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Hyperhidrosis - Management
How should I manage someone with primary focal hyperhidrosis?

  • Provide advice about lifestyle measures and sources of information and support.
  • Recommend 20% aluminium chloride hexahydrate:
    • Driclor® and Anhydrol Forte® roll-ons are licensed, and can be prescribed or bought over-the-counter.
    • Odaban® spray is not a licensed medicinal product. However, it can be prescribed or bought over-the-counter.
    • Advise that aluminium chloride should be applied at night just before sleep:
      • To dry skin of the axillae, feet, hands, or face (avoiding the eyes), and should be washed off in the morning.
      • Every 1–2 days, as tolerated, until the condition improves.
      • And then, as required, which may be up to every 6 weeks.
    • Advise the person to avoid shaving for 24 hours before and after application.
    • Consider soaking lotion pads for application to the face.
    • For plantar hyperhidrosis, an aluminium salt dusting powder (Zeasorb®) can be used as an alternative to 20% aluminium chloride hexahydrate solution or spray.
    • Advise that skin irritation may occur. This can be managed by:
      • The use of topical emollients and soap substitutes.
      • A reduction in the frequency of application.
      • Giving a short course of 1% hydrocortisone cream, for up to 2 weeks.
    • Review 1–2 months after starting treatment. If successful, it can be continued indefinitely.
  • Consider treating any underlying anxiety, which may be an exacerbating factor:
    • Cognitive behavioural therapy may be preferable to antidepressants or propranolol, which can cause or worsen hyperhidrosis.
  • Refer to a dermatologist if the above measures are inadequate or unacceptable.

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