Introduction and current guidance
Hyperhidrosis is a chronic condition in which a person sweats in excess of what is necessary to maintain normal body temperature. Hyperhidrosis can be classified by the presence or absence of an underlying cause (primary [idiopathic] or secondary) and location (localised [focal] or generalised). Primary hyperhidrosis has no recognised cause, and is generally localised to certain parts of the body, mainly the axillae (armpits), hands, feet, face or scalp. It typically begins during childhood or adolescence, but can occur at any age and is usually life-long (clinical knowledge summary on hyperhidrosis).
Secondary hyperhidrosis is caused by another condition, such as hyperthyroidism, diabetes, neuropathy, spinal disease or spinal injury, or can be an adverse effect of a drug. Secondary hyperhidrosis can be generalised, affecting the whole body, or can affect only localised areas, similar to primary hyperhidrosis.
Excessive sweating can have a profound effect on quality of life, interfering with daily activities and causing anxiety and embarrassment (NICE interventional procedures guidance on endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb).
NICE has not published a guideline on managing hyperhidrosis.
The clinical knowledge summary on hyperhidrosis recommends that people with primary localised hyperhidrosis should receive advice on lifestyle measures, information and support on their condition and an antiperspirant (20% aluminium chloride hexahydrate). If these measures are inadequate or unacceptable a referral to a dermatologist may be required. Treatments that may be offered in secondary care include:
topical therapies (including emollients, antiperspirants and antimuscarinic medicines)
iontophoresis (with tap water or glycopyrronium)
botulinum toxin type A injections
systemic therapies (for example oral antimuscarinics [such as oxybutynin, propantheline and glycopyrronium: see the NICE evidence summary on glycopyrronium for hyperhidrosis for more information], clonidine, diltiazem, benzodiazepines)
surgery (NICE has published interventional procedures guidance on endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb).
The clinical knowledge summary on hyperhidrosis recommends that people with secondary localised hyperhidrosis or generalised hyperhidrosis should be investigated for an underlying cause, which should be managed appropriately.
Specialists involved in the production of this evidence summary advised that the choice of initial treatment for hyperhidrosis is usually guided by the site of excessive sweating.