands like Carpe.

    If you aren’t sure that taking a pill is right for you, then you might want to consider trying a clinical strength antiperspirant product. Recently, Carpe has come out with a product line called Carpe Clinical Regimen that can tackle even the most stubborn underarm sweat.

    Sources
    1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0 
    2. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science. Retrieved from https://novapublishers.com/shop/hyperhidrosis-causes-treatment-options-and-outcomes/ 
    3. Walling, H., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. . American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved September 5, 2018, from https://pubmed.ncbi.nlm.nih.gov/21714579/
    4. Dahl, M. V. (2016). Oxybutynin for Hyperhidrosis. NEJM Journal Watch. Dermatology. doi:10.1056/nejm-jw.NA39817. Retrieved from https://www.jwatch.org/na39817/2016/01/14/oxybutynin-hyperhidrosis
    5. Autonomic nervous system. (2018). Retrieved September 6, 2018, from https://www.merriam-webster.com/dictionary/autonomic nervous system
    6. Qbrexza. (2018). Retrieved February 20, 2019, from https://dermira.com/our-medicines/ 
    Complications of Hyperhidrosis

    Night Sweats: Causes and Treatment Options

    By Katie Crissman /

    Have you been wondering: what are night sweats? We’ve got you covered! Keep reading to find out more about night sweats and what you can do to stop them.

    Night sweating refers to excessive sweating that occurs at night while a person sleeps. This kind of sweating happens in the absence of any environmental stimuli that would normally trigger sweating (like hot temperature). Usually, it causes all-over body sweating. It can get so bad that it causes some people to soak through clothes and bedsheets![1]

    Night sweats are usually a symptom associated with secondary hyperhidrosis, or diaphoresis - unexplained excessive sweating. This is a type of hyperhidrosis that causes excessive sweating due to specific biological factors like illness, drugs, or hormonal states.[2]

    Many times, night sweats are a common symptom and pose no reason for concern, but in some cases they may be a signal of a larger problem. It is important to know when to be concerned about night sweats. If you suddenly begin experiencing night sweats or are having other health issues in conjunction with them, then you shouldmanage your hyperhidrosis with a dermatologist or other qualified doctor. Otherwise, there are many effective tools you can use to learn how to stop your night sweats and find relief.

    Causes of Night Sweats

    There are many possible diseases and conditions that cause secondary hyperhidrosis, and subsequently night sweating. Often, one of the most common causes of night sweats are side effects of medication or drugs.[2] Below is an in-depth look at the possible causes of night sweats.

    Medications and Drugs that Cause Night Sweating

    There is a long list of common medicine that cause hyperhidrosis and any of these medications have the potential to also induce night sweats.[2]

    Of the drugs that can cause secondary hyperhidrosis antidepressants seems to be the most common cause of night sweating. One meta analysis found that between 10% and 14% of those on SSRIs, a very common antidepressant, suffer from night sweating.[3]

    Here is a brief break-down of the types of medications that can cause secondary hyperhidrosis as well as night sweating:

    • Pain medications: many types of opiates, NSAIDs (which are over the counter anti-inflammatories) and marinol (cannabinoid medication)
    • Psychiatric medications: antidepressants, antipsychotics, anxiolytics and ADHD medications
    • Hormonal medications: birth control and other medications containing estrogen or testosterone
    • Diabetes medication[2]

    There are many other medications that can cause secondary hyperhidrosis, which in turn leads to night sweating. Those listed above are just the most common types. So, if you believe a medication may be the reason you are sweating at night then it would be prudent to look at a comprehensive list and determine if your medication may be to blame.[2]

    It should also be known that drug intoxication or withdrawal has the potential to cause night sweating, especially withdrawal from alcohol.[4] If the onset of night sweats is concurrent with the cessation of drug use this cause should be considered.

    Menopause

    Menopause is a notorious cause of night sweats and hot flashes. It usually begins in a woman’s 40’s. It is a hormonal change that indicates a woman is at the end of her childbearing years. Up to 80% of women going through menopause will suffer from night sweats and hot flashes at some point, so it is extremely common.

