Pearls for Treatment Selection and Managing Adverse Effects in Hyperhidrosis

Hyperhidrosis can be a profoundly impactful condition, often misunderstood by both patients and clinicians.

Adam Friedman, MD, FAAD, a dermatologist based in Washington, DC, and a professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences, shared valuable insights on tailoring treatment and mitigating adverse effects for this common but underdiagnosed disorder.

Tailoring Treatment: A Symbiotic Approach

Friedman emphasizes that personalized treatment is critical due to the variable nature of hyperhidrosis. "When it comes to medication selection, there’s a lot that plays into it, in terms of how many sites, where those sites are, [and whether there is] associated irritant contact dermatitis from the sweating," he explained.

Clinicians must also account for patient comorbidities, concurrent medications, and skin conditions like atopic dermatitis when crafting a management plan. Friedman advocates a "symbiotic combination approach," blending multiple therapies for optimal outcomes.

He also highlighted the importance of new options, such as sofpironium bromide, which offers a topical solution with reduced systemic adverse effects.

Managing Adverse Effects of Oral Therapies

Systemic treatments like anticholinergics, clonidine, and propranolol offer relief for widespread hyperhidrosis but are not without potential adverse effects. Friedman detailed common adverse effects, particularly with anticholinergics like glycopyrrolate: The side effects we know and love, like xerostomia, dry eyes, urinary retention, are dose-dependent, and that will get worse as you go up that ladder."

Clonidine, often used for flushing-associated hyperhidrosis, requires careful monitoring of blood pressure to avoid dizziness or fainting. Similarly, propranolol, while effective for situational sweating, is contraindicated in patients with asthma or bradycardia. Friedman underscored the need for a "test run" in a controlled environment to ensure patient safety.

Empowering Patients and Clinicians

Ultimately, success in hyperhidrosis management hinges on patient education and clinician awareness of the expanding treatment landscape. Friedman’s approach exemplifies this: "It’s really that creativity...that allows us to create a personalized management strategy."