Hyperhidrosis (excessive sweating)

Clinic A/P, adults, Clinic A/P, Peds, Hospital A/P, Adults, Hospital A/P, Peds

–Differential diagnosis of hyperhidrosis.

Primary focal hyperhidrosis, Treatment
1st line = Antiperspirants
-Mild hyperhidrosis: Treat with nonprescription antiperspirants
-If nonprescription antiperspirants fail, use prescription strength antiperspirants such as 20% aluminum chloride hexahydrate or 6.25% aluminum chloride hexahydrate.
Other options:
Tap water iontophoresis
2nd-line = Botox
Intradermal botulinum toxin injection helps alleviate hyperhidrosis.

Generalized hyperhidrosis
Start Oxybutinin at 2.5 mg per day and increase gradually to 7.5 mg per day.
Oxybutinin 2.5 mg from day 1 to 4; Oxybutinin 5 mg from day 5 to 7; Oxybutinin 7.5 mg from day 8 on.

Surgical treatments
Endoscopic transthoracic sympathectomy
Excixion of axillary sweat glands, and
Axillary Liposuction

MOA:
Oxybutinin is an anticholinergic medication. It antagonizes acetylcholine at muscarinic receptors; Relaxes bladder smoth muscle, and inhibits involuntary detrusor muscle contractions.

It is able to work in hyperhidrosis because sweat glands are activated through muscarinic receptors.

Further Reading

Checktheirsweat.com has patient resources to manage hyperhydrosis.

Br J Dermatol. 2015 Nov;173(5):1163-8. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. https://www.ncbi.nlm.nih.gov/pubmed/26114588

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