Policy Number: SRP 063
Policy Name: Hyperhidrosis-Botulinum toxin Type A
Status: Group Prior Approval
Effective Date: 1st April 2024
Next Review Date: 1st April 2026
Mid and South Essex ICB commissions management of hyperhidrosis with botulinum toxin Type A on a restriction basis for patients with:
- severe localised hyperhidrosis i.e. Hyperhidrosis Disease Severity Scale score of 3 or more- sweating which is barely tolerable and frequently interferes with daily activities, AND
- a resting sweat production of at least 100mg/5 minutes (per axilla) on a restrictive basis.
| Subjective Score | Clinical interpretation |
|---|---|
| My sweating is never noticeable and never interferes with my daily activities | 1 mild |
| My sweating is tolerable but sometimes interferes with my daily activities | 2 moderate |
| My sweating is barely tolerable and frequently interferes with my daily activities | 3 severe |
| My sweating is intolerable and always interferes with my daily activities | 4 severe |
Patients with generalised hyperhidrosis (severe or otherwise) must not be referred to secondary care but managed in primary care with medication as per MSE ICB guidance and self-funded iontophoresis if indicated.
Patients with severe localised hyperhidrosis should not be referred to a specialist without having tried for at least six months.
- self- funded topical strong antiperspirants AND
- self-funded iontophoresis with tap water
Tap-water iontophoresis is non-invasive and is appropriate for axillary, palmar, plantar and craniofacial hyperhidrosis.
Iontophoresis with glycopyrronium bromide is not funded as the level of evidence for adding glycopyrronium bromide solution is weak and costs in primary care is prohibitive.
For severe localised hyperhidrosis, where specialist treatment with botulinum toxin Type A is clinically indicated, treatment must not be repeated more frequently than once every 6 months.
MSE ICB does not commission and will not fund Endoscopic Thoracic Sympathectomy (ETS) due to weak evidence and significant risk of morbidity.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances.