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Management of hyperhidrosis in secondary care

Hyperhidrosis is uncontrollable excessive sweating, which occurs at rest, regardless of temperature. It can have a major impact on people's quality of life. Primary hyperhidrosis is thought to affect at least 1% of the UK population. There is considerable variation in the availability of treatments in specialist care. This systematic review from the UK assessed the effectiveness of treatments used in specialist care for patients with hyperhidrosis. A comprehensive search was undertaken to find relevant studies of hyperhidrosis treatments. The quality of the studies was assessed. Patient advisors contributed to the interpretation of the results. Fifty studies were included in the review, most were small and of poor quality. The treatments assessed were iontophoresis, botulinum toxin injections, anticholinergic medications, curettage and other technologies that damage the sweat gland. Some studies assessing botulinum toxin injections for hyperhidrosis of the armpit were pooled together to estimate average effects. Our review found that there was moderate quality evidence that botulinum toxin injections reduce symptoms of armpit hyperhidrosis in the short and medium term (up to 16 weeks), compared with placebo (no treatment). There was weak but consistent evidence of some benefit from using iontophoresis for hyperhidrosis of the hands. Evidence for other interventions was of low or very low quality. Overall, the evidence for the effectiveness of treatments for primary hyperhidrosis is limited and few firm conclusions can be drawn. However, there is moderate quality evidence to support the use of botulinum toxin injections in clinical practice. A well conducted, adequately powered, randomised controlled trial of botulinum toxin injections compared with iontophoresis (which is the current standard treatment in many dermatology units for palmar hyperhidrosis, which affects the palms of the hands) for palmar hyperhidrosis may be warranted.