13.12 Antiperspirants

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.

Circumstances under which treatments for focal hyperhidrosis are commissioned in Devon can be found in the Commissioning Policy

Drugs used but not listed here:

• Oxybutynin See section 7.4 Drugs for genito-urinary disorders
  • Hyperhydrosis (unlicensed indication)
• Botulinum toxin type A See section 4.9 Drugs used in parkinsonism and related disorders

Aluminium chloride hexahydrate

• Roll-on applicator 20% (click here for preferred brand)

Indications

• Hyperhidrosis

Dose

• Apply at night to dry skin, wash off the following morning. Reduce applications as symptoms allow.

Notes

1. Advise patient that skin irritation may occur. This can be managed by:
   • The use of topical emollients and soap substitutes
   • A reduction in the frequency of application
   • Giving a short course of 1% hydrocortisone cream, for up to 2 weeks
2. Review 1–2 months after starting treatment. If successful, it can be continued indefinitely
3. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)

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