    There are blood tests that can be done to determine whether a woman is going through menopause and it is advisable to have one done to determine whether it is the cause of night sweats.[5] One study published in the journal Climacteric studied menopausal women from various cultures and it showed that night sweats and hot flashes are a shared physiological phenomenon experienced by women all over the world.[6]

    Illness

    Several illnesses are known to cause night sweating. In some cases, these are short-term illnesses that produce a fever and will go away without intervention in a short period of time. Many times a short-lived fever can be responsible for temporary night sweats.[7]

    Other times, night sweating can indicate a more serious condition, especially if night sweats are ongoing. This is when to be concerned about night sweats. Some cancers, especially lymphoma, can have night sweating as an initial symptom. This is more likely if there has also been unintended weight loss occurring at the same time as the onset of night sweats. Another potentially serious cause of night sweating is Tuberculosis, a serious lung infection. If night sweats have been occurring for a long period of time and are accompanied by weight loss, long-term fevers, enlarged spleen and lymph nodes, then immediate action needs to be taken to ensure that the sweating is not being caused by a serious medical condition.[4]

    There are several other diseases and conditions that can cause secondary hyperhidrosis and night sweats including certain neurological disorders, hormonal conditions, hypoglycemia, and other serious infections.[1] It is important to explore all of the possible causes and discuss your night sweats with a doctor if they are ongoing and disruptive.

    It is also important to point out that in some cases, anxiety can cause night sweats to occur. If this is the case, then addressing the cause of the anxiety or treating the anxiety should help to improve symptoms.[8] Other physiological conditions should be ruled out before anxiety can be deemed as a causative factor. Anxiety which causes night sweats can lead to chronic insomnia so it is important to get address the issues as quickly as possible.

    Night Sweats in Children

    Night sweating can occur in children. One study published in the Archives for Disease in Childhood found that night sweats were most commonly seen in children suffering from eye, respiratory, or atopic diseases. It was also found that these children were more likely to suffer from other sleep related disruptions. Boys tended to have a higher occurrence of sweating than girls.[9]

    If a child is suffering from night sweats there are ways to help kids with hyperhidrosis. It is important to have them checked by a doctor to make sure that there is no serious underlying condition and there are medical treatments available to kids with hyperhidrosis if night sweats are severe.

    How to Stop Night Sweats

    There are several ways doctors know how to stop night sweats. However, the most effective treatment for night sweating is to determine the underlying cause and correct it. This is because night sweats are a symptom of secondary hyperhidrosis, and as such, are most frequently a symptom of another condition.[2]

    If night sweats are something a person will be dealing with for a prolonged time, taking measures to manage hyperhidrosis at home are a good next step. Try some of these natural remedies to stop night sweats:

    • Take a cool shower before bed
    • Keep the bedroom temperature low
    • Change bedding often
    • Turn your pillow over after sweating
    • Dress in layers so you can take clothes off easily
    • Use a bedside fan
    • Avoid triggers like caffeine, alcohol, and spicy foods before bed
    • Use new pajamas every night, and have a clean set by your bedside in case they are needed in the middle of the night.[10]

    How to Stop Night Sweats with Medical Treatments

    If natural treatments are not enough, patients can learn how to stop night sweats by using antiperspirant and topical creams to reduce sweating. These typically use a combination of aluminum and other ingredients to prevent excessive sweating at the sweat gland. They are most effective when used on dry skin and applied at night to allow the formulation to sink in.[2]

    Finally, if a patient cannot fix the root cause of their night sweats, there are oral medications that can prevent systemic sweating. The most common class of medications used to do this are called anticholinergics. They are not without side effects but can be of great help to patients who may otherwise be unable to get proper rest. There are other medications available, but anticholinergics are typically the most effective in this case.[2]

    If you are experiencing night sweats due to menopause then there are several things you can try to reduce your symptoms. Eating a proper diet can improve symptoms as well as reducing substances like caffeine, spicy foods, and alcohol.[11] Women can also try hormonal medications to reduce the side effects of menopause and ease the stress of excessive sweating.

    Now, when you wonder “what are night sweats?” you know the answer - they are a symptom of something else. Overall, stress reduction, a healthy lifestyle and figuring out the cause of your excessive sweating can greatly improve, and even stop night sweats. So, don’t give up and speak to your doctor!

