Trip Answers

Question answered:13/03/08

CKS have a guideline on hyperhidrosis [1], this includes a general outline of focal hyperhidrosis:

 

“Advise on sweat reduction and concealment: people should avoid known trigger factors, use an antiperspirant, use an absorbent dusting powder (talc), and wear appropriate clothing.

 

If this provides inadequate relief, prescribe a topical aluminium salt antiperspirant:
 - Formulations available are a dusting powder or roll-on solution. Prescribe according to the person's preference and the site affected.
 - They should be applied to dry skin of the axillae, feet and hands (face not recommended), and washed off in the morning.
 - They should be applied every 1–2 days, as tolerated, until the condition improves.
 - Application every 1–3 weeks is usually required to continue to control sweating.

 

Topical aluminium salts may cause skin irritation. If this occurs, consider:
 - The use of topical emollients and soap substitutes.
 - A reduction in the frequency of application.
 - Giving a short course of 1% hydrocortisone cream, for a maximum of 2 weeks.
 - Reviewing after 2 weeks, and refer if the person is intolerant of treatment despite the above measures.”

 

It also reports:

 

“Refer to a dermatologist if:
 - Symptoms continue to be troublesome despite lifestyle advice and use of topical aluminium salt antiperspirants.
 - The person is unable to tolerate treatment with topical aluminium salts (despite reduced frequency of application and short-term use of topical hydrocortisone 1%).”

 

Later in the guideline they have a section ‘What treatments might be considered in secondary care?’, which is too large to reproduce here.  The section includes pharmaceutical and surgical interventions.  In relation to surgery it gives the following summary:

 

“Various surgical techniques have been used in the past to treat primary focal hyperhidrosis. Surgery is usually only considered if other treatment options have failed or have not been tolerated.

 

Before surgery is considered, the person should be evaluated by both a surgeon (usually a specialist vascular surgeon) and a dermatologist [Hornberger et al, 2004].

 

There are two main types of surgical treatment:
 - Local axillary surgery
 - Endoscopic thoracic sympathectomy

 

People considering either form of surgery should be fully informed of the risks of surgery and the likely success rates.”

 

Reference

1) http://www.cks.library.nhs.uk/hyperhidrosis/view_whole_guidance

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