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There are no studies treating patients with palmar hyperhidrosis with exclusively topical agents (10% aluminium chloride, 5% methenamine, 5% glutaraldehyde, 5% propantheline bromide). There was one placebo-controlled RCT of 5% methenamine based on 109 patients with palmar and plantar hyperhidrosis.17 In this study the mean ± SEM hyperhidrosis score was 1-39 ± 0-11 for patients treated for 28 days with 5% methenamine, compared with 2-52 ± 0-9 in the placebo group (P < 0-001). Of the treated patients, 71/109 (65-1%) rated the result as good or excellent, compared with 19/109 (17%) of the placebo group. In another study by Phadke et al.,18 60 patients were randomised to treatment with topical 10% methenamine aqueous solution, 5% glutaraldehyde, or tap water iontophoresis with direct current. After 4 weeks, 19 of 20 patients treated with methenamine, 13 of 20 patients treated with glutaraldehyde and 11 of 20 treated with iontophoresis described good or excellent results.

The case series of Ewert et al.11 on the efficacy of 10% aluminium chloride plus 5% propantheline bromide in a solution included patients with axillar hyperhidrosis as well as palmar and plantar hyperhidrosis. In this European study the efficacy was reported to be good or very good.

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