    Sources
    1. 8 Causes of Night Sweats. (n.d.). Retrieved August, 2018, from https://www.webmd.com/menopause/guide/8-causes-of-night-sweats
    2. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
    3. Giudice, M. (2006). Tracing night sweats to drug can be challenging. . Canadian Pharmacists Journal, 139(1), 59-60. Retrieved August 27, 2018, from https://www.researchgate.net/publication/292841542_Tracing_night_sweats_to_drug_can_be_challenging
    4. Greenham, A. (2011). Night sweats. GP, 34-35. Retrieved August 27, 2018, from http://ezproxy.co.wake.nc.us/login?url=https://search.proquest.com/docview/883399774?accountid=14867
    5. Paisly, A. N., & Buckler, H. M. (2010). Investigating secondary hyperhidrosis. BMJ : British Medical Journal (Online), 341. doi:10.1136/bmj.c4475 Retrieved from https://www.bmj.com/content/341/bmj.c4475.full
    6. Freeman, E. W., & K. S. (2007). Prevalence of hot flushes and night sweats around the world: A systematic review. Climacteric, 10(3), 197-214. Retrieved August 27, 2018, from https://pubmed.ncbi.nlm.nih.gov/17487647/
    7. Bishop, S. (2010). For Vast Majority, Night Sweats Don’t Represent Medical Concern. Retrieved August, 2018, from https://newsnetwork.mayoclinic.org/discussion/for-vast-majority-night-sweats-dont-represent-medical-concern/
    8. What Causes Night Sweats? (2018). Retrieved August, 2018, from https://www.webmd.com/a-to-z-guides/ss/slideshow-night-sweats
    9. So, H. K., Li, A. M., Au, C. T., Zhang, J., & Lau, J. (2012). Night sweats in children: Prevalence and associated factors. Archives of Disease in Childhood, 97(5). doi:10.1136/adc.2010.199638 Retrieved from https://pubmed.ncbi.nlm.nih.gov/21427123/
    10. Dealing with Menopausal Hot Flashes and Night Sweats. (n.d.). Retrieved August, 2018, from https://www.healthline.com/health/menopause/hot-flashes-at-night
    11. AntiAging Institute of California; How to Overcome Menopause Hot Flashes, Night Sweats and Other Symptoms. (2014). Pain & Central Nervous System Week. Retrieved August 27, 2018, from https://search-proquest-com.proxy187.nclive.org/docview/1476527644?pq-origsite=summon
    Hyperhidrosis Treatments

    Oral Medications for Hyperhidrosis

    By Katie Crissman /

    Oral medications are often used for the treatment of hyperhidrosis. They are most effective when used in conjunction with other therapies, like topical treatments, to control and minimize the symptoms of hyperhidrosis. They are considered to be a second or third line therapy, and should only be used when other, more localized, treatments have failed to show significant improvement. If someone is planning to use oral medication, it is important to manage hyperhidrosis with an experienced doctor. Medications can be an important aspect of a treatment plan for individuals suffering from hyperhidrosis, and it can greatly improve their quality of life. There are several types of medications used in the treatment of hyperhidrosis which include anticholinergic agents, beta-adrenergic blockers, alpha-adrenergic agonists, benzodiazepines, and a few other less commonly used drugs. No oral drugs are currently approved by the FDA for use in patients with hyperhidrosis, but they can be used off-label for this purpose.[1]

    What type of hyperhidrosis patients should consider oral medications?

    Patients who tend to find oral medications the most effective are those who suffer from all-over sweating, usually caused by secondary generalized hyperhidrosis, and those with primary focal hyperhidrosis who have tried localized therapies, and found them ineffective or intolerable. It is usually recommended that patients try topical creams, botox treatment, iontophoresis, local permanent treatment options for axillary hyperhidrosis, or other localized treatments before moving on to systemic medications. Oral medications can also be especially helpful for patients in which the cause of their hyperhidrosis cannot be removed or remedied. For example, in a patient with a psychiatric illness who suffers hyperhidrosis as a result of a medication, but who can’t stop taking it. Adding another medication to reduce the sweating would be more effective than simply taking the patient off of their psychiatric medication.[1] There are several common medications that can actually cause hyperhidrosis, so situations where medications must be given as an addition to another treatment are not uncommon. Oral medication can also be useful for patients who had a surgical procedure for primary focal hyperhidrosis and need relief from compensatory sweating.[1]

    Some patients, in particular, are not good candidates for oral medication. People who play sports and have hyperhidrosis and people who may become overheated easily are two groups of people that should not take oral medication for hyperhidrosis. This is especially pertinent with the use of anticholinergic agents because they cause the body produce less sweat everywhere, which makes it so the body cannot properly cool itself down during times of excessive heat or increased activity. It is also important to consider the possible dangers of oral medication use in kids who have hyperhidrosis, as they have difficulty with self-monitoring and may become dangerously overheated. There are medical treatment options for children with hyperhidrosis, but parents should be weary when considering oral medications for their children.[1]

    Types of Oral Medication:

