Excessive sweating, also known as hyperhidrosis, is a condition characterised by excessive sweating to a degree where it becomes socially disruptive. The excessive sweating typically occurs of the underarms, the groin, the hands and feet. The condition can be primary, which means that there is no immediate cause of the disease, or it can be secondary, i.e. it is a result of an underlying disease such as diabetes, thyroid problems or Hodgkin’s disease.
The excessive sweating is a sign of increased activity in the sympathetic nervous system, which for instance occurs due to abstinence, hypoglycaemia, hypovolaemia and brain damage.
New studies have found ways to relieve the problems, namely two drugs developed by two different pharmaceutical firms. The two drugs treat hyperhidrosis, and they are currently being scrutinised before they can be marketed.
DRM04
One study has studied a small molecule called DRM04, which is applied to the skin of the armpit and which suppresses the sympathetic nervous system. DRM04 has been tested on people with hyperhidrosis and the results are promising. In the study, patients with hyperhidrosis received treatment either with or without DRM04, and the patients did not know which treatment they received. This way, the patients would not be biased when reporting any changes after the study.
After being treated for 4 weeks, the study concluded that the patients – treated with DRM04 – reported significant improvements in their hyperhidrosis-related quality-of-life, compared to patients who did not receive the effective treatment. Previous studies of DRM04 have indicated that 72-77 % of patients using DRM04 experienced a 50 % reduction in their sweating volume when DRM04 was applied daily for 4 weeks. At the same time patients reported significant improvements in disease severity.
In terms of side effects, DRM04 was generally well-tolerated by patients in both studies. The side effects were mainly mild to moderate, and included dry mouth, soreness where the drug was applied and enlarged pupils.
The next step is a study of the effect when used for a year, and after this, Dermira – the company behind the product – hopes to have DRM04 approved by the FDA (The U.S. Food and Drug Administration), so it becomes available to patients with hyperhidrosis.
DRM04 is thus an effective, well-tolerated and convenient way of treating hyperhidrosis, and according to Dermira, there is a need for this.
THVD-102
Another pharmaceutical firm, TheraVida, made a drug against hyperhidrosis as well, and this is currently being tested in clinical trials. They call the product THVD-102. This drug is a combination oral treatment in the form of a pill taken twice a day. Since the pill is taken orally, the active substances act systemically, affecting the entire body. The pill is thought to relieve both primary and secondary hyperhidrosis.
It is the only oral, systemically-acting drug for hyperhidrosis in the works. It contains both oxybutynin, which is released immediately, and pilocarpine, which is released more slowly and has a delayed effect. Today, oxybutynin is occasionally used to treat hyperhidrosis, but it can have side effects like dry mouth which limits the use in the long run. The delayed-release pilocarpine is added to combat oxybutynin’s side effects, including dry mouth. The two substances thus act in two opposing ways; oxybutynin suppresses the sympathetic nervous system, whereas pilocarpin stimulates it.
A clinical trial of the effect of THVD-102 on patients with primary focal hyperhidrosis has shown that the treatment reduced sweating and limited discomfort such as dry mouth, and it was therefore significantly better than taking oxybutynin alone. According to TheraVida, this effect cannot be achieved by taking the two meds separately – as they are currently available – as THVD-102 has a proprietary technology which enables pilocarpin’s delayed release and a certain dose which reduces the frequency and severity of side effects.
Currently available treatments
Today, the treatment options for hyperhidrosis are limited. In the event of local hyperhidrosis, e.g. in the armpit, aluminium chloride hexahydrate can be applied to the skin and washed off after a couple of hours, but many people experience local irritation. Another treatment involves injections with botulinum toxin every 6-9 months, which appears to work for 4 out of 5 patients, but the treatment is very painful. In addition, it is possible to treat hyperhidrosis surgically by interrupting the sympathetic nerve paths, but this treatment involves a high risk of severe side effects.
In all probability, new treatments for hyperhidrosis will be welcomed by patients suffering from the condition. The condition has turned out to impact the patients’ daily activities as well as their professional, emotional, psychological, social and physical capabilities negatively. Hopefully, the two new drugs will become available and contribute to improved quality of life for the patients.
Sources:
2. http://investor.dermira.com/phoenix.zhtml?c=253686&p=irol-newsArticle&ID=2174171
3. https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/hud/symptomer-og-tegn/svedtendens/
