Interventional management of hyperhidrosis in secondary care: a systematic review

Wade, R., Llewellyn, A., Jones-Diette, J., Wright, K., Rice, S., Layton, A. M., Levell, N. J. ORCID:, Craig, D. and Woolacott, N. (2018) Interventional management of hyperhidrosis in secondary care: a systematic review. British Journal of Dermatology, 179 (3). pp. 599-608. ISSN 0007-0963

[thumbnail of Accepted manuscript]
PDF (Accepted manuscript) - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (1MB) | Preview


Background: Hyperhidrosis is uncontrollable excessive sweating, which occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life.  Objectives: To undertake a systematic review of the clinical effectiveness and safety of treatments available in secondary care for the management of primary hyperhidrosis.  Methods: Fifteen databases (including trial registers) were searched to July 2016 to identify studies of secondary care treatments for primary hyperhidrosis. For each intervention randomised controlled trials (RCTs) were included, where available; where RCT evidence was lacking, non‐randomised trials or large prospective case series were included. Outcomes of interest included disease severity, sweat rate, quality of life, patient satisfaction and adverse events. Trial quality was assessed using a modified version of the Cochrane Risk of Bias tool. Results were pooled in pair‐wise meta‐analyses where appropriate, otherwise a narrative synthesis was presented.  Results: Fifty studies were included in the review; 32 RCTs, 17 non‐randomised trials and one case series. Studies varied in terms of population, intervention and methods of outcome assessment. Most studies were small, at high risk of bias and poorly reported. The interventions assessed were iontophoresis, botulinum toxin injections (BTX), anticholinergic medications, curettage and newer energy‐based technologies that damage the sweat gland.  Conclusions: The evidence for the effectiveness and safety of treatments for primary hyperhidrosis is limited overall, and few firm conclusions can be drawn. However, there is moderate quality evidence to support the use of BTX for axillary hyperhidrosis. A trial comparing BTX with iontophoresis for palmar hyperhidrosis is warranted.

Item Type: Article
Additional Information: This article is protected by copyright. All rights reserved.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 05 Apr 2018 14:30
Last Modified: 27 Oct 2022 00:08
DOI: 10.1111/bjd.16558

Actions (login required)

View Item View Item