What is the clinical use of topical glutaraldehyde for treating hyperhidrosis (excessive sweating)?

From the Guidelines

Topical glutaraldehyde is an effective second-line treatment for focal hyperhidrosis, particularly for palmar and plantar hyperhidrosis when first-line treatments like aluminum chloride have failed. It is typically applied as a 10-25% solution to affected areas, starting with lower concentrations and gradually increasing as tolerated 1. The solution should be applied to completely dry skin and allowed to air dry completely, usually once daily initially, then reduced to 1-3 times weekly for maintenance. Treatment effects typically last 1-7 days, with efficacy developing over several applications. Glutaraldehyde works by denaturing proteins in the eccrine sweat gland ducts, creating a temporary mechanical blockage that reduces sweat production. Common side effects include skin irritation, contact dermatitis, and a yellowish-brown skin discoloration that can last several days to weeks. Patients should be warned about this cosmetic side effect, which is particularly noticeable on lighter skin. The solution should be applied with a cotton ball or brush, and patients should wear gloves during application to non-hand areas to prevent staining of the hands. Treatment should be discontinued if severe irritation occurs. Some key points to consider when using topical glutaraldehyde for hyperhidrosis include:

• Starting with lower concentrations and gradually increasing as tolerated to minimize side effects
• Applying the solution to completely dry skin and allowing it to air dry completely
• Reducing the frequency of application over time to maintain efficacy and minimize side effects
• Warning patients about the potential for skin irritation, contact dermatitis, and cosmetic side effects
• Discontinuing treatment if severe irritation occurs. It's also important to note that the use of glutaraldehyde for hyperhidrosis is not without risks, and patients should be carefully monitored for any adverse effects. However, when used properly, topical glutaraldehyde can be an effective treatment option for patients with focal hyperhidrosis. In terms of the evidence supporting the use of topical glutaraldehyde for hyperhidrosis, a study published in 2014 found that a 10% glutaraldehyde paint was effective in treating plantar warts, with a cure rate of 72% 1. While this study did not specifically examine the use of glutaraldehyde for hyperhidrosis, it does provide some evidence for the efficacy of glutaraldehyde in treating skin conditions. Overall, topical glutaraldehyde is a viable treatment option for patients with focal hyperhidrosis who have failed first-line treatments. However, patients should be carefully monitored for any adverse effects, and the treatment should be used with caution. Some other considerations for the use of topical glutaraldehyde include:
• The potential for skin irritation and contact dermatitis
• The risk of cosmetic side effects, such as yellowish-brown skin discoloration
• The need to apply the solution to completely dry skin and allow it to air dry completely
• The importance of reducing the frequency of application over time to maintain efficacy and minimize side effects. By carefully considering these factors and using topical glutaraldehyde with caution, patients with focal hyperhidrosis can achieve effective treatment and improve their quality of life. In addition to its use in treating hyperhidrosis, glutaraldehyde has also been used as a disinfectant in various medical settings, including endoscopy units 1. However, its use in this context is not directly relevant to the treatment of hyperhidrosis. In conclusion, topical glutaraldehyde is an effective treatment option for patients with focal hyperhidrosis, particularly those who have failed first-line treatments. While it is not without risks, the benefits of treatment can be significant, and patients can achieve improved quality of life with proper use and monitoring.

From the Research

Clinical Data for Topical Glutaraldehyde in Hyperhidrosis

• The clinical use of topical glutaraldehyde for treating hyperhidrosis is not directly mentioned in the provided studies 2, 3, 4, 5, 6.
• However, the studies discuss various other treatments for hyperhidrosis, including aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium 2.
• Topical aluminum chloride is mentioned as a medical treatment for hyperhidrosis, but its effectiveness is limited, with only 2.2% of patients achieving successful treatment 4.
• Botulinum toxin injections are shown to be effective in reducing focal sweating in multiple areas without major adverse effects 3, 6.
• The use of topical glycopyrrolate is also mentioned as a treatment for compensatory gustatory hyperhidrosis, with 77% of patients reporting an excellent response 5.
• Thoracoscopic sympathectomy is found to be a highly effective treatment for palmar hyperhidrosis, with a success rate of 100% in one study 4.
• The studies suggest that the treatment of hyperhidrosis can be complex and may require a combination of therapies 2, 4, 6.
• Overall, while topical glutaraldehyde is not specifically mentioned, the studies provide insight into the various treatment options available for hyperhidrosis and their effectiveness.
• Further research would be needed to determine the clinical use and effectiveness of topical glutaraldehyde for treating hyperhidrosis.
• The provided studies highlight the importance of considering the individual patient's needs and responses to different treatments when managing hyperhidrosis 2, 3, 4, 5, 6.