In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lawrence Green, MD, clinical professor at George Washington University and practicing dermatologist, to discuss the evolving landscape of hyperhidrosis and the latest FDA-approved therapy, sofpironium bromide gel. 

Dr Green highlights that an estimated 16 million people in the US experience clinical hyperhidrosis, with axillary hyperhidrosis being the most frequently reported. However, a significant challenge is patient reluctance to discuss symptoms, often due to embarrassment or frustration with ineffective or irritating treatments. Dr Green suggests raising awareness through social media, office signage, and intake forms to help identify more patients needing care. 

The discussion then shifts to treatment options, including botulinum toxin, devices such as the Brella SweatControl Patch and the energy-based miraDry, and pharmacologic therapies. 

They explore anticholinergic treatments in depth, explaining how sofpironium bromide gel differs from traditional glycopyrrolate wipes. While glycopyrrolate wipes can be messy, highly saturated, and prone to causing systemic absorption from contact with the hands, sofpironium bromide gel is applied via an applicator in a metered dose, reducing unintended exposure and improving application precision. Unlike glycopyrrolate, which affects muscarinic M1 receptors found throughout the body, sofpironium targets muscarinic M3 receptors, which are more specific to sweat glands, reducing the likelihood of systemic side effects. 

They next review clinical trial methodologies for hyperhidrosis, including the Hyperhidrosis Disease Severity Measure and gravimetric sweat production assessments, noting that they favor patient-reported outcomes over objective sweat measurements, as perceived symptom relief is the most important assessment for this condition. 

Tune in to the full episode to hear expert insights on identifying and treating hyperhidrosis with new and emerging therapies that improve both efficacy and the patient experience.