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Dermira and Qbrexza
Written by Katie Crissman
October 01 2020

Hyperhidrosis, a condition in which the body produces sweat in excess of what is needed to maintain homeostasis of thermoregulation, is often underdiagnosed and undertreated. It is estimated that it affects about 3% of the US population, and even higher proportions of the populations in some other countries. While there are various treatment options available, they are often time consuming and expensive.[1] That is why it is so important that future treatments and research for hyperhidrosis is being conducted. Currently, anticholinergic medications, like glycopyrrolate and oxybutynin, are treatment options for heavy sweaters, but until recently they were not available in a topical form that was effective in treating hyperhidrosis. When taken orally, anticholinergic medications can have systemic side effects that often deter patients from sticking with their treatment.[1] Qbrexa is a notable product because it allows patients to use anticholinergic medication, which are effective at preventing sweat production, without exposing them to as many side effects because it is a localized treatment.

Qbrexza: What It Is and How It Works

Qbrexza is the newest product approved by the FDA to treat primary axillary hyperhidrosis. It is a medicated cloth which can be used as a topical treatment to stop the excessive axillary sweating that many people with hyperhidrosis suffer from. According to the company’s website, Qbrexza contains a topical anticholinergic medication called Glycopyrronium Tosylate which is highly effective at inhibiting sweat gland activation, thus blocking sweat production.[2] Qbrexza is simple and easy to use. Each medicated cloth is designated to be used one time on a clean underarm. Qbrexza should only be used to treat axillary sweating as it is not approved for use on other parts of the body. It only needs to be applied once every 24 hours, making it quite convenient.[3]

There have been other treatments for axillary hyperhidrosis approved by the FDA. In 2004 Botox injections were approved and in 2011 the FDA approved a treatment called Miradry. Botox treatment for axillary hyperhidrosis is highly effective, but it needs to be repeated after several months and it can be invasive and expensive.[1] Miradry is a local permanent treatment option for axillary hyperhidrosis, it has been found to be effective but it is also very expensive. The cost of hyperhidrosis is an issue for many patients seeking treatment for their condition, and continues to be a problem as many insurance plans don’t cover options like MiraDry.[1] This makes Qbrexza unique as it provides patients with a treatment option that is effective, noninvasive, and cost effective.

In order to receive FDA approval, Qbrexza has gone through clinical trials, the results of which can be found on Dermira’s website. The results of two of these clinical trials, called ATMOS-1 and ATMOS-2, are what led to the FDA giving Qbrexza approval. The clinical trials were done to test the efficacy and safety of Qbrexza. Both trials tested the change in the amount of sweat production participants produced before and after treatment. Participants were tested by weighing the amount of sweat they produced and by giving them an Axillary Sweating Daily Diary which is a patient-reported outcome tool developed by Dermira under the consultation of the FDA.[2]

Qbrexza may provide relief for many people who would otherwise lack appropriate treatment. While there have been innovations in treatment options for axillary hyperhidrosis over the years, there hasn’t been an easy and effective prescription solution for those with hyperhidrosis.[4] However, there are over-the-counter antiperspirant wipe alternatives that can be obtained without a doctor’s prescription. For example, Carpe has a line of antiperspirant wipes that can be used for both axillary hyperhidrosis and hyperhidrosis that affects other areas of the body.[5] So, for those who want the ease of a medicated wipe, but who don’t have severe hyperhidrosis, that may be a safer option. Hopefully, in the coming years Qbrexza will provide a successful treatment option for those with hyperhidrosis who are either unable to receive other treatments or who haven’t found another treatment option that works.

Who Can Use It?

