REMEDY : BNSSG referral pathways

Hyperhydrosis (focal)

Checked: 23-10-2017 by Rob.Adams Next Review: 23-10-2018

Funding Approval Required

Patients must not be referred to secondary care, including dermatology, for management of focal hyperhidrosis unless funding approval has been secured from the commissioner.  Please visit BNSSG CCG’s INNF Webpage for further guidance.

Principles of Management

Generalised hyperhidrosis needs further investigation to exclude underlying causes. See CKS hyperhidrosis guidelines.

Focal hyperhidrosis

1 - Provide advice about lifestyle measures and sources of information and support.

Modification of behaviour to avoid identified triggers where possible (such as crowded rooms, caffeine or spicy food)

For primary axillary hyperhidrosis - use a commercial antiperspirant frequently (as opposed to a deodorant), avoid tight clothing and manmade fabrics, wear white or black (rather than coloured clothing) to minimise signs of sweating, consider use of armpit/sweat shields to absorb excess sweat and protect clothing (obtained on internet or from Hyperhidrosis Support Group)

For primary plantar hyperhidrosis - where possible avoid food and drink triggers if they exacerbate symptoms (including caffeinated products, chocolate, spicy or sour foods, hot foods, alcohol, sweets, food and drinks containing citric acid) 

2.  Recommend that 20% aluminium chloride (Driclor is BNSSG Formulary choice) is used.  This can be prescribed or bought over the counter.

Aluminium chloride should be applied at night, just before sleep to dry skin of the axillae, feet, hands or face (avoiding eyes) and washed off in the morning.  Apply every 1 to 2 days (as tolerated) until condition approves then apply as required (may be up to every 6 weeks).

If skin irritation occurs use topical emollients and soap substitutes, reduce frequency of application or give short course of 1% hydrocortisone cream for up to 2 weeks. Review progress after 1 to 2 months and if successful, treatment can be continued indefinitely.

3.  Consider treating any underlying anxiety which be an exacerbating factor (antidepressants or propranolol can worsen hyperhidrosis and so cognitive behavioural therapy may be preferable)

PCDS also has further advice about management

Referral Guidance

NHS treatment in secondary care in BNSSG is now rarely, if ever, funded. In exceptional circumstances individual funding can be applied for. Please visit BNSSG CCG’s INNF Webpage for further guidance

Useful Links

Hyperhydrosis Support Group

International Hyperhydrosis Society