Initial treatment of primary focal hyperhidrosis

First-line treatment for primary focal hyperhidrosis is usually topical treatment with an antiperspirant. Antiperspirants are most suitable for axillae but can be used on palms and soles. Antiperspirants for the face may be impractical to use, but can be trialled in some patients (eg children). If antiperspirants are impractical to use, consider trialling systemic therapy, as for generalised hyperhidrosis.

Simple over-the-counter antiperspirants, which often contain an aluminium salt, can provide relief. Antiperspirants with higher concentration aluminium salts (eg aluminium dichlorohydrate 20%, aluminium chloride 15%) can be trialled if simple antiperspirants are not sufficient. Various commercial antiperspirant sprays and roll-on devices are available—application instructions on the product label should be followed¹.

The commercial product Driclor (containing aluminium chloride hexahydrate 20%) has been discontinued in Australia, but similar preparations can be compounded.

For more severe primary focal hyperhidrosis not controlled by antiperspirants, consider systemic therapy (as for generalised hyperhidrosis). Alternatively, refer to a specialist (eg dermatologist or neurologist with expertise in sweating disorders) for site-specific specialist treatment.