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Hyperhidrosis is defined as excessive sweating at rest and during normal temperature, and can be classified as being focal or generalised.
Most cases of focal hyperhidrosis are idiopathic, with a possible genetic predisposition. Most commonly affected areas are the axillae, palms and soles. There are no standardised diagnostic criteria for focal hyperhidrosis, and the diagnosis is based on history and physical signs.
Aluminium chloride hexahydrate 20%
Patients with focal hyperhidrosis that is significantly impacting on daily activities and quality of life despite topical aluminium chloride deodorant can be referred to the dermatology department for consideration of iontophoresis (palmoplantar hyperhidrosis) or 6-monthly botulinum toxin (axillary hyperhidrosis).
Patients with axillary hyperhidrosis must be informed not to wear deodorant to their clinic appointment as sweat measurements will be performed.
Endoscopic sympathectomy (vascular surgery department) is only considered for severe selected cases of palmar hyperhidrosis unresponsive to other treatments.
Circumstances under which treatments for focal hyperhidrosis (see Commissioning Policy for more details)
Generalised hyperhidrosis can be caused by underlying infections, malignancy or endocrine abnormalities. Appropriate investigations are required; this will often require a referral to secondary care. Following investigation treatment with an anticholinergic propantheline bromide or oxybutynin (off license) may be required (secondary care initiation).