Top

Dermatology and Therapy

Published in:

Open Access 03-11-2022 | Umeclidinium | Review

Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics

Authors: Nikita S. Wong, Taylor M. Adlam, Geoffrey A. Potts, Mehdi Farshchian

Published in: Dermatology and Therapy | Issue 12/2022

Abstract

Background

Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate.

Objective

This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options.

Methods

We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH.

Results

The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate.

Conclusion

Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.

Baker LB. Physiology of sweat gland function: the roles of sweating and sweat composition in human health. Temp Multidiscip Biomed J. 2019;6(3):211–59. https://doi.org/10.1080/23328940.2019.1632145.CrossRef

Smith FCT. Hyperhidrosis. Surgery. 2013;31(5):251–5. https://doi.org/10.1016/j.mpsur.2013.03.005.CrossRef

Walling HW, Swick BL. Treatment options for hyperhidrosis. Am J Clin Dermatol. 2011;12(5):285–95. https://doi.org/10.2165/11587870-000000000-00000.CrossRefPubMed

Stashak AB, Brewer JD. Management of hyperhidrosis. Clin Cosmet Investig Dermatol. 2014;7:285–99. https://doi.org/10.2147/CCID.S53119.CrossRefPubMedPubMedCentral

Liu V, Farshchian M, Potts GA. Management of primary focal hyperhidrosis: an algorithmic approach. J Drugs Dermatol. 2021;20(5):523–8. https://doi.org/10.36849/JDD.5774.CrossRefPubMed

Kurta AO, Glaser DA. Emerging nonsurgical treatments for hyperhidrosis. Thorac Surg Clin. 2016;26(4):395–402. https://doi.org/10.1016/j.thorsurg.2016.06.003.CrossRefPubMed

Hebert AA, Glaser DA, Green L, et al. Long-term efficacy and safety of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: post hoc pediatric subgroup analysis from a 44-week open-label extension study. Pediatr Dermatol. 2020;37(3):490–7. https://doi.org/10.1111/pde.14135.CrossRefPubMedPubMedCentral

Hyun MY, Son IP, Lee Y, et al. Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study. J Eur Acad Dermatol Venereol. 2015;29(2):278–82. https://doi.org/10.1111/jdv.12518.CrossRefPubMed

Kisielnicka A, Szczerkowska-Dobosz A, Purzycka-Bohdan D, Nowicki RJ. Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities. Postepy Dermatol Alergol. 2022;39(2):251–7. https://doi.org/10.5114/ada.2022.115887.CrossRefPubMedPubMedCentral

10.

Pariser R, Hebert A, Nast A, et al. DRM04 for the treatment of primary axillary hyperhidrosis: primary results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. J Am Acad Dermatol. 2017;76(6):AB105. https://doi.org/10.1016/j.jaad.2017.04.419.CrossRef

11.

Pariser D, Gopalan R, Drew J, Green L. Clinical management of anticholinergic adverse events with topical glycopyrronium tosylate, a treatment for primary axillary hyperhidrosis. J Clin Aesthetic Dermatol. 2019;12(5):S19.

12.

Glaser DA, Hebert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. J Am Acad Dermatol. 2019;80(1):128-138.e2. https://doi.org/10.1016/j.jaad.2018.07.002.CrossRefPubMed

13.

Lain EL, Glaser DA, Gopalan R, Yan V, Drew J, Pariser DM. Long-term efficacy of glycopyrronium cloth in patients with primary axillary hyperhidrosis. J Am Acad Dermatol. 2019;81(4):AB234. https://doi.org/10.1016/j.jaad.2019.06.1049.CrossRef

14.

Glaser DA, Hebert A, Gopalan R, Drew J, Pariser D. Short- and long-term efficacy and safety of glycopyrronium cloth for the treatment of primary axillary hyperhidrosis. J Dermatol Nurses Assoc. 2020;12(2). https://www.embase.com/search/results?subaction=viewrecord&id=L634427626&from=export

15.

Pariser DM, Lain EL, Mamelok RD, Drew J, Mould DR. Limited systemic exposure with topical glycopyrronium tosylate in primary axillary hyperhidrosis. Clin Pharmacokinet. 2021;60(5):665–76. https://doi.org/10.1007/s40262-020-00975-y.CrossRefPubMedPubMedCentral

16.

Lamb YN. Topical glycopyrronium tosylate in primary axillary hyperhidrosis: a profile of its use. Clin Drug Investig. 2019;39(11):1141–7. https://doi.org/10.1007/s40261-019-00853-x.CrossRefPubMedPubMedCentral

17.

Arnold MJ, O’Connor C. Glycopyrronium (qbrexza) topical wipes for hyperhidrosis. Am Fam Physician. 2019;100(6):372–3.PubMed

18.

Nofal E, Salem S, Khashaba SA. Intradermal botulinum toxin a injection versus topical 2% glycopyrrolate for the treatment of primary facial hyperhidrosis: a pilot study and review of literature. Dermatol Surg. 2022;48(8):843–8. https://doi.org/10.1097/DSS.0000000000003490.CrossRefPubMed

19.

Abels C, Soeberdt M, Kilic A, et al. A glycopyrronium bromide 1% cream for topical treatment of primary axillary hyperhidrosis: efficacy and safety results from a phase IIIa randomized controlled trial. Br J Dermatol. 2021;185(2):315–22. https://doi.org/10.1111/bjd.19810.CrossRefPubMedPubMedCentral

20.

Nguyen NV, Gralla J, Abbott J, Bruckner AL. Oxybutynin 3% gel for the treatment of primary focal hyperhidrosis in adolescents and young adults. Pediatr Dermatol. 2018;35(2):208–12. https://doi.org/10.1111/pde.13404.CrossRefPubMedPubMedCentral

21.

Davila GW. Oxybutynin topical gel in the treatment of overactive bladder. Open Access J Urol. 2010;2:91–8.CrossRefPubMedPubMedCentral

22.

Kontochristopoulos G, Markantoni V, Agiasofitou E, et al. Treatment of primary axillary hyperhidrosis with a cream formulation of oxybutynin chloride 10%. J Eur Acad Dermatol Venereol. 2021;35(8):e524–6. https://doi.org/10.1111/jdv.17297.CrossRefPubMed

23.

Baldwin CM, Keating GM. Transdermal oxybutynin. Drugs. 2009;69(3):327–37. https://doi.org/10.2165/00003495-200969030-00008.CrossRefPubMed

24.

Artzi O, Loizides C, Zur E, Sprecher E. Topical oxybutynin 10% gel for the treatment of primary focal hyperhidrosis: a randomized double-blind placebo-controlled split area study. Acta Derm Venereol. 2017;97(9):1120–4. https://doi.org/10.2340/00015555-2731.CrossRefPubMed

25.

Kirsch B, Smith S, Cohen J, et al. Efficacy and safety of topical sofpironium bromide gel for the treatment of axillary hyperhidrosis: a phase II, randomized, controlled, double-blinded trial. J Am Acad Dermatol. 2020;82(6):1321–7. https://doi.org/10.1016/j.jaad.2020.02.016.CrossRefPubMed

26.

Gregoriou S, Tsiogka A, Kontochristopoulos G, Offidani A, Campanati A. Sofpironium bromide: an investigational agent for the treatment of axillary hyperhidrosis. Expert Opin Investig Drugs. 2022;31(1):15–21. https://doi.org/10.1080/13543784.2022.2017880.CrossRefPubMed

27.

Paik J. Sofpironium bromide: first approval. Drugs. 2020;80(18):1981–6. https://doi.org/10.1007/s40265-020-01438-1.CrossRefPubMed

28.

Nasir A, Bissonnette R, Maari C, et al. A phase 2a randomized controlled study to evaluate the pharmacokinetic, safety, tolerability and clinical effect of topically applied umeclidinium in subjects with primary axillary hyperhidrosis. J Eur Acad Dermatol Venereol. 2018;32(1):145–51. https://doi.org/10.1111/jdv.14651.CrossRefPubMed

29.

Nasir A, Bissonnette R, DuBois J, Maari C, Haddad J, Yamaguchi Y. A phase 2a study to evaluate the safety, tolerability, and clinical effect of topically applied umeclidinium in subjects with primary axillary hyperhidrosis. J Am Acad Dermatol. 2017;76(6):AB20. https://doi.org/10.1016/j.jaad.2017.04.098.CrossRef

30.

