Data regarding systemic medications in the management of hyperhidrosis (HH) are limited.Objective:
The goal of this study was to provide evidence for the safety and efficacy of systemic medications for primary HH.Methods:
A retrospective chart review was conducted of patients seen at an academic dermatology department prescribed systemic medications for primary HH.Results:
A total of 71 patients were prescribed systemic agents. Twelve patients (17%) were lost to follow-up and were excluded from further analysis. A total of 59 patients with at least 2 months of follow-up data (mean age 28.9 ± 12.0 years; 37 women, 22 men; mean follow-up 19.5 months) were included in the analysis. Palmoplantar and/or axillary HH was most common (42/59; 71%); followed by generalized (9/59; 15%) and craniofacial (8/59; 14%) HH. Glycopyrrolate (generally 1–2 mg once or twice daily) was prescribed to 45 patients, with response rate of 67% (30/45). Fifteen treatment failures included 6 nonresponders and 9 with adverse effects, including xerostomia and gastrointestinal disturbance. Clonidine (0.1 mg twice daily) was prescribed to 13 patients, with a response rate of 46% (6/13). Seven treatment failures included 3 nonresponders and 4 with adverse effects, all relating to decreased blood pressure. One patient responded to oxybutynin at 5 mg twice daily. There were no significant differences in efficacy (P = .21; odds ratios 0.43, 95% confidence interval 0.12–1.5) or adverse effects (P = .46; odds ratios 1.78, 95% confidence interval 0.44–7.1) in comparing glycopyrrolate versus clonidine.Limitations:
This was a retrospective study from a single, university-based population.Conclusion:
Systemic therapy with glycopyrrolate or clonidine can be effective for HH. Nearly two-thirds responded to therapy, and less than a quarter had treatment-limiting adverse effects, all of which were self-limited and nonserious.