Qbrexza can be used by hyperhidrosis patients that are over the age of nine.[2] Another fact that makes Qbrexza notable is that it can be used by the pediatric population. Most of the other doctor prescribed treatments options available cannot be safely used by children.[1] More studies are currently being conducted to see how Qbrexza affects children ages nine to sixteen and the results of these studies will be critical to its use in younger patients. At this time, the studies that have been done on patients between the ages of 9 and 16 have shown promising results regarding the drug’s safety.[6] A product that allows a hyperhidrosis patient to experience relief during adolescents may prevent the development of anxiety that is often associated with hyperhidrosis. It is important to note, however, that children can use over-the-counter topical solutions for hyperhidrosis, and these are the first-line treatments for the condition. If children haven’t tried an over-the-counter antiperspirant prior to Qbrexza they may want to try an alternative antiperspirant wipe first, like those made by Carpe, because over-the-counter antiperspirants don’t require a doctor’s prescription and they generally have less side effects.[1] There is currently no information available regarding the use of Qbrexza in pregnancy and while breastfeeding. It is always advisable to avoid medications during pregnancy and breastfeeding unless they are proven to be safe.[2]

Adverse Reactions

There are several potential adverse reactions that are similar to the side effects produced by oral anticholinergics. Adverse reactions from Qbrexza are less likely to occur than those caused by oral medications for hyperhidrosis because the active ingredient is given in a topical form on a localized area of the body. The most common side effects were dry mouth (24.2%), mydriasis (6.8%), oropharyngeal pain (5.7%), headache (5.0%), urinary hesitation (3.5%), vision blurred (3.5%) and several other effects that occurred in less than 3% of patients.[2]

Aside from the known adverse reactions that patients can experience, it is important to understand how Qbrexza can affect people over the long term. One study, that was presented at the Fall Clinical Dermatology Conference in 2017, found that those who used Qbrexza daily for a period of 48 weeks tolerated it well during that time period. Most side effects were related to local skin reactions and those were experienced by about one third of the people in the study. Eight percent of the people in the study dropped out because of severe reactions, so it is important to understand that serious reactions can occur. Transient blurred vision occured in several participants and it can be a particularly bothersome side effect.[7]

Unfortunately, Qbrexza can only be used on the underarms, which leaves some people with hyperhidrosis lacking the ability to use these potentially helpful wipes. Anticholinergics, the type of medication Qbrexza uses, are powerful drugs and they may not be safe for use on certain sensitive areas of the body.[9] It remains to be seen whether approval for use on other areas of the body will eventually be approved.

For hyperhidrosis patients who want the ease of a medicated wipe like Qbrexza, but who do not wish to use prescription strength drugs, there are other options available on the market. Carpe has recently come out with antiperspirant wipes that utilize Aluminum Chlorohydrate as the active ingredient in their wipes.[5] Aluminum Chlorohydrate is commonly used in over-the-counter topical treatments for hyperhidrosis to reduce excessive sweating.[1] Antiperspirant wipes, like those created by Carpe, have been found to be quite effective and and they can be used safely on most parts of the body.[5] This makes them more versatile than wipes that can only be used for axillary sweating. They also don’t require a require a doctor’s prescription which is can be more convenient for those suffering from hyperhidrosis. Here is how Qbrexza compares to Carpe’s antiperspirant wipes and how to tell which product is the right one for you.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
  2. Qbrexza. (2018). Retrieved September 26, 2018, from https://dermira.com/our-medicines/
  3. PATIENT INFORMATION Qbrexza™. (2018). Retrieved September 26, 2018, from http://pi.dermira.com/QbrexzaPPI.pdf
  4. Dermira Provides Launch Readiness Update for QBREXZA(TM) (glycopyrronium) Cloth for Primary Axillary Hyperhidrosis. (2018, September). Dow Jones Institutional News. Retrieved September 26, 2018, from https://www.nasdaq.com/press-release/dermira-initiates-proofofconcept-study-to-evaluate-qbrexza-glycopyrronium-cloth-in-patients-with-20190222-00305
  5. Innovation Counter. (2018). Final Product Profile Carpe Antiperspirant Wipes [Brochure]. North Carolina: Author.
  6. PROVEN SAFETY AND TOLERABILITY WITH ONCE-DAILY USE IN PEDIATRIC PATIENTS. (2019). Retrieved April, 2019, from https://www.qbrexza.com/hcp/pediatric-safety
  7. Innovation Counter. (2018). Final Product Profile Carpe Antiperspirant Wipes [Brochure]. North Carolina: Author.
  8. Glasser, D. A., Herbert, A. A., Nast, A., Werschler, W. P., Shideler, S., Green, L., Pariser, D. M. (2017, October 12). Open-Label Study (ARIDO) Evaluating Long-Term Safety of Topical Glycopyrronium Tosylate (GT) in Patients With Primary Axillary Hyperhidrosis [Scholarly project]. Retrieved February 19, 2019, from https://www.sweathelp.org/pdf/2017 - Glaser - Open-label study (ARIDO) evaluating long-term safety of topical GT.pdf
  9. Qbrexza™ Rx Topical Cloths/Wipes. (n.d.). Retrieved April, 2019, from https://www.sweathelp.org/hyperhidrosis-treatments/qbrexza
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Antiperspirant

