HNY Policy and Pathway Repository - York

May be generalised or localized excessive sweating. It is predominantly a subjective problem and perceptions of normal sweating vary considerably. 

Consider underlying causes-see management section below. See websites below for other associated conditions. 

General advice:

Wearing cotton socks and leather shoes, removing footwear when possible, keeping generally cooler, minimising spicy foods, hot drinks etc.

• Rule out hormonal conditions e.g. menopause, diabetes, hyperthyroidism, endocrine causes e.g. phaeochromocytoma, acromegaly, hypoglycaemia.
• Medication-induced causes: SSRIs, tricyclic antidepressants, opioids, ACE inhibitors.

Generalised Hyperhidrosis:

• First line- slow-release oxybutynin (lyrinel XL) starting at 5mg, increasing in 5mg increments to a maximum of 20mg od
• Anticholinergic drugs such as propantheline,hyoscine butylbromide 5mg up to tds, increase to 10mg tds if needed (warn re anticholinergic side effects),
• B-blockers- if anxiety is a significant precipitant eg propranolol.

Localised hyperhidrosis – try the following:

1. Aluminium chloride e.g. Driclor, Sweatstop cream (patient can purchase, better for non-axillary areas, less irritant)
   Ensure skin dry before application. Use twice daily.
   It can induce inflammatory reaction – if sore reduce application time or apply eumovate ointment.
2. Formaldehyde solution
   For soles of feet to harden skin and block sweat glands-prescribe 3% solution to be used daily to the feet, soak feet for up to 15mins/day See BNF for additional prescribing information.
3. Iontophoresis - method of passing small electric current through water:
   1. Can be effective for palms of hands and soles of feet and pads for axillae,
   2. Equipment for home use can be bought for a few hundred pounds,
   3. Hyperhidrosis UK has links to different machines. Unfortunately, we are no longer able to offer trials of this beforehand.
   4. Adding a spoonful of sodium bicarbonate (bicarbonate of soda) to the tap water solution can increase efficacy
   5. GP can prescribe as a special prescription 0.05% glycopyrollate in aqueous solution in 500ml as an electrolyte medium to use once a week which can be more effective than tap water (though this is expensive and may need an IFR)
4. Botox –Twice a year for axillae or possibly scalps; not suitable for palms or soles due to pain and muscular weakness of small muscles.- the patient would need to arrange this privately or would need an IFR and referral to Leeds Vascular service.
5. Sympathectomy - very rarely performed because of compensatory hyperhidrosis. Most successful for hand hyperhidrosis.

Surgery to remove sweat glands not available under NHS  

Unfortunately, we are no longer accepting referrals for hyperhidrosis management.

Patient information leaflets/ PDAs

https://bad.org.uk/pils/hyperhidrosis

http://www.patient.co.uk/health/excessive-sweating-hyperhidrosis

http://www.hyperhidrosisuk.org/ - information for patients and clinicians

 

References

http://www.dermnetnz.org/hair-nails-sweat/hyperhidrosis.html