Topical glycopyrrolate should not be overlooked in treatment of focal hyperhidrosis
Bibliographic record
Abstract
Conflicts of interest: none declared. Sir, The recent review article by Lowe et al.1 on the place of botulinum toxin type A in the treatment of focal hyperhidrosis omits the topical antimuscarinic agent, glycopyrronium bromide. Topical glycopyrrolate (0·5–4% cream, solution or pads) is indicated mainly for the head and neck2, 3 and various types of gustatory sweating (compensatory,4 diabetic5 and Frey's)6 and, in our experience, is effective and well tolerated. EP and USP grade glycopyrrolate powder can be imported into the U.K. and the desired formulation prepared by ‘Special Order Manufacturers’ (SOMs). The cream formulation should use an acidic base, e.g. Unguentum M, to reduce drug hydrolysis and extend stability; a 3‐month expiry is given by some SOMs. The solution, on the other hand, has a shorter expiry, of 1 month, if pH‐stabilized and refrigerated. Glycopyrrolate may be used twice daily, but it is more usually applied at night. Care should be taken to avoid the nose, mouth, and particularly the eyes, where an inadvertent splash can cause failure to accommodate. Patients often experience a dry mouth and throat, and should be warned about that also. We advise not to wash treated skin for 3–4 h after application, and to store the drug in a cool place. If local prescribing authorities do not allow for provision of glycopyrrolate, it may be obtained by mail from Canada (at http://www.pharmacy.ca).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".