    Anticholinergic Agents

    An anticholinergic agentic is a type of medication that blocks the neurotransmitter acetylcholine in both the central and peripheral nervous systems. Sweat glands are innervated by the sympathetic nerves and use acetylcholine as their primary neurotransmitter, which is how they communicate. Therefore, when an anticholinergic agent blocks acetylcholine it prevents the body from sending the messages that tell it to produce sweat. This makes anticholinergic medications one of the most effective and commonly used oral medications to treat hyperhidrosis. Unfortunately, acetylcholine receptors can be found in other places throughout the central and autonomic nervous systems so anticholinergic medications can cause unwanted side effects when they block receptors that are not related to perspiration. Some of these side effects can interfere with the GI system, eye function, nervous system function and cause certain respiratory and urinary issues. There are several kinds of anticholinergic agents doctors prescribe for hyperhidrosis and each one acts slightly differently and has differing side effects. Glycopyrrolate and oxybutynin are the most commonly prescribed anticholinergics used to treat hyperhidrosis.[1]

    Glycopyrrolate is the most commonly used anticholinergic agent prescribed for hyperhidrosis. This is in part because it does not cross the blood-brain barrier as easily as other anticholinergic agents, and thus causes less central nervous system side effects. This medication is taken daily and is quite effective at reducing the amount of sweat caused by hyperhidrosis. It does, however, have a host of side effects, the most common being dry mouth. In a study of children taking this medication 90% had a reduction of hyperhidrosis symptoms.[4] In another study of adults taking glycopyrrolate, it was found that up to 80% had side effects from the drug and one third had to discontinue use of the medicine because of those side effects.[1]

    Oxybutynin is another anticholinergic agent prescribed for hyperhidrosis. In one study, 70% of patients taking reported improvement in their axillary and palmar hyperhidrosis symptoms, while 90% reported improvement from plantar hyperhidrosis symptoms.[1][4]

    There are several other types of anticholinergic agents that may be useful in the treatment of hyperhidrosis, but studies on them are limited or they and they are less commonly used.

    Beta-adrenergic Blockers

    Beta blockers are a type of medication that can affect blood pressure, but are often used to treat patients who want to improve symptoms from social phobia and performance related anxiety. Many people who suffer from hyperhidrosis report a worsening of symptoms during times of performance anxiety and this is when a drug like propranolol (a type of beta blocker) can be useful. For example, a hyperhidrosis patient about to have a public speaking session may take a beta blocker beforehand.[1] These are typically taken on an as-needed basis for people who experience episodic or event related bouts of hyperhidrosis. They are not generally intended for long-term or daily use.[1]

    Alpha-adrenergic Agonist

    The predominant alpha-adrenergic medication used to treat hyperhidrosis is clonidine. It is generally used to treat hypertension (high blood pressure) and some anxiety and phobic disorders. It has been most effective for people who suffer from craniofacial hyperhidrosis. Some side effects include dry mouth, dizziness, constipation, and sedation.[1]

    Benzodiazepines

    Occasionally, benzodiazepines are listed as a treatment for hyperhidrosis but they are primarily used for the treatment of anxiety and psychiatric disorders. Hyperhidrosis is known to cause anxiety, but patients should be careful when usng benzodiazepines. Issues can easily arise due to dependence and abuse issues, so normally doctors prefer to use propranolol for performance related hyperhidrosis.[1]

    Other Medications

    There are other medications that may help with the treatment of hyperhidrosis but there is little to no research on these drugs, and they are only of use in limited situations. Some of these medications include the calcium channel blocker diltiazem, an arthritis medication called indomethacin and the neuropathic pain medicine gabapentin. All of these have been used in limited cases but may be worth looking into if no other treatments are effective.[1] In some situations antidepressants have been found to aid in the treatment of hyperhidrosis as well.[3]

    If first-line treatments for hyperhidrosis are not working, then looking into an oral medication may greatly improve your quality of life. It is important to manage your hyperhidrosis with a doctor and talk to them about pros and cons of systemic medication.

    Sources
    1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
    2. Medications. (n.d.). Retrieved July 27, 2018, from https://www.sweathelp.org/hyperhidrosis-treatments/medications International Hyperhidrosis Society
    3. Walling, H. W., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved July 27, 2018, from https://search-proquest-com.ezproxy.wakegov.com/docview/1467836763?pq-origsite=summon.
    4. Grabell, D. A., & Herbert, A. A. (2016). Current and Emerging Medical Therapies for Primary Hyperhidrosis. doi:10.1007/s13555-016-0148-z
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