Diphemanil Methylsulfate in Hyperhidrosis

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Abstract
Hyperhidrosis of the feet is a common problem, especially in warm climates and during summer months. It is embarrassing and uncomfortable, and can have fairly serious consequences such as maceration of the skin and exacerbation of intercurrent dermatoses. Hyperhidrosis significantly retards healing of dermatophytosis. Formaldehyde solution, aluminum chloride, potassium permanganate, and ferric chloride are used topically with some success; however, sensitization (as with formaldehyde) or staining (as with ferric chloride and potassium permanganate) are disadvantages. Anticholinergic agents, administered orally, exert a marked anhidrotic effect through parasympathetic inhibition. Oral administration of diphemanil methylsulfate (Prantal), a quaternary ammonium compound, provides satisfactory relief of hyperhidrosis,1,2 but xerostomia and other undesired effects of parasympathetic inhibition occur in a significant number of patients. The drug is available for topical use as a 2% cream, which is effective against hyperhidrosis3 and against dermatoses in which moisture is an exacerbating factor.4,5,6 Recently, diphemanil methylsulfate

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