What You Need to Know About Carpe Clinical Regimen

By Katie Crissman /

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen - it combines several high performing products with a specific care routine to provide long term sweat reduction for even the heaviest sweaters. Read on to see if Carpe Clinical Regimen is right for you!

Antiperspirant is great - for most people. You apply it once a day and it stops your sweat! It’s easy. But, what if that’s not what happened? You bought it, read the label, and used it exactly as directed and, unfortunately, you’re still sweating - excessively. If this is you, then you’ve come to the right place. There are products specifically made for heavy sweaters who haven’t had luck with traditional antiperspirants. These products typically include the words “extra strength”, “clinical strength” or “prescription strength” and they are, thankfully, available over the counter without a doctor’s prescription. 


The difference between clinical strength products and their weaker counterparts are the active ingredients they use. Clinical strength lines typically use one of several newer types of metallic salt ingredients that are known to be both stronger and less irritating than aluminum chloride (which is the standard active ingredient in antiperspirants) [1]. While there are many clinical strength products on the market, we are going to focus on a new clinical strength regimen that combines a strong active ingredient with a specific care routine to get excessive sweating under control. 


Carpe Clinical Regimen -  What It Is and How It’s Different

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen. It’s different from other prescription grade products because it combines several strong products with a specific care routine to ensure maximum product performance. It’s also different from Carpe’s other products because it uses a stronger active ingredient and delivery system. The system is geared toward people who experience intractable armpit sweating, but Carpe also makes products for people who struggle with other types of sweat. The Carpe Clinical Grade Underarm includes three specific products that, when used together, have been found to be highly effective at reducing sweat production. These products include:

  • Carpe Clinical Grade Underarm Antiperspirant 
  • Carpe Clinical Grade Exfoliating Wash
  • Carpe Clinical Grade Underarm Wipes[2]

Carpe Clinical Grade Regimen uses an active ingredient called Aluminum Zirconium Tetrachlorohydrex GLY (20%) combined with other soothing inactive ingredients to effectively stop sweat in its tracks while reducing skin irritation.[3] Aluminum Zirconium Tetrachlorohydrex is a newer generation metallic salt that stops sweat production and is known to be more effective than other types of active ingredients antiperspirants typically use. One study mentioned in the journal Dermatologic Clinics found that antiperspirants using Aluminum Zirconium Tetrachlorohydrex were, on average, 34% more effective than antiperspirants that used aluminum chloride as an active ingredient.[1] Carpe’s traditional products use an active ingredient called Aluminum Sesquichlorohydrate at 15% which is effective, but less potent than Aluminum Zirconium Tetrachlorohydrex.[4]


It’s important to note that Carpe’s Clinical Grade Regimen provides a long term impact on sweat reduction from making short term lifestyle changes. This is because the results build up over time and peak at about 4 weeks. It takes 4 weeks of using the Carpe clinical grade products once each morning and every other night to see the full effect of what they can do. This is typical of all antiperspirants as their effects tend to build up with consistent use. Consistently using antiperspirant products is especially important for those with hard to treat sweat problems because it can be the difference between treatment success or failure.[1][2] 


If you’re frustrated with the way your current antiperspirant is working or how it isn’t working, then consider giving Carpe’s Clinical Grade Regimen a try! It’s active ingredient is comparable to other prescription strength products on the market but it’s multistep system with easy to use wipes is completely unique! Remember, an easy to use, consistent antiperspirant routine is going to give you long term sweat reduction so it’s important to find a system that works for your lifestyle. 


