Clinical ResearchLong-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis
Introduction
Axillary hyperhidrosis (AH) is characterized by excessive sweating primarily in the armpits. This condition usually affects patients' quality of life (QOL), compromising emotional, social, professional, and leisure activities.1 This disease usually starts during the childhood or adolescence and is, by some authors, reported as the most common presentation of hyperhidrosis.2, 3
Topical treatment includes iontophoresis and application of botulinum toxin. These procedures present good results but are time limited and demand frequent redo procedures.4, 5 One possible surgical solution is excision/resection of the eccrine sweat glands, but this approach may present low efficacy, high recurrence rates,6 and unsightly scarring.7 Another surgical treatment option—video-assisted thoracic sympathectomy (VATS)—has a high success rate and low operative risk for the definite treatment of AH, but compensatory hyperhidrosis (CH) is usually a troublesome complaint, with up to 94% of patients referring to some degree of this distress.8
Regarding pathophysiological substrates for hyperhidrosis, it has been demonstrated that there is a higher expression of acetylcholine and alpha-7 nicotinic receptors in sympathetic ganglia.9 Oxybutynin is an antimuscarinic agent, initially described in the resolution of hyperhidrosis in 1988.10 In the last ten years, specific treatment with this drug began to be reported for excessive sweating11, 12: it has been used for palmar13, plantar14, and facial15 sweating, and has been studied in a randomized placebo-controlled trial.16 Short-term results on pharmacologic treatment of AH have been published,17, 18 but long-term results in treatment with this particular drug are lacking.
The aim of this study was to assess the long-term clinical efficacy of a large series of consecutive patients (n = 181) with AH treated with low doses of oxybutynin for at least 6 months (median = 17 months).
Section snippets
Patients
This was a nonrandomized and uncontrolled study in accordance with ethical standards of the Committee of Ethics for Analysis of Research Projects on Human Experimentation from the institutions. Data were retrieved from our dedicated and prospective institutional protocol, which is standardized and has been in use at our facilities since 2001 for all patients with hyperhidrosis.
From September 2007 to September 2013, a total of 431 consecutive patients with AH as their main complaint were
Results
By inclusion criteria, all patients were followed for at least 6 months. Follow-up ranged from 6 to 72 months (median = 17 months).
QOL before treatment is presented in Table II. More than 97% of patients reported poor or very poor QOL before treatment.
Improvement in QOL after 6 weeks of treatment is presented in Table III. More than 90% of patients presented (at least some degree of) improvement in QOL after 6 weeks of treatment.
Improvements in sweating after 6 weeks and in the last visit are
Discussion
Oxybutynin has provided good short-term results in the amelioration of hyperhidrosis. The main contraindication is closed-angle glaucoma. Excluding this concern, it is a safe medication but with limited tolerability due to antimuscarinic side effects, especially noted with the administration of doses >15 mg/day.20 The maximum dose of 10 mg/day, associated with the slow and progressive increase in dosage used in our protocol, lowers the incidence of side effects, maintains effectiveness, and
Conclusions
Our present data show that anticholinergic treatment with oxybutynin is feasible, with considerably positive results for those patients who were able to maintain therapy for 6 weeks, and after a median of 17 months, >80% of patients displayed moderate or great improvement in excessive sweating. The results for AH were better in female patients and in those who achieved better QOL after 6 weeks.
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