In June 2018, the U.S. Food & Drug Administration (FDA) approved a new topical treatment for axillary hyperhidrosis called Qbrexza®. Qbrexza is owned by Journey Medical Corporation, headquartered in Scottsdale, Arizona. The Japanese company Maruho Co. also has the rights to license and commercialize Qbrexza in Japan, South Korea, Taiwan, Hong Kong, Macau, Thailand, Indonesia, Malaysia, Philippines, Singapore, Vietnam, Brunei, Cambodia, Myanmar and Laos.
International Hyperhidrosis Society founders and board of directors members Dr. Dee Anna Glaser (St. Louis University School of Medicine), Dr. Adelaide Hebert (University of Texas Medical School at Houston), and Dr. David Pariser (Eastern Virginia Medical School and Pariser Dermatology Associates) were involved in studying the safety and effectiveness of this new treatment.
Qbrexza (pronounced kew brex' zah) comes in individually packaged cloths that are to be used at home once per day to reduce underarm sweating. One wipe is intended for two underarms. The treatment works by blocking receptors responsible for sweat gland activation. In studies, Qbrexza was found to be effective and well-tolerated, including in children as young as 9 years old.
The active ingredient in Qbrexza is glycopyrronium tosylate. In theory, by applying the medication to the top of the skin instead of taking it by mouth, there may be a reduced incidence of systemic side effects. Also, there have been concerns over the years about older patients taking anticholinergics for long periods of time and increased risks of dementia – these concerns may be reduced with Qbrexza.
In research studies with Qbrexza, the most common side effects were:
- Dry mouth (in 16.9-24.2% of patients)
- Erythema/area redness (in 17% of patients)
- Burning/stinging (in 14.1% of patients)
Qbrexza was shown in clinical trials to improve sweating symptoms as soon as 1 week after starting the regimen. Studies also found that patients using Qbrexza wipes once daily for four weeks improved their “sweating severity” by nearly 25% to 30% (compared to 4% to 5% with placebo) and that measured sweat volume was reduced by 50% or more (in most patients.) The wipes were "well-tolerated" and any reported side effects were primarily mild to moderate (see above).
Of note, Qbrexza is FDA-approved for patients who are 9 years of age or older. As Qbrexza is a non-invasive, at-home option that is approved for pediatrics (age 9 or older), it may lead to meaningful, practical relief in this group.
Some questions still remain:
- How much will Qbrexza cost and will health insurance policies cover it? Will healthcare policies require patients to try and fail with other hyperhidrosis treatments before covering Qbrexza? Will insurance tools or financial assistance be made available? (For information about the Qbrexza Patient Savings Card click here.)
- Given that the current FDA approval is for underarms only, will Journey seek further approval for other body locations where excessive sweating is common? We hear from patients that hands, feet, faces, back, groin/buttocks, and under the breasts are areas of unmet need.
- Will it be appropriate to use Qbrexza “off-label” for other body areas?
Some research is available on the active ingredient in Qbrexza (topical 2% glycopyrrolate) and its use off-label for head/face excessive sweating. In 2022, researchers found in comparing topical 2% glycopyrrolate and botulinum toxin A (Botox) injections for facial hyperhidrosis treatment that both modalities showed complete response in 75% of cases, but with a longer duration of action in the botulinum toxin group--up to 6 months. Side effects were minor and temporary. The researchers concluded that topical glycopyrrolate 2% showed comparable results to botulinum toxin A in facial Hh treatment with faster onset, but shorter duration of action.
IHhS co-founder and board member, Dr. David Pariser has led research on the best technique for the use of Qbrexza off-label for palmar hyperhidrosis. The study compared four different ways of using Qbrexza to manage palm sweating. Results were published in the May 2022 edition of Journal of Drugs in Dermatology. One hundred and twenty patients, age nine years or older with self-reported excessive palm sweating took part in the study, which lasted four weeks and consisted of one of four different daily palmar Qbrexza application routines. The study found that the application of the Qbrexza cloth onto both hands (until the cloth was dry or about 3 minutes), then wearing clean cotton gloves for 30 minutes, and then washing the hands achieved the best sweat-reducing results with the most acceptable safety profile. For this group, “hand sweat severity” dropped an average of 4 points out of a 10-point scale. To learn more about this research, read our blog
or the full study.
Research and References