Safety of available and emerging drug therapies for hyperhidrosis

Expert Opin Drug Saf. 2017 Sep;16(9):1039-1049. doi: 10.1080/14740338.2017.1354983. Epub 2017 Jul 16.


Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.

Keywords: Hyperhidrosis; aluminum salts; anticholinergics; botulinum toxin; safety.

Publication types

  • Review

MeSH terms

  • Administration, Topical
  • Aluminum Compounds / administration & dosage
  • Aluminum Compounds / adverse effects
  • Animals
  • Botulinum Toxins / administration & dosage
  • Botulinum Toxins / adverse effects
  • Cholinergic Antagonists / administration & dosage
  • Cholinergic Antagonists / adverse effects
  • Humans
  • Hyperhidrosis / drug therapy*
  • Hyperhidrosis / physiopathology
  • Quality of Life*


  • Aluminum Compounds
  • Cholinergic Antagonists
  • Botulinum Toxins