Document type
Clinical pathways
Place
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Pathway
Treatment for Hyperhidrosis in Primary Care

Hyperhidrosis Management

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/

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