Treat hyperhidrosis with topical therapies first, then dermatological or systemic therapies

Hyperhidrosis (HH) includes chronic focal primary HH (PHH) stemming from sweat gland overactivity, and generalised secondary HH (SHH), which warrants investigation for an underlying cause. PHH, which may be axillary, plantar, palmar and/or craniofacial, decreases patients’ quality of life and often goes undiagnosed. Topical therapies, starting with aluminium chloride, are often effective. Additional recommendations for severe or recalcitrant PHH, and in craniofacial HH, are iontophoresis, topical or systemic anticholinergic agents and onabotulinum toxin injections.