This is a poster presentation by Dr. Nicholas Anacarico working with Dr. Sarah Salas at the Department of Physical Medicine and Rehabilitation at the University of Kentucky in Lexington, Kentucky. The topic is topical glycopyrrolate for residual limb hyperhidrosis. Limb loss has a prevalence estimated at 1.6 million in 2005, with significant increases since then, largely due to the increased prevalence of diabetes. Complications of amputation include multiple comorbidities, including residual limb pain, phantom pain, phantom sensation, and hyperhidrosis of the residual limb. Typically, hyperhidrosis can be caused by the type of prosthetic liner, which impedes sweat evaporation due to the water-resistant properties of the silicone or polyurethane. However, it can occur independent of the prosthetic fit or the liner, and may be due to re-innervation of the residual limb. Typically, treatments for hyperhidrosis include topical antiperspirants, such as aluminum chloride, oral glycopyrrolate, subcutaneous botulinum toxin injections, and microwave thermolysis of the sweat glands. Topical glycopyrrolate is second-line treatment for hyperhidrosis of the axilla, and while not approved for hyperhidrosis of other anatomical locations, does lend itself to treat hyperhidrosis of other areas due to its mechanism of action as an anticholinergic. So the two cases where two patients were treated with topical glycopyrrolate, the first one is a 52-year-old male with a left traumatic transtibular amputation who had severe residual limb hyperhidrosis. He had been undergoing residual limb volume changes and had increased sock ply and had gone to his prosthetist for prosthetic changes to improve his fit. However, this did not improve his hyperhidrosis. And as such, we treated him with topical glycopyrrolate patches to his residual limb, which then caused a significant decrease in his residual limb hyperhidrosis. The second patient is a 52-year-old female with a dysvascular right transtibular amputation due to an unprovoked arterial thrombus who presents with severe hyperhidrosis, who did have a recent significant weight loss of greater than 15 pounds. She did not undergo prosthetic changes to her socket due to anticipated further weight loss. She too was treated with topical glycopyrrolate patches to her residual limb that resulted in significant decrease in her residual limb hyperhidrosis. These two cases demonstrate the utility of topical glycopyrrolate in the treatment of severe residual limb hyperhidrosis. And residual limb hyperhidrosis can occur in the residual limbs of patients without a preexisting history of hyperhidrosis in other areas. These cases suggest that severe hyperhidrosis may be related to poor prosthetic socket fit. However, these symptoms did not totally resolve with improvements in fit, such as additional sock ply or even socket changes with a prosthetist. Topical glycopyrrolate patches are an easy option for treatment of severe residual limb hyperhidrosis in amputee patients and should be used in conjunction with clinical reasoning and a search for the underlying cause should always be undertaken. And while in agreement with previous studies that indicate that the severity of hyperhidrosis may be associated with poor prosthetic fit and warmer ambient temperatures, in some cases hyperhidrosis may be refractory to fixing those, which may indicate prescription of topical glycopyrrolate in these patients or potentially other therapeutic options.

Dr. Nicholas Anacarico

Dr. Sarah Salas

topical glycopyrrolate

severe residual limb hyperhidrosis

amputee patients