Evidence-based review of the nonsurgical management of hyperhidrosis

The most common nonsurgical modern treatments for hyperhidrosis include topical treatments such as aluminum chloride, iontophoresis (usually with tap water), oral medications such as anticholinergics, and BTX-A. Topical treatments should always be first-line therapy. For those who fail such treatment, iontophoresis is typically recommended for those with palmar or plantar hyperhidrosis, whereas BTX is often considered as first- or second-line therapy in severe axillary hyperhidrosis. Oral anticholinergics are considered after failure of all other nonsurgical treatments.