title: Systemic therapy for primary hyperhidrosis: a retrospective study of 59 patients treated with glycopyrrolate or clonidine.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  This was a retrospective study from a single, university-based population.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of Iowa, Iowa City, Iowa, USA. hobartwalling@yahoo.com
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Walling
mesh_terms: D000293:Adolescent; D000328:Adult; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006024:Glycopyrrolate / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy*; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D013565:Sympatholytics / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018727:Muscarinic Antagonists; D013565:Sympatholytics; D003000:Clonidine; D006024:Glycopyrrolate