Table 1.

Topical anticholinergics for treatment of hyperhidrosis

Agent	Mechanism of action	HH location	Key results/findings
Glycopyrronium tosylate (GT)	Competitively inhibits acetylcholine receptors found on peripheral tissues (including sweat glands) [16]	Axillary	GT demonstrated a significant reduction in the severity of sweat production over the course of 4 weeks with once-daily application. [12] Anticholinergic effects were mild or moderate and transient leading to discontinuation only infrequently [12]
Oxybutynin	Inhibits M1, M2, and M3 muscarinic acetylcholine receptors, M3 receptors are present on sweat glands [32]	Axillary, palmar, plantar	47.8% of patients with axillary HH reported erythema and pruritus upon application. [24] 50% of patients with plantar HH reported that oxybutynin was “sticky” and unpleasant to use. Twice-daily application of 10% oxybutynin gel resulted in a significant reduction in HDSS [24]
Sofpironium bromide	Inhibits muscarinic receptors in eccrine glands. [25]	Axillary	≥ 1 or 2 points improvement in HDSM-Ax from baseline and a 50% or more reduction in total gravimetric weight of sweat. [33] Side effects were typical of anticholinergic symptoms in addition to dermatitis and irritant reactions [26]
Umeclidinium (UMEC)	Long-acting muscarinic antagonist, reducing the overproduction of perspiration. [28]	Axillary, palmar	A decrease in sweat was noted from day 3 of application and the HDSS. [34] The most common reported side effects were application site reactions. [28] Greater absorption through the axillae than the palm