Management of hyperhidrosis

Hyperhidrosis is defined as excessive sweating at rest and during normal temperature, and can be classified as being focal or generalised.

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.

Focal hyperhidrosis

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.

Topical treatment

Aluminium chloride hexahydrate 20%


Provide advice about lifestyle measures and sources of information and support. Useful information is available on the Clinical Knowledge Summaries website and from the Hyperhidrosis Support Group.

Specialist referral

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

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 (oxybutynin or propantheline bromide) may be required.


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