- RAG rating
- n/a
- Document type
- Clinical pathways
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Pathways
- Pathway
- Treatment for Hyperhidrosis in Primary Care
Hyperhidrosis Management
- Diagnostic criteria for primary hyperhidrosis see NICE CKS link: https://cks.nice.org.uk/hyperhidrosis#!diagnosissub
- Offer lifestyle advice and self-management: https://cks.nice.org.uk/hyperhidrosis#!scenario
Primary/Focal Hyperhidrosis:
- Conduct baseline HDSS score
- first line management commercial antiperspirant with 20% aluminium chloride hexahydrate e.g. Driclor® and Anhydrol Forte® which may be purchased (if skin irritation occurs and other conservative measures fail consider adding 1% hydrocortisone cream - see NICE guidance as above). Advise to purchase over the counter.
- If treatment unsuccessful** after one month recommend further self-management with iontophoresis (patient to purchase) if axillary or palmar/plantar hyperhidrosis, or consider oral anticholinergic* (off label).
- If self-management (including oral anticholinergic if tried) not successful** after 3-6 months, manage according to severity
- If HDSS score 1-3 stop treatment
- If HDSS score 4 despite all self-management treatments as above, refer to skin health triage
Secondary Hyperhidrosis: address cause if known (e.g. hyperthyroidism, menopause, medication, amphetamines), if unknown cause refer to secondary care for investigation as appropriate.
NOTES
*First-line Oxybutynin 2.5mg IR: start with 2.5mg OD & gradually titrate according to response.
Alternative anticholinergics can be tried but lack evidence (off-label).
Propantheline bromide is licensed for hyperhidrosis but less effective. Oral glycopyrronium bromide is unlicensed in the UK & costs are prohibitive: evidence base is similar as for oxybutynin.
**Criteria for successful treatment of hyperhidrosis: reduction in HDSS score. Treatment failure can be defined as no change in HDSS score after 1 month of therapy or lack of tolerability for the treatment.
For further information, see Priorities Forum statement The Management of Hyperhidrosis / https://www.nhs.uk/conditions/excessive-sweating-hyperhidrosis/