Sources
  1. 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>https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
  2. How It Works (Clinical). Carpe. https://mycarpe.com/pages/how-it-works-clinical. 
  3. Clinical Underarm  PM Wipes. Carpe. https://mycarpe.com/products/clinical-grade-underarm-antiperspirant-wipes?variant=34814174724229
  4. Underarm Antiperspirant for Excessive Underarm Sweating. Carpe. https://mycarpe.com/products/underarm-antiperspirant-tube?variant=39247505358981
Body Areas Affected by Hyperhidrosis

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating

By Daniel McCarthy /

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating


On my first day of work a few years ago, I got dressed to impress and walked the 20 minutes to my new office to meet my new colleagues for the first time. Having just moved to the southern US, I’d been getting used to the unbearable humidity and its effects on my excessive armpit sweating. Luckily (I thought), the sun wasn’t out and the temps dropped below 80, so maybe my sweat glands wouldn’t take center stage! Well...I arrived to meet my colleagues looking like a wet bass in business clothes. Thank goodness I arrived 15 minutes early, which brings me to the first outrageous thing people try to avoid armpit sweating. 

  1. The Hand Dryer 

I anxiously scurried to the nearest bathroom, declothed, and put the hand dryer to good use on my shirt stains and sweat stains. More outrageously, I awkwardly hovered my sweaty extremities (including my sweaty underarms) over the hand dryer. Thankfully, I reapplied my antiperspirant and headed out to meet my colleagues a decently dry man. That was the day I knew I really needed clinical strength antiperspirant for my excessive armpit sweating (and a car). 


  1. Pantyliners


Many with excessive underarm sweating already know that underarm pads are one way to help with sweating armpits. But if you find yourself sans pad and worried about your excessive armpit sweating, you would not be the first person to try pantyliners. That’s right, pantyliners have been used in a pinch to help keep sweat stains at bay. 

  1. Give a shirt

In 2019, a reddit user posted that to combat his excessive armpit sweating, he skipped the typical clothing and made his own shirt. He posted asking others to try out his creation and received over 250 replies! By creating and giving others shirts, this innovative reddit user designed his way into the hearts of many with smelly armpits. 

  1. Get inked

If you’ve been debating whether to get a tasteful tattoo and you have hyperhidrosis, this finding may just help you make your decision. A 2017 study found that getting inked helped reduce sweat [1]! Now, I don’t recommend choosing a tattoo as a means of treatment for excessive armpit sweating (and maybe don’t tattoo your armpit), but the connection is a fun little fact nonetheless. 

  1. Become a naked mole rat

If you can’t pull the trigger on an armpit tattoo, another method some people have tried is hair removal. Yes, like Steve Carrell (who actually has hyperhidrosis himself) in the hit movie 40-year Old Virgin, removing hair can help reduce sweat buildup for you too. Many likely already “naturally” lose hair thanks to some sweat prevention products, but more natural hair removal may just be the trick to solving excessive sweating. 

  1. Armpit art

Even though we know most sweaty armpit causes, like too much caffeine or spicy foods, it’s no fun to cut these out completely. A more outrageous approach to excessive underarm sweating is actually turning sweating armpits into art. Multiple users of the Reddit community r/Hyperhidrosis have created shirts, sweatshirts, and other clothing that includes beautiful tie-dye in the armpits. Creative, fun, and beautiful, and even better when combined with sweat prevention like antiperspirant or carpe underarm. 

  1. Vinegar your armpit

You may already know how to get rid of pit stains with vinegar, but there are other interesting ways it can help with excessive armpit sweating. Splashing vinegar on your sweaty underarms  is one method many recommend. Those that swear by this method also recommend using deodorant or antiperspirant, too. 

While we don’t know how this was discovered, I like to think someone accidentally splashed vinegar on their pits hundreds of years ago and voila! Too bad the first person to splash his pits with vinegar didn’t also have access to the best antiperspirant for his excessive armpit sweating. 

  1. Baking soda your sweaty underarms

If you find deodorant or antiperspirant irritating, one creative way to help alleviate your excessive underarm sweating is baking soda. Many crafty people with hyperhidrosis swear that not only can baking soda help reduce sweat, but it can also help alleviate pesky underarm smell with some of the best sweat prevention. 

  1. Restart the plaid fad

Black t-shirt, black sweatshirt, black button down, black tank top. If this sounds like your closet, you’re clearly an expert on the hyperhidrosis wardrobe. But if you want some variety as you fight excessive armpit sweating, add some plaid, a trick many with hyperhidrosis use that you may not know. Hey, you just may be starting the resurgence of the plaid fad, and at worst, you’ll add some fun, lumberjack variety to your dark closet. 


