How do you manage axillary hyperhidrosis that is refractory to oral glycopyrrolate and aluminum-based antiperspirants in patients with neuromuscular disorders?

An excellent option for a patient in this clinical scenario is the miradry procedure. Miradry is a machine that utilizes microwave-like technology to preferentially and permanently destroy sweat glands in the axillae. While not typically covered by insurance, its effects are very long-lasting and th...

I agree with the above ideas. It's also good to point out that Botox could still be an option depending on what type of neuromuscular disorder we are dealing with. Botox is contraindicated in Myasthenia gravis but can be used with caution in patients with peripheral motor neuropathic diseases, amyot...

Some patients may respond to oral oxybutynin, despite not responding to glycopyrrolate.

I agree with the suggestions above. I have used oxybutynin and iontophoresis with good success. Hidrex makes an iontophoresis machine with plates for application to the axillae.

• Botox
• Rubinal

• Miradry, I think, is the best.
• Botox - I have a hard time getting it covered except for hands.
• Compounded glycopyrrolate or QBREXZA...
• Brella is now approved but have no personal experience with it.
• Iontophoresis - see if there are any preferred machines you can write a script for through insurance...