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Page last updated:
16 November 2023
Hyperhidrosis describes sweating in excess of normal body temperature regulation. It can be classified by its location (focal or generalised) and by the presence of an underlying cause (primary or secondary). The condition appears to improve with age and is uncommon in the elderly.
NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is mild to moderate hyperhidrosis (excessive sweating).
Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.
Primary focal hyperhidrosis involves specific areas of the body but has no identifiable underlying cause.
Self-care management strategies include:
Additional advice and support for patients is available from the British Association of Dermatologists, Hyperhidrosis UK and the NHS information leaflet for excessive sweating (hyperhidrosis).
Where standard antiperspirant products are ineffective, consider advising the use of an aluminium chloride hexahydrate 20% roll-on antiperspirant or spray. These are readily available over the counter (OTC) from pharmacies and can be used alongside other self-care management strategies.
Review after 6 weeks. If response is inadequate or treatment is not tolerated, oral treatment with systemic anticholinergics can be considered.
Consider treatment with an oral systemic anticholinergic where there is an inadequate response to at least 6 weeks of treatment with a topical aluminium antiperspirant and self-care management strategies. Where tolerated, topical aluminium products can be continued alongside oral treatment.
Although it is an off-label use, specialists advise that for patients with hyperhidrosis, oxybutynin is considered ahead of the licensed alternative (propantheline bromide) owing to greater evidence of efficacy and lower cost
OR
Review after 6 weeks. If response is inadequate after at least 6 weeks at the maximum tolerated dose of oxybutynin or propantheline, or treatment cannot be tolerated, consider making an Advice and Guidance request to Dermatology.
Refer to Hyperhidrosis Clinical Referral Guidelines:
Secondary hyperhidrosis occurs due to an underlying condition or as a side effect of medication. Cases are usually generalised, affecting the entire skin surface. Whilst secondary focal hyperhidrosis can occur, cases are rare.
Initial management should focus on the identification and management of underlying causes (See Hyperhidrosis clinical referral guidelines: Western Locality / South Devon and Torbay).
For patients with moderate to severe hyperhidrosis (HDSS score of 3 or 4) where symptoms persist despite the management of underlying causes, consider oral treatment with a systemic anticholinergic drug.
Although it is an off-label use, specialists advise the use of oxybutynin rather than the licensed product propantheline bromide, owing to greater evidence of efficacy and lower cost.
OR
Review after 6 weeks. Where response is inadequate after at least 6 weeks at the maximum tolerated dose, or treatment cannot be tolerated, consider making an Advice and Guidance request to Dermatology.
Refer to Hyperhidrosis Clinical Referral Guidelines: