• Antiperspirants spray, stick, roll-on and paints are available. Choose an unfragranced aluminium salt preparation suitable for hyperhidrosis (10-25% in alcohol or as a gel). Antiperspirants should be applied when the skin is dry, after a cool shower, just before bed. Wash off in the morning. They should be used for several consecutive nights then once or twice weekly. The stronger products can irritate; if so, apply hydrocortisone cream for a few days.
  Note: ‘deodorants’ are fragrances designed to disquise unpleasant smells. They don't affect the amount of sweat produced.
• Talcum Powder and Corn Starch Powder are suitable for mild hyperhidrosis. Apply between the toes, under the breasts and other skin folds.

Treatment available from a specialist

• The anticholinergic drugs, oral propantheline (Pro-banthine) and oxybutymin (Ditropan) may reduce sweating, but unfortunately can cause blurred vision, dry mouth, and constipation.
• Beta blockers may also be helpful but are unsuitable for those with asthma or peripheral vascular disease.
• A dusting powder containing diphemanil may be used for mild hyperhidrosis.
• Iontophoresis is available at some hospital departments for hyperhidrosis of palms, soles and armpits. A low electrical current is passed across the skin surface daily for several weeks and stops sweat production. Visits are then required weekly or less often. Iontophoresis may cause irritation or dermatitis.
• Battery Powered iontophoresis: The Drionic device is less powerful than the hospital version but may be more convenient.
• Botulinum toxin injections into the armpits are increasingly popular as they can reduce or even stop sweating for three to six months. Botulinum toxin is also effective for the palms and soles. Botulinum toxin may temporarily weaken the small muscles of the hands. Regional or local anaesthesia is desirable in these sites as the injections are painful.
• Chemical or surgical sympathectomy (often done by endoscopic surgery) are operations on the spinal sympathetic nerves, which considerably reduce sweating of the armpits and the palms. Unfortunately the effect may not be permanent (recurring in up to 15% of cases), and is accompanied by undesirable skin warmth and dryness. There is a low risk of serious complications such as Horner's syndrome, pneumothorax, pneumonia and persistent pain (affecting less than 2% of patients). However compensatory hyperhidrosis elsewhere occurs after surgery in many individuals (about 50%). Sympathectomy is therefore reserved for the most severely affected individuals. Lumbar sympathectomy is not recommended for hyperhidrosis affecting the feet as it can interfere with sexual function.
• Surgery to remove the sweat gland-bearing skin of the armpits is a major procedure usually requiring skin grafts. Overactive sweat glands may also be removed by tumescent liposuction or subcutaneous curettage.