To assess the therapeutic effect of methotrexate iontophoresis and coal tar ointment on laboratory mass scale ‘sweat output’ and hyperhidrosis disease severity scale in primary palmer hyperhidrosis. Design: A single-blinded randomized clinical study. Setting: Outpatient-setting. Subjects: Sixty participants with primary palmer hyperhidrosis (15-35 years old) were allocated randomly into two groups. Group (A) received methotrexate iontophoresis; Group (B) received coal tar ointment. Intervention: 30 minutes per session, three sessions a week for four weeks for group A; and while group B received coal tar ointment. Outcome measures: Laboratory mass scale ‘sweat output’ and hyperhidrosis disease severity scale was measured pretreatment, after 6 sessions (post I) and after 12 sessions (post II). Results: Sixty patients with hyperhidrosis participated in this study. There was no significant difference between groups in age and sex distribution (p >0.05). There was a significant decrease in sweat output in both groups at post II compared with that pretreatment and post I (p <0.01) and a significant decrease at post I compared with pretreatment (p <0.001). There was a significant decrease in HDSS in both groups at post II compared with that pretreatment and post I (p <0.001) and a significant decrease at post I compared with pretreatment in group A (p <0.001) while there was no significant difference between pretreatment and post I in group B (p >0.05). There was no significant difference between groups pretreatment (p > 0.05). There was a significant decrease in sweat output and HDSS of group A compared with that of group B at post I and post II (p <0.001). Conclusion: Application of four consecutive weeks (30 minutes per session, 12 sessions, 3sessions/week) of methotrexate iontophoresis has a significant improvement in severity of symptoms and sweat output that is better compared to coal tar ointment in improving sweat output and symptoms severity in primary palmar hyperhidrosis