Pene Dumitrescu T, Santos LL, Hughes SC, et al. A novel method for studying the pharmacokinetics of [(14) C]umeclidinium after application to the axilla or palm of healthy male subjects. Clin Transl Sci. 2016;9(4):183–91. https://doi.org/10.1111/cts.12406.CrossRefPubMedPubMedCentral

31.

Fujimoto T, Abe Y, Igarashi M, et al. A phase III, 52-week, open-label study to evaluate the safety and efficacy of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis. J Dermatol. 2021;48(8):1149–61. https://doi.org/10.1111/1346-8138.15927.CrossRefPubMedPubMedCentral

32.

Campanati A, Gregoriou S, Kontochristopoulos G, Offidani A. Oxybutynin for the treatment of primary hyperhidrosis: current state of the art. Skin Appendage Disord. 2015;1(1):6–13. https://doi.org/10.1159/000371581.CrossRefPubMedPubMedCentral

33.

Fujimoto T, Okatsu H, Miyama H. Two-week prospective observational study of 5% sofpironium bromide gel in Japanese patients with primary axillary hyperhidrosis. J Dermatol. 2022;49(6):594–9. https://doi.org/10.1111/1346-8138.16384.CrossRefPubMedPubMedCentral

34.

Gregoriou S, Campanati A, Rigopoulos D, Maria Offidani A, Stratigos A, Kontochristoulos G. Investigational topical anticholinergics in clinical development for the treatment of hyperhidrosis. Expert Opin Investig Drugs. 2021;30(5):479–82. https://doi.org/10.1080/13543784.2021.1900114.CrossRefPubMed

35.

Chabicovsky M, Winkler S, Soeberdt M, Kilic A, Masur C, Abels C. Pharmacology, toxicology and clinical safety of glycopyrrolate. Toxicol Appl Pharmacol. 2019;370:154–69. https://doi.org/10.1016/j.taap.2019.03.016.CrossRefPubMed

36.

Pariser DM, Lain EL, Mamelok R, Aurora B, Mould DR. 26301 Pharmacokinetic analyses show limited systemic exposure with topical glycopyrronium tosylate. J Am Acad Dermatol. 2021;85(3):AB96. https://doi.org/10.1016/j.jaad.2021.06.405.CrossRef

37.

Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: therapeutic options. J Am Acad Dermatol. 2019;81(3):669–80. https://doi.org/10.1016/j.jaad.2018.11.066.CrossRefPubMed

38.

Grabell DA, Hebert AA. Current and emerging medical therapies for primary hyperhidrosis. Dermatol Ther. 2016;7(1):25–36. https://doi.org/10.1007/s13555-016-0148-z.CrossRef

39.

Nasser S, Farshchian M, Kimyai-Asadi A, Potts GA. Techniques to relieve pain associated with botulinum injections for palmar and plantar hyperhidrosis. Dermatol Surg. 2021;47(12):1566–71. https://doi.org/10.1097/DSS.0000000000003182.CrossRefPubMed

40.

Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin. 2008;18(2):157–66. https://doi.org/10.1016/j.thorsurg.2008.01.004.CrossRefPubMed

Title: Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics
Authors: Nikita S. Wong
Taylor M. Adlam
Geoffrey A. Potts
Mehdi Farshchian
Publication date: 03-11-2022
Publisher: Springer Healthcare
Keywords: Umeclidinium
Oxybutynin
Hyperhidrosis
Glycopyrronium
Published in: Dermatology and Therapy / Issue 12/2022
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI: https://doi.org/10.1007/s13555-022-00838-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics

Abstract

Background

Objective

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2022

Correction to: Leg Ulcer Therapy by Local Injection of Autologous Growth Factors: Results of a Pilot Study

Current and Emerging Therapies in Pediatric Atopic Dermatitis

Maintenance and Concomitant Therapy Use with Chlormethine Gel Among Patients with Stage IA/IB Mycosis Fungoides-Type Cutaneous T-Cell Lymphoma (MF-CTCL): A Real-World Evidence Study

A Review of the Clinical Trial Landscape in Psoriasis: An Update for Clinicians

Letter to the Editor Regarding Long-Term Benefit–Risk Profiles of Treatments for Moderate-to-Severe Plaque Psoriasis: A Network Meta-analysis

Development, Psychometric Validation and Responder Definition of Worst Itch Scale in Children with Severe Atopic Dermatitis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page