Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • nil

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Inclusions

  • hyperhidrosis with failed response to conventional treatment
  • hyperhidrosis with significant psychosocial impact

Exclusions

  • referrals for botox injections, sympathectomy, iontophoresis and microwave or ultrasound thermolysis of eccrine sweat glands

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • hyperhidrosis with failed response to conventional treatment
  • hyperhidrosis with significant psychosocial impact

Additional information to assist triage categorisation

  • psychosocial impact of hyperhidrosis
  • location of hyperhidrosis, axillary/palms/soles/generalised/localised
  • age of onset of hyperhidrosis
  • triggers of hyperhidrosis

Clinical management advice

Hyperhidrosis involves excessive and uncontrollable sweating and is classified as either primary or secondary

Primary hyperhidrosis

  • consists of localised sweating of palms, soles or axillae.
  • commences in childhood and axillary hyperhidrosis in adolescence, with a tendency to improve with age.
  • sweating reduces at night and does not typically occur during sleep.

Secondary hyperhidrosis

  • can occur at night or during sleep
  • due to endocrine/neurological conditions or certain medications.

General management measures

  • minimise potential triggers (exercise, exposure to heat, spicy food, management of anxiety)
  • wear light, loose cotton clothing
  • change clothes regularly as required
  • avoid re-wearing or staying in damp clothes, socks or shoes for long periods.

Exclusion of secondary causes of hyperhidrosis

blood tests if clinical history is suggestive:

  • HbA1c
  • thyroid function tests (TFTs)
  • thiopurine methyltransferase (TPMT)
  • complete blood examination (CBE) with blood film

Consideration of medications as triggers including alcohol, caffeine, corticosteroids, cholinesterase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, nicotinamide and opioids

Specific management measures

Apply topical antiperspirants that contain 10 to 25% aluminium chloride hexahydrate/dichlorohydrate (i.e. No More Sweat) to reduce sweating. Apply after a shower to dry skin, leave on overnight and wash off in the morning. Use from once weekly to daily if necessary.

Topical anti-cholinergics (for children older than 9 years old). Use glycopyrrolate 2% lotion topically to affected areas, must be compounded.

Botulinum toxin is available for axillary hyperhidrosis under the Pharmaceutical Benefits Scheme (PBS)

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.