June 30, 2018

Possible Solution to Excessive Facial Sweating?

Image by artur84 on freedigitalphotos.net
Every once in awhile, I see a patient with a chief complaint of excessive facial sweating. Treatment for this condition is quite limited with options that have unfortunate downsides. But one new recently FDA approved treatment may change the landscape for this particular complaint.

But first, let's go over current treatment options:

• Botox injections. It helps not only wrinkles, but also helps prevent sweating from skin wherever botox injection is performed. Downside is that in order to get good coverage over the face for sweating purposes, your face will need a LOT of injections.
Anti-perspirant. You can not only use it under the armpits, but also over the face. Downside is... well... it can be greasy, messy, leaves an obvious residue, etc. Such downsides may not be relevant when hidden under the armpit, but not so for the face.
Robinul (glycopyrrolate). This oral medication can help reduce sweating all over the face, but also all over the body. This medication is commonly used during surgical procedures with general anesthesia to help with airway management (you don't want a lot of oral/throat secretions when you are under). Downsides are that it not only makes you dry on the outside, but also the inside. There are also other unrelated but undesirable side effects including blurred vision, difficulty with urination, heart palpitations, taste loss, headaches, confusion, weakness, dizziness, nausea, constipation, etc.
Surgical intervention. Essentially involves trying to remove or destroy the sweat glands (laser, liposuction, etc). This option is not really a viable option for facial skin and is geared towards other non-visible parts of the body.

As you can see, none of the options are ideal when it comes to excessive facial sweating.

But a new drug called Qbrexza might potentially be a game-changer.

Think Robinul because Qbrexza contains the same active ingredient, but instead of a pill, it is a cloth wipe you can apply ONE time over the facial skin once a day. It is FDA approved specifically for excessive armpit sweating... NOT the face. But it should work just as well mainly because skin is skin.

BUT... I can see some potential undesirable side effects even with this cloth wipe, mainly due to how close the eyes and mouth are to the facial skin. Side effects would principally be blurry vision and dry mouth. If you look at the list of adverse reactions in the package insert, other risks include:

dry mouth (24.2%)
mydriasis (6.8%)
oropharyngeal pain (5.7%)
headache (5.0%)
urinary hesitation (3.5%)
vision blurred (3.5%)
nasal dryness (2.6%)
dry throat (2.6%)
dry eye (2.4%)
dry skin (2.2%)
constipation (2.0%)
Local skin reactions, including erythema (17.0%), burning/stinging (14.1%) and pruritus (8.1%)

I suspect that over time as more experience is garnered with Qbrexza, its use may skyrocket for purposes beyond the armpit including the face whether a patient was born that way or developed it (Fry's Syndrome after parotidectomy).

This drug is anticipated to become available in October 2018.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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