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Management of localized hyperhidrosis (localised sweating e.g. armpits, palms, soles)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The usual areas affected are the axillae, palms and soles. Often the condition is worse in the summer and may be exacerbated by emotional triggers.

  • aluminium chloride preparations
    • are the first line treatment
    • applied at night just before sleep
    • used daily initially together with standard antiprespirant and once the symptoms improve, could be used as required
  • topical glycopyrrolate - anticholinergic drugs

Patients who fail to respond to lifestyle advice and topical aluminium chloride (trialled for at least six weeks) should be referred to a dermatologist. Treatment options available in secondary care include:

  • iontophoresis
    • although mode of action is unknown, many guidelines recommend its use.
    • each palm or sole is placed in a small tray filled with tap water, through which a current of 15-20 mA is run.
    • once the level sweating is controlled with treatment maintenance treatment should be undertaken once a week or less.
  • oral anticholinergic drugs
    • e.g. - oxybutynin, glycopyrrolate
    • not currently licensed for UK use in primary hyperhidrosis,
  • botolinum toxin may be considered in selected cases depending on the site affected
    • botulin A toxin (BTX-A) is the most commonly used and it inhibits acetylcholine release temporarily but more effectively than topical agents.
    • used in axillary hyperhidrosis unresponsive to topical agents
    • effect of treatment last for six to nine months and , lifelong treatment is necessary
  • surgery
    • endoscopic thoracosympathectomy
      • most commonly used method which provides permanent relief
      • usually performed as a day case procedure under general anaesthesia
      • reserved for patients who are unresponsive to other less invasive interventions
      • patients should be infoemd about the irreversible nature of the surgery and possible side effects (compensatory hyperhidrosis elsewhere on the body.)
    • other emerging surgical tecniques
      • suction curettage - an arthroscopic shaver or similar device is used to debride the subcutaneous tissue and clear the glands through a small (1-2 cm) incision, usefull in the management of axillary hyperhidrosis
      • laser treatment - used in a similar way to suction curettage (1).

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