Axhidrox: Europe’s First Hyperhidrosis Cream at Lecheng

I still remember the day a young woman sat in my consultation room, her arms pressed tightly against her sides even though the air conditioning was on full blast. She was a 26-year-old marketing executive, smart, articulate, and visibly accomplished. But when I asked her to extend her arms for a physical examination, she hesitated. Then, slowly, she raised them — and I saw two large, dark sweat stains spreading from her underarms all the way down to her waist. She had been changing her shirt three times a day. She had stopped wearing anything but black. She had canceled client meetings because she was afraid of leaving damp marks on the conference room chairs.

“I’ve tried everything,” she told me. “Clinical-strength antiperspirants that burned my skin. Botox injections that cost a fortune and wore off after six months. I even looked into surgery — but the thought of cutting my sympathetic nerves scared me too much.” She paused, then added quietly, “I just want to be able to raise my arms without feeling ashamed.”

That was two years ago. I did not have a good answer for her then. Today, I do.

Hyperhidrosis is a chronic medical condition characterized by excessive sweating beyond what is physiologically necessary for temperature regulation. It is not a matter of poor hygiene or nervousness — it is a genuine disorder of the autonomic nervous system. The condition is broadly classified into two types. Primary hyperhidrosis, which accounts for the vast majority of cases, has no identifiable underlying cause; it is often localized to specific areas such as the palms, soles, underarms, or face, and frequently runs in families. Secondary hyperhidrosis, by contrast, results from an underlying medical condition — such as hyperthyroidism, diabetes, or menopause — or from certain medications.

How common is it? Globally, approximately 5% of the population suffers from primary hyperhidrosis. In China, epidemiological surveys have estimated the prevalence of primary palmar hyperhidrosis at around 2.08%, with rates reaching 2.81% in coastal regions. Some studies have reported even higher figures, with prevalence ranging from 2.8% to 4.8% in the general population. Axillary hyperhidrosis — excessive underarm sweating — affects an estimated 1.4% of the U.S. population and up to 5.75% in some Asian populations. With over 1.4 billion people in China, that translates into tens of millions of individuals quietly suffering, often in silence.

The impact on quality of life is profound. Patients with hyperhidrosis often avoid social situations, limit physical activities, and struggle with professional and personal relationships. Many report significant emotional distress, anxiety, and even depression. And yet, for decades, the treatment options have been remarkably limited.

Axhidrox is a topical cream containing 1% glycopyrronium bromide, a well-established anticholinergic agent. It was developed by Dr. August Wolff GmbH & Co. KG Arzneimittel, a German pharmaceutical company with over a century of history in dermatological research. The cream is delivered via a metered-dose pump: each actuation delivers 270 mg of cream, containing 2.2 mg of glycopyrronium. The recommended dose is two pump actuations per armpit, applied once daily, preferably in the evening.

How does it work? Hyperhidrosis results from overstimulation of the eccrine sweat glands. Glycopyrronium blocks the action of acetylcholine at muscarinic receptors, which are responsible for activating sweat glands. By competitively inhibiting these receptors, Axhidrox effectively “turns off” the neural signal that triggers excessive sweating.

What makes Axhidrox truly different from existing treatments is its localized mechanism of action. Unlike oral anticholinergic medications — which circulate systemically and often cause debilitating side effects such as dry mouth, constipation, blurred vision, and urinary retention — Axhidrox is applied directly to the skin. The glycopyrronium molecule contains a highly polar quaternary ammonium group, which reduces its lipid solubility and limits its ability to cross the skin barrier and the blood-brain barrier. As a result, systemic absorption is less than 1%, and the risk of central nervous system side effects is dramatically reduced.

For my patients, this is the single most important feature. They can finally treat their condition without trading one set of problems for another.

The traditional treatment landscape for axillary hyperhidrosis has been, frankly, inadequate. Let me walk you through the options I used to offer — and their limitations.

Topical aluminum-based antiperspirants are the first line of defense for many patients. They work by physically blocking sweat ducts with aluminum salts. But for patients with severe hyperhidrosis, they are often ineffective, and they can cause significant skin irritation, especially with repeated use.

Botulinum toxin (Botox) injections are more effective, reducing sweating by blocking acetylcholine release at the nerve terminal. Clinical trials show that Axhidrox achieves a sweat reduction of approximately 82% after four weeks of treatment — comparable to botulinum toxin, which achieves about 80%. But botulinum toxin requires repeated injections every four to six months, is painful, expensive, and carries risks of compensatory sweating in other areas.

Oral anticholinergic medications, such as oxybutynin or glycopyrrolate tablets, can be effective, but they come with a heavy burden of systemic side effects that many patients find intolerable.

Endoscopic thoracic sympathectomy (ETS) is a surgical procedure that involves cutting the sympathetic nerves that trigger sweating. It is invasive, irreversible, and carries significant risks, including compensatory hyperhidrosis — excessive sweating in other parts of the body that can be even more disabling than the original condition.

Axhidrox offers something none of these options can: high efficacy, non-invasiveness, and minimal systemic side effects, all in a convenient once-daily topical application.

I am a clinician who bases my recommendations on evidence, not marketing. And the evidence for Axhidrox is robust.

The pivotal Phase IIIa trial was a multicenter, randomized, double-blind, placebo-controlled study involving 518 patients aged 18 to 65 with severe primary axillary hyperhidrosis. After four weeks of once-daily treatment, patients in the Axhidrox group experienced a mean reduction in sweat production of approximately 82%, compared to only 28% in the placebo group. The difference was highly statistically significant.

Equally important are the long-term data. The Phase IIIb open-label extension study followed patients for up to 72 weeks. At week 12, the median sweat reduction from baseline was 65.6% — an absolute reduction of 119.30 mg of sweat. And the improvement persisted throughout the 72-week follow-up period, with no evidence of tachyphylaxis (loss of effect over time) or cumulative toxicity. Patients also reported sustained improvements in quality-of-life measures, including the Hyperhidrosis Quality of Life Index and the Dermatology Life Quality Index.

In terms of safety, the most common adverse events were mild-to-moderate local skin reactions — pruritus, erythema, burning, or dryness — which were generally transient and reversible. Systemic anticholinergic side effects were significantly lower than with oral medications. In fact, NICE (the UK’s National Institute for Health and Care Excellence) has concluded that Axhidrox is a cost-effective option compared with botulinum toxin, supporting its recommendation for use in the NHS.

Axhidrox has received regulatory approvals in a growing number of countries worldwide — a testament to the strength of its clinical evidence and safety profile.

In Europe, the product was approved through a decentralized procedure led by Sweden, receiving its first marketing authorization on April 11, 2022. Within the first year, eleven European countries granted marketing authorization, including Denmark, Latvia, Austria, Sweden, Estonia, Finland, Croatia, Germany, the Netherlands, Norway, and Lithuania. Since then, the product has expanded to at least 14 European Union member states.

In the United States, the FDA approved Axhidrox for the treatment of primary axillary hyperhidrosis in patients aged 9 years and older in June 2024.

In the Asia-Pacific region, Axhidrox was approved in Macau in 2025, marking it as the first targeted topical medication for primary axillary hyperhidrosis in that market. The UK’s NICE has also recently recommended the treatment.

And now, in 2026, Axhidrox has officially arrived in China through the Boao Lecheng International Medical Tourism Pilot Zone — bringing this innovative therapy to Chinese patients for the first time.