Sources: 

[1] Luetkemeier, M. J., Hanisko, J. M., & Aho, K. M. (2017). Skin Tattoos Alter Sweat Rate and Na+ Concentration. Medicine and science in sports and exercise, 49(7), 1432–1436. https://doi.org/10.1249/MSS.0000000000001244
Body Areas Affected by Hyperhidrosis

How to Cure Sweaty Hands Permanently at Home

By Daniel McCarthy /

How to Cure Sweaty Hands Permanently at Home 

Scenario 1: You’re invited into the office, confident you will land the job. You’ve prepared, you’re highly qualified, you have absolutely nothing to worry about. You walk in and confidently reach out to shake the CEOs hand. But then, your confidence turns to dread as the CEO pulls her hand back, wet with your sweat. 

Scenario 2: You’re at home, playing video games with your friends and absolutely dominating. They get so upset, they tell you to take a break to let another friend play. But there’s another problem... nobody wants to use your controller after you finish. Despite your domination, your palmar hyperhidrosis (excessively sweaty hands) has taken center stage. 

Do these scenarios sound familiar? Wondering how to cure sweaty hands permanently? Although you may not have had these exact things happen to you, your sweaty hands likely have caused something similar and you’re looking for a home remedy. To stop sweating these situations, let’s talk about how to cure sweaty hands permanently at home. 

One of the best ways to cure sweaty hands at home is actually not related to the hands at all. Instead, working on reducing anxiety can have immensely positive results on how to cure sweaty hands permanently naturally. There are many root causes of anxiety, and some or many may be related to your hyperhidrosis. Likewise, it is easier said than done to reduce anxiety. But there are also many ways to work on reducing anxiety that are worth a try. One interesting way to reduce anxiety, and in turn, sweaty hands, is to be grateful. Specifically, Petrocchi and Couyoumdjian found that “grateful people experience less anxiety mostly because they are able to encourage and be compassionate and reassuring toward themselves when things go wrong in life” [1]. Other ways include stepping outside for a walk, drinking tea, or even distracting yourself. In general, starting with anxiety reduction not only can help with how to cure sweaty hands, but also your wellbeing in general. 

Another great way to cure sweaty hands at home permanently is to reduce consumption of coffee and alcohol. Now you may be reading this and thinking “Hey, those are all my favorite things! I’m done with this article!”. And while I wholeheartedly agree and enjoy coffee and alcohol myself, consumption in moderation is key, especially with hyperhidrosis. Caffeine, for example, activates part of the brain that is already a main part in causing hyperhidrosis symptoms. Instead of giving it up, try to reduce consumption to under 200 mg or add in decaf to your routine. Alcohol can affect hyperhidrosis in a similar manner, but like coffee, 1-2 glasses of alcohol may be okay. When figuring out how to cure sweaty hands permanently naturally, it is important to find a balance of coffee, alcohol, and managing your hyperhidrosis. And remember to always drink responsibly, in moderation. 

Tackling how to cure sweaty hands permanently, naturally, and at home may require more than behavioral changes we’ve talked about so far. Luckily, there are other great remedies you can try at home! First, finding the right antiperspirant is of paramount importance, especially appropriate antiperspirant for hands. Another possible over the counter option is anti-sweat wipes. If neither of these work for you, another option to cure your sweaty hands permanently is to buy your very own iontophoresis machine for at-home use. This machine delivers mild electrical currents to your hands (or other affected body part) while submerged in water. A combination of these treatments may have your hands feeling less clammy in no time! 

Ultimately, your palmar hyperhidrosis may not be treatable at home and permanently, but these recommendations may help alleviate some of your symptoms. If symptoms persist, consult a medical professional for further assistance with how to cure sweaty hands. 



Sources

Sources

1. Nicola Petrocchi & Alessandro Couyoumdjian (2016) The impact of gratitude on depression and anxiety: the mediating role of criticizing, attacking, and reassuring the self, Self and Identity, 15:2, 191-205, DOI: 10.1080/15298868.2015.1095794

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