From the Research
Compounded topicals for hyperhidrosis in the USA should typically include glycopyrrolate, aluminum chloride, and anticholinergic combinations, with glycopyrrolate 1-2% cream or solution being the first-line compounded option, as recommended by the most recent study 1. The treatment of hyperhidrosis can be complex and may require a combination of several therapies. According to the latest evidence 1, conventional non-surgical treatments of hyperhidrosis include aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium.
- Key considerations for treating hyperhidrosis include:
- The severity of the condition
- The specific area affected
- The patient's medical history and potential comorbidities
- The potential side effects of treatment, such as skin irritation, dryness, or anticholinergic effects like dry mouth if absorption occurs For more severe cases, aluminum chloride hexahydrate 10-20% in anhydrous ethanol (compounded stronger than over-the-counter options) can be effective when applied nightly to dry skin and washed off in the morning, as supported by earlier studies 2, 3. Some compounding pharmacies also create combination formulations containing glycopyrrolate with other anticholinergics like oxybutynin 3% or methantheline bromide in a vanishing cream base. These medications work by blocking acetylcholine receptors in sweat glands or, in aluminum chloride's case, by forming plugs in sweat ducts and causing atrophy of secretory cells. Patients should work with both a dermatologist and compounding pharmacist to determine the appropriate formulation, as these medications need to be prescribed and customized based on the specific area affected and severity of hyperhidrosis, as emphasized by recent research 4, 5.