From the Research
For facial hyperhidrosis due to social performance anxiety, the most effective treatment option is topical glycopyrrolate, as it has been shown to be safe, efficacious, and well-tolerated, with minimal side effects, as demonstrated in the study by 1. The study published in 2022 in the journal Dermatologic Surgery, 1, compared the efficacy and safety of topical 2% glycopyrrolate versus intradermal botulinum toxin A injection in the treatment of primary facial hyperhidrosis. The results showed that both modalities were effective, with 75% of patients achieving complete response, and the topical glycopyrrolate had a faster onset of action, although the duration of action was shorter. Some key points to consider when treating facial hyperhidrosis due to social performance anxiety include:
- Topical glycopyrrolate (1-2% applied to affected areas) is a effective and well-tolerated treatment option, as shown in the study by 1.
- Botulinum toxin (Botox) injections (50-100 units divided across the forehead and face) can provide 4-6 months of relief, but may have a slower onset of action and higher cost, as mentioned in the study by 2.
- Anticholinergics like glycopyrrolate (1-2mg taken 30-60 minutes before anxiety-provoking situations) or oxybutynin (5-10mg daily) can be effective, but may cause dry mouth and blurred vision, as noted in the study by 3.
- Beta-blockers such as propranolol (10-40mg taken 30-60 minutes before events) can address both physical symptoms of anxiety and associated sweating, but may cause fatigue or lightheadedness, as mentioned in the study by 2.
- Selective serotonin reuptake inhibitors (SSRIs) like paroxetine (20-50mg daily) or sertraline (50-200mg daily) may help address underlying anxiety disorder, but require several weeks to reach full effectiveness and may have initial increase in anxiety or sexual dysfunction as side effects, as noted in the study by 2. It is essential to individualize treatment based on symptom severity, event frequency, and tolerance to side effects, as each patient may respond differently to various treatment options, as demonstrated in the studies by 2, 1, 4, 3, and 5.