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Topical Treatments: Astringent agents
Agents used for tanning with astringent properties
have been used for hyperhidrosis.[58,148]
These agents denature keratin proteins in the stratum corneum
layer lining the sweat pore, which leads to a superficial
closure of the pore that lasts several days, until reparative
desquamation of the cell layer occurs.[58]
Acids and aldehydes such as formaldehyde, glutaraldehyde,
tannic acid, and trichloroacetic acid have all been used
to treat hyperhidrosis.[58]
These agents are now essentially considered obsolete, although
low concentrations of astringents may be found in some commercial
preparations.[58]
Formaldehyde induces contact sensitivity, leading
to allergic contact dermatitis in 15% to 20% of patients.[58]
Methenamine, used systemically as a urinary tract antiseptic, releases formaldehyde in the presence of acid. Methenamine,
contained in several commercial products, has been successfully
used as a topical agent for hyperhidrosis by slowly releasing
formaldehyde in the presence of acid eccrine sweat.[15,58]
Patients using commercially prepared stick antiperspirant
with 5% methenamine had a significant improvement in palmoplantar
sweating (P<0.001) and no development of allergic contact
sensitization.[15]
In another study, 24 of 26 patients had decreased palmar
and plantar sweating with use of the 5% methenamine stick;
one patient with prior allergic contact dermatitis due to
formaldehyde had no reaction to methenamine.[30]
Glutaraldehyde is another tanning agent that
has been used to treat hyperhidrosis.[68]
Patients who are sensitized to formaldehyde did not react
to glutaraldehyde.[68]
A 10% glutaraldehyde solution decreased sweating on the
soles of all 25 patients treated, but had no clinical effect
on axillary hyperhidrosis.[68]
Yellow-brown discoloration occurs in the skin with use of
glutaraldehyde, and thus it may only be clinically useful
on the soles.[148]
Tannic acid is less effective than glutaraldehyde and can
also cause skin discoloration.[148]
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