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Hyperhidrosis

 

Useful link: http://www.pcds.org.uk/clinical-guidance/hyperhidrosis

 

 

CLASSIFICATION:

  • Focal/primary
  • Generalised – consider the need to investigate for an underlying medical condition
  • Gustatory

 

FOCAL:

  1. Antiperspirants 1/12 e.g. Anydrol Forte or Driclor (This should be OTC as per NHS guidance – see link)NHS England OTC guidance- If there is local irritation apply 1% hydrocortisone cream the morning after the treatment if necessary (also available to purchase over the counter (OTC)
  2. Oral anticholinergics – e.g. Propantheline 15mg three times a day, one hour before each meal, and 30mg at bedtime, may be increased up to 120mg per day. If intolerant, trial modified release oxybutynin (off-licence) e.g. Lyrinel XL 10mg.

Referral -If tried (or intolerant of) all of the above then refer. Essentially for iontophoresis which can be useful for axillary, palmar and plantar hyperhidrosis if primary care management has failed.

Please include details of treatments in primary care when referring.

 

 

GENERALISED HYPERHIDROSIS:

Possible aetiology:

  • Familial – often starts in late childhood and improves in middle age
  • Check drug causes: antidepressants, opioids, ciprofloxacin, Zoladex, oestrogens,
  • Other - Obesity/menopause/alcohol/caffeine

- If no obvious cause arrange the following investigations: FBC, U&E, LFTs, HbA1c, TFTs, CRP, CXR.

- Consider (depending on risk): HIV, TB, blood film for malaria

(Rare conditions- if the attacks are associated with pallor, tremor or headaches consider a phaeochromocytoma or insulinoma. Ideally, the relevant investigations need to be done during an attack)

Treatment- Systemic anticholinergics as above

Referral –failure to respond to primary care management and patient wishes further treatment

 

IONTOPHORESIS:

 - Patient will be asked to attend for multiple appointments for the first month and if successful will be advised to purchase their own machine (as there is a very long waiting list for limited machines).

 

NOT AVAILABLE ON NHS:

Botulinum toxin

Endoscopic thoracic sympathectomy (ETS)

 

PATIENT INFO:

  • BAD patient leaflet  - https://www.bad.org.uk/shared/get-file.ashx?id=93&itemtype=document
  • Hyperhidrosis support group - https://hyperhidrosisuk.org/

 

Review date                August 2024

Next review due           August 2026

Reviewing GP              Dr Madeleine Attridge