Clinical Research
Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis

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Background

Axillary hyperhidrosis (AH) is a common disease, with a significant impact on quality of life (QOL). Good short-term results are reported with oxybutynin, but longer follow-up data are lacking. We evaluated its effectiveness in a large series of patients who were not surgically treated and who had at least 6 months of follow-up.

Methods

From September 2007 to September 2013, 431 consecutive patients were enrolled in “pharmacological first” protocol for treatment of AH with oxybutynin. Thirty-four patients were lost to follow-up, and data are available for 397 patients treated for at least 6 weeks. Data at the start of the protocol, 6 weeks after beginning treatment, and at final visit were analyzed.

Results

One hundred fourteen patients (28.7%) did not improve and were referred for surgery (sympathectomy). Eight patients (2.01%) presented significant side effects (e.g. dry mouth) and discontinued therapy. Twenty-six patients (9.4%) preferred surgery over pharmacologic treatment. Sixty-two patients have not yet been under treatment for 6 months. The 181 patients with more than 6 months of follow-up (median: 17 months, range: 6–72) were analyzed as follows: 82.9% of patients presented moderate or great improvement in AH and 89% of patients presented improvement in other sites of hyperhidrosis after a median of 17 months.

Conclusions

In patients with good initial response to oxybutynin, >80% presented moderate or great improvement in axillary and in other sites of excessive sweating. Results were particularly better in women and those who presented better QOL after 6 weeks.

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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