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Suggested management protocol for primary hyperhidrosis (sweating)

Last edited 10 Jul 2026

suggested stepwise management of primary hyperhidrosis

The following (based on published recommendations) have been suggested for management of primary hyperhidorsis

Type of hyperhidrosis	Management steps
First	Second	Third	Fourth	Fifth
Axillary hyperhidrosis	topical aluminium chloride at increasing doses as tolerated	botulin A injections	systemic anticholinergic treatment at increasing doses as tolerated	iontophoresis using tap water ±topical anticholinergics	thoracoscopic sympathectomy
Palmar hyperhidrosis	topical aluminium chloride at increasing doses as tolerated	iontophoresis using tap water ±topical anticholinergics	systemic anticholinergic treatment at increasing doses as tolerated	thoracoscopic sympathectomy
Plantar hyperhidrosis	topical aluminium chloride at increasing doses as tolerated	iontophoresis using tap water ±topical anticholinergics	systemic anticholinergic treatment at increasing doses as tolerated
Craniofacial hyperhidrosis	topical aluminium chloride at increasing doses as tolerated; topical glycopyrrolate	systemic anticholinergic treatment at increasing doses as tolerated	thoracoscopic sympathectomy

NICE state (2):

Glycopyrronium bromide cream can be used as an option to treat severe primary axillary hyperhidrosis in adults, if lifestyle advice, topical aluminium-based antiperspirants and oral antimuscarinics:

have not controlled underarm sweating, or
are contraindicated or not tolerated.

Reference:

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Suggested management protocol for primary hyperhidrosis (sweating)

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