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Botulinum Toxin A for the management of focal hyperhidrosis

This is a summary of the NHS Devon commissioning policy for focal hyperhidrosis.

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Referral Criteria

Referral Criteria:

  • Hyperhidrosis Disease Severity Scale score of 3 or more (sweating which is barely tolerable and frequently interferes with daily activities)
  • which has failed to respond to at least six weeks of topical aluminium chloride and self-management strategies.

Botulinum toxin A is only commissioned for use in patients with severe axillary hyperhidrosis. Patients must satisfy the above referral criteria AND have a resting sweat production of at least 100mg/5 minutes (per axilla).

In severe cases which are unresponsive to these treatments, surgical intervention can be considered. However, the procedure (endoscopic thoracic sympathectomy) often leads to compensatory hyperhidrosis and so is rarely used in practice.

Please note iontophoresis is no longer available in secondary care.

Generalised hyperhidrosis

Consider referral to Dermatology for patients with generalised hyperhidrosis where:

  • underlying causes cannot be identified despite appropriate investigations.
  • Symptoms persist despite management of underlying conditions and/or adjustments to potential causative medications

NHS Devon commissioning policy for Botulinum Toxin A for the management of focal hyperhidrosis

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Exceptional /Individual Funding Requests (IFR).

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Patient Information

Individual Funding Request (IFR)

Date of publication: May 2013

Updated: November 2023

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