Key points

• Limited data suggest that 10-30% aluminium chloridehexahydrate is effective but there is a trade-off between efficacy and side-effects (local irritation of the skin).

• Evidence from RCTs suggests the efficacy of botulinum toxin A in focal hyperhidrosis. Botulinum toxin A is a highly effective treatment for axillar hyperhidrosis.

• There is limited evidence on the efficacy of oral anticholinergics, bornaprin and methanthelinum bromide. These are associated with anticholinergic side-effects.

• Iontophoresis of the palm may be moderately effective. The efficacy of iontophoresis of the axillae is questionable. Local irritation is common.

• There is little evidence in support of the surgical removal of axillar sweat glands. No hard outcome criteria had been used in any of the published studies. Therefore the real efficacy is not clear.

• There is some evidence for the efficacy of sympathectomy, although there is a lack of objective criteria to measure efficacy. Sympathectomy for axillar and palmar sweating is associated with long-term side-effects such as compensatory and gustatory sweating. Because of the unknown long-term side-effects, sympathectomy should be only considered in very severe cases.

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