Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Formulated anti-sweating creams are specially made creams that contain anti-cholinergic properties. In summary, these family of drugs block the production of sweat by the sweat gland.
The idea behind creams is to deliver the drug to the localised areas of sweating, such as the hands, feet and face, and avoid systemic absorption of the drug. This in theory can decrease any side effects from anti-cholinergic drugs.
Our specialist use a variety of topicals (creams, lotions, and solutions) to help decrease sweating.
This antiperspirant remains the first line of treatment before any prescription medication.
The most commonly prescribed cream we use is a glycopyrrolate based cream. The concentration of this cream is determined by your Specialist. In general, sweating of areas such as the face and neck will require a lower concentration compared to sweating on the hands and feet.
Anti-sweating creams, such as compounded glycopyrrolate and propantheline are usually well tolerated, however side effects can occur.
Side effects include:
Skin irritation: especially if used in skin folds of excess sweat areas such as the groin and armpit. (Armpit areas respond best to Driclor or sweat stopping treatments injections).
Systemic absorption: This means the drug gets sufficiently absorbed through the skin, leading to drug in the blood stream. This may cause side effects such as dry mouth, sedation (feeling tired), blurred vision and constipation.
Side effects are usually dose related. The trick is to find a concentration that will deliver the necessary results, at a certain concentration, whilst minimizing side effects. Our Specialists will come up with a solution for you.
Anti-sweat creams such as Glycopyrrolate can be used up to twice a day, but we advise all patients to start once at night. It is best applied to dry, clean skin, avoiding the eyes and mouth areas. Remember to wash your hands after application of any anti-sweat creams!
Leave the cream on for 3-4 hours before washing off. If you do not experience any side effects, patients can leave on over night, before washing off in the morning.
Twice a day application is the maximal application recommended for Glycopyrrolate.
If side effects occur, decrease the contact time with the skin. For example, was the Glycopyrrolate solution off within 2-3 hours of application.
Anti-sweating creams can be used in almost every area of sweating, HOWEVER certain factors limit their use. First of all, skin irritation may occur if they are used in places such as the armpits, and groin area. Secondly, if these creams are used in large areas of sweating, then absorption may occur. This can lead to side effects such as sedation and dry mouth.
In summary, anti-sweating compounded creams are best used for places such as:
Excessively sweating hands
Excessively sweating feet
Excessively sweating face and head areas
Compensatory or rebound sweating
No. These creams such as Glycopyrrolate are highly specialised in their formulation, in addition most patients will require a customised concentration to obtain the best results, whist minimising side effects. Special pharmacies known as COMPOUNDING pharmacies can help formulate anti-sweating creams. Most of these pharmacies are located in Brisbane and the Gold Coast, however we can point patients to various online pharmacies throughout Australia.
Compounding Pharmacies in Brisbane:
Ladhope Pharmacy Brisbane
Wickham Hourse Pharmacy Brisbane
Don’t despair if creams are of limited value, or if side effects occur. We usually use formulated anti-sweat creams as second line treatment, as other treatment options are available.
Iontophoresis involves blocking the sweat gland with ions and minerals. Additionally this method can be used to deliver drugs such as glycopyrrolate directly in to the sweat gland areas. It is best used for sweating of the hands and feet, and less useful for excessively sweaty armpits.
Sweat stopping treatments can block sweating for up to 7 months. This procedure involves multiple small injections into the area of maximal sweating. Over a period of 7-14 days, sweat stopping treatments blocks the function of sweat glands. This treatment can be used to treating excessive sweating of the underarms, face, feet, hands, and focal areas of compensatory hyperhidrosis. It is subsidised by Medicare for the treatment of severe underarm sweating not responding to over the counter antiperspirants.
ETS or Endoscopic Thoracic Sympathectomy is a surgical procedure that transects or destroys the nerves in the chest wall. This procedure has a very high success rate, and can be considered for treatment of excessive sweating of the hands and cases of facial sweating associated with blushing. It can not treat sweaty feet. ETS for underarm sweating has largely been replaced with sweat stopping treatments injections.
Systemic agents are tablets used to decrease sweating. They can be useful for generalised sweating, but may help localised areas such as sweaty hands and feet, as well as facial sweating. Most commonly used tablet is Propantheline Bromide. The limiting side effect is sedation, dry mouth, blurred vision and constipation.
Dr Davin S. Lim
The use of formulated anti-sweating creams can be useful for certain types of sweating, including excessive sweating of the hands, feet and face. Formulated anti-sweat agents such as glycopyrrolate can be customised to different concentrations depending on skin irritation and side effect profile.
I prefer the use of Iontophoresis for hands and feet, sweat stopping treatments for sweaty armpit areas, however the use of creams cannot be over looked.
The challenge is to find the correct concentration whereby the patient receives benefit, whilst minimising side-effects such as sedation and dry mouth syndrome.