title: Compensatory hyperhidrosis: results of pharmacologic treatment with oxybutynin.
abstract: BACKGROUND
  Hyperhidrosis may affect nearly 3% of the population, and thoracic/lumbar sympathectomy has been highly effective. Compensatory hyperhidrosis is a risk associated with surgical procedures, and its treatment is both complex and not well defined. Treatment of primary hyperhidrosis with oxybutynin has yielded positive results; however, its use in compensatory hyperhidrosis (CH) has not been described.
  
  
  METHODS
  Twenty-one patients (11 female patients) received oxybutynin for severe CH at a median of 5 years after sympathectomy. Patients were evaluated to determine quality of life before starting oxybutynin and 6 weeks afterward; they assigned grades to determine improvement after 6 weeks and at their last consult visit for each site at which they complained of symptoms.
  
  
  RESULTS
  Six and 15 patients underwent operation for axillary hyperhidrosis and palmar hyperhidrosis, respectively. Median follow-up time with oxybutynin was 377 days (49-1,831 days). Most common CH sites were the back (n=8) and abdomen (n=5). After 6 weeks, the quality of life improved in 71.4% of patients. Five patients stopped treatment: 2 because of unbearable dry mouth, 1 because of absence of pharmacologic response, 1 because of excessive somnolence, and 1 because of probable tachyphylaxis. At the last visit, 71.4% of patients presented with moderate to major improvement at the main sites at which sweating was noted.
  
  
  CONCLUSIONS
  More than 70% of patients presented with improved overall quality of life and improvement at the most prominent site of compensatory sweating. Long-term treatment was ineffective in less than 25% of patients, primarily because of the side effects of dry mouth and somnolence. Oxybutynin appears to be effective in treating bothersome CH.
authors.affiliation: Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: dr.marcelo@consultoriovasculares.med.br.
authors.forename: Marcelo Passos
authors.initials: MP
authors.lastname: Teivelis
authors.affiliation: Hospital Israelita Albert Einstein, and Department of Surgery, Vascular and Endovascular Division, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.affiliation: Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Krutman
authors.affiliation: Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: José Ribas
authors.initials: JR
authors.lastname: Milanez de Campos
authors.affiliation: Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Kauffman
authors.affiliation: Department of Surgery, Vascular and Endovascular Division, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
mesh_terms: D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage*; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D013546:Sweating / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008333:Mandelic Acids; D010276:Parasympatholytics; C005419:oxybutynin