Retrospective analysis of hyperhidrosis diagnosis association with antidepressant, antipsychotic, and stimulant medication use

Summary: Hyperhidrosis refers to excessive sweating surpassing that needed to maintain thermoregulation. Antidepressant, antipsychotic, and stimulant medications have all been associated with hyperhidrosis. However, limited literature exists examining this association, particularly which medications have the highest risk; analyses of patient cohorts are also rare. In this study, we used retrospective data from a large academic center to examine the association of hyperhidrosis with each of the aforementioned drug classes and the individual medications most commonly implicated. The proportion of patients with hyperhidrosis taking a medication of interest was significantly higher than patients with hyperhidrosis not on a medication of interest (p < 2.2e-16). The median time from medication prescription to hyperhidrosis diagnosis was 58 months (IQR: 21 - 112). Antidepressants were found to be the main culprit, with escitalopram being the most common. It is uncertain whether escitalopram is the most commonly associated medication due to a higher mechanistic effect, or because it is very commonly a first-line antidepressant prescribed. Doolittle et al. found that only 51% of patients suffering from hyperhidrosis discuss their condition with healthcare providers. Given the high percentage of patients who are undiagnosed, we recommend providers screen patients on longer-term antidepressants for this adverse effect. Dermatologists often see patients for the management of hyperhidrosis, and many current treatments are employed. However, it is also imperative that dermatologists evaluate for any drug-induced etiology. For these scenarios, dose reduction, antidepressant discontinuation, or substitution may be viable options prior to starting a hyperhidrosis-targeting medication. Atithi Patel¹, Lily Herbig¹, Paras Vakharia¹ 1. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Clinical Research: Epidemiology and Observational Research