70 years old lady presented with the excessive sweating on the head,face and nec

Management approach: For a 70-year-old woman with a three-year history of excessive resting sweating localized to the head, face, and neck, with normal blood tests and unresponsive to avoidance of caffeine, alcohol, and spicy foods, the condition is consistent with primary craniofacial hyperhidrosis.

First-line treatment includes the use of topical aluminium salt preparations. Although these are commonly used for axillary, palmar, and plantar hyperhidrosis, they can be applied off-label to the face by soaking lotion pads for application, taking care to avoid eyes and mucous membranes. Use a 20% aluminium chloride hexahydrate preparation applied at night to dry skin, washing off in the morning, and adjusting frequency based on tolerance and symptom control. Skin irritation is a common side effect and can be managed by reducing application frequency, using emollients, or a mild topical corticosteroid if needed.

If topical aluminium salts are ineffective or not tolerated, oral anticholinergic medications such as oxybutynin or glycopyrronium bromide may be considered as off-label options. These reduce sweat secretion by blocking muscarinic receptors near sweat glands but have potential side effects including dry mouth, blurred vision, constipation, and urinary retention, which may be more pronounced in older adults. Modified-release formulations may improve tolerability. Propantheline bromide is licensed for generalized hyperhidrosis but less commonly used for focal craniofacial hyperhidrosis.

Referral to a dermatologist for specialist management should be considered if symptoms persist despite these treatments or if adverse effects occur.