# Primary Focal Hyperhidrosis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: International Hyperhidrosis Society Guidelines 2019 · Anhydrol Forte 20% w/v cutaneous solution SmPC sections 4.1-4.4 (eMC product 3749) - Verified date: 2026-08 ## Verified against - Anhydrol Forte 20% w/v cutaneous solution SmPC sections 4.1-4.4 (eMC product 3749) - International Hyperhidrosis Society Guidelines 2019 - Primary Focal Hyperhidrosis - disease-level clinical article (hyperhidrosis-clinical.txt) ## Treatment metadata - Aluminium chloride — topical - Referral & safety-netting (no drug therapy) - Glycopyrronium — 1 mg — oral.solid ## Complete treatment card ```text PRIMARY FOCAL HYPERHIDROSIS Sources: International Hyperhidrosis Society Guidelines 2019 · Anhydrol Forte 20% w/v cutaneous solution SmPC sections 4.1-4.4 (eMC product 3749) Review status: REVIEWED against Anhydrol Forte 20% w/v cutaneous solution SmPC sections 4.1-4.4 (eMC product 3749), International Hyperhidrosis Society Guidelines 2019, Primary Focal Hyperhidrosis - disease-level clinical article (hyperhidrosis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Excess sweating is reported in areas dense with sweat glands - palms, soles, face, scalp, or armpits [sweating] - Primary disease tends to affect younger patients, those with symptoms over 6 months, a family history, and bilateral involvement - Onset after midlife should raise concern for a secondary cause rather than primary disease - By definition, primary disease spares sleep - sweating decreases or stops at night [sweating] - Diagnostic criteria require symmetric sweating on both sides of the body [sweating] - Episodes of excess sweating last at least 7 days at a time under the diagnostic criteria [sweating] - The formal criteria restrict primary disease to onset at age 25 or younger TESTS (4) - When a secondary cause is suspected, work-up includes a complete blood count, basic metabolic panel, TSH, ESR, ANA, HbA1c, and chest x-ray - These tests screen for infection, kidney problems, cancer, diabetes, thyroid disease, or a connective tissue disorder as causes of secondary sweating - A measuring scale can grade how much of the palm is affected, or a starch-iodine test can map the pattern - Visual assessment alone is usually sufficient to diagnose, so these scoring tools are not widely used in practice IF NOT THIS - what else fits (3) - Thyroid overactivity, a peripheral nerve disorder, or low blood sugar episodes are also on the differential - An adrenal catecholamine-secreting tumor, the menopausal transition, or an underlying lymphoma should also be considered - Active tuberculosis or alcohol dependence are also listed as possible causes Source StatPearls "Hyperhidrosis" - disease-level clinical article Status traced to the source above 1. ALUMINIUM CHLORIDE [1st line] Adult Apply 20% solution to clean, completely dry skin once daily at bedtime until sweating is controlled, then reduce frequency; wash off in morning x 1-2 weeks nightly initiation, then 1-2 times weekly maintenance Peds Children >=12 years: apply sparingly at night Source Anhydrol Forte 20% w/v cutaneous solution SmPC sections 4.1-4.4 (eMC product 3749) Why Topical aluminium chloride hexahydrate solution acts as first-line antiperspirant/astringent barrier; available as standalone 20% preparation in Egypt. Caution Apply only to completely dry skin to minimize skin irritation and burning. Do not apply to broken, inflamed, or recently shaved skin. Wash off thoroughly in the morning; may stain clothing. Wash it off in the morning - it is not left on through the day. No shaving and no depilatory within 12 hours either side of an application to the armpits, and do not bathe just before applying. Broken or freshly shaved skin is what turns this into a burn, and the burn is why people give up on a treatment that works. Egypt ABC MOCOTIVE TOPICAL SPRAY 70 ML > EGYSTAR PHARM 30.00 EGP -> ! also contains alcohol, chamomile, glycerin, tea tree oil, vit.e 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hyperhidrosis - disease-level clinical article (hyperhidrosis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Work up and exclude secondary causes of hyperhidrosis (infection, malignancy, thyroid disease, diabetes mellitus). 3. GLYCOPYRRONIUM [2nd line] Adult 1-2 mg 1-2 times daily on an empty stomach - long-term under monitoring Peds Specialist dermatological advice required Source International Hyperhidrosis Society Guidelines 2019 Why Oral glycopyrronium is not registered in Egypt. Every glycopyrronium product in the register is an inhaled COPD device, so no brand and no price is shown - it is a real option a physician may import or compound, not one the pharmacy will hand over. Caution CONTRAINDICATED in narrow-angle glaucoma, urinary retention, severe gastrointestinal obstruction, and severe ulcerative colitis. Systemic anticholinergic effects include dry mouth, blurred vision, dizziness, constipation, and tachycardia. Take on an empty stomach (1 hour before or 2 hours after meals). No oral glycopyrronium tablet is on sale in Egypt - the register carries only inhaled COPD capsules. Do not substitute one; it is the wrong route and the wrong dose. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)