Palmar (Hand) Hyperhidrosis


The most common type of hyperhidrosis is characterized by excessive sweating of the hands.  Palmar hyperhidrosis, or sweaty palms, perhaps more than any other form of hyperhidrosis, can have adverse impact on the social, professional, athletic, sexual and emotional aspect of patients’ lives. Often individuals with excessive sweaty palms carry a towel or handkerchief in their hands and are reluctant to shake or hold other people’s hands.

Symptoms of palmar hyperhidrosis

  • Excessive sweat dripping from hands
  • Hands become exceedingly cold, clammy and wet
  • Difficulty grasping objects
  • Difficulty writing
  • Difficulty handling paper or pens
  • Reluctance to shake or hold hands
  • Avoiding sports or hobbies that require hand work

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Treatment options for sweaty palms

There are several treatment options your physician will consider when treating sweaty palms. Typically, the least invasive means will be utilized first with progressive treatments following until the condition is cured.

  1. Anticholinergic – medication
  2. An anticholingeric is a synthetic medication that blocks the transmission of acetylcholine thereby inhibiting the message to produce excessive sweat in the glands.

    Robinul and Robinul Forte are common brand name tablets that contain the synthetic anticholinergic glycopyrrolate and are used to reduce excessive sweating.

    Side effects
    As with any medication, there are potential side effects, which you must understand. The most common are blurred vision, dizziness, drowsiness, dry eyes and dry mouth. Some people also experience abdominal bloating and constipation.

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  3. BOTOX® –  Botolinum Toxin
  4. BOTOX® is a brand name for a bacterial toxin that is used medically to paralyze the nervous activity of the sweat ducts which prevents the production of perspiration. It was first approved for use on humans by the United States by the FDA in December 1989, and approved as a treatment for underarm sweating in 2004.

    Although BOTOX injections are commonly used and highly effective in the  treatment of  sweaty armpits, the treatment requires multiple treatments a year. For palmar (sweaty hands) and plantar (sweaty feet) hyperhidrosis, treatment is very painful. Additionally, muscle and finger weakness are frequently bothersome after the application of BOTOX injections to the hands.

    On average, each hand and foot requires more than 50 BOTOX injections, while each armpit requires approximately 25 injections. All these numbers can vary depending upon the size of an individual’s hands, feet and armpits; the amount of sweating in each area (i.e., the intensity and area of hyperhidrosis); and the practitioner’s preference and experience in treating hyperhidrosis with BOTOX injections. BOTOX can be quite expensive because of its limited duration of effect.

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  5. Iontophoresis
  6. Your physician may suggest using iontophoresis which works by passing a low dose electrical current through wet skin in order to coagulate protein in the sweat ducts to form temporary plugs. The partial blocking of the sweat glands subsequently reduces the rate of perspiration. The treatment involves immersing the effected part of the body into water or having damp pads attached through which an electrical current is passed for around twenty to thirty minutes.

    The process causes a strong tickling sensation that varies according to the strength of the current used. Iontophoresis is a safe and useful complimentary treatment to an antiperspirant, especially for palmar (sweaty hands) and plantar (sweaty feet) hyperhidrosis; however, some individuals find the necessary regime too inconvenient as treatments 0f 30-45 minutes are required several times per week.

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Endoscopic Thoracic Sympathectomy (ETS)Sympathectomy is a surgical procedure that divides nerves in the sympathetic system. It is designed to decrease excessive sweating. Although sympathectomies were considered major surgery in the past, significant advancements have been made over the past 10 years.Now sympathectomies are performed endoscopically using VATS. One or two small incisions (5 mm) are made on each side of the chest cavity through which a fiber optic camera and other instruments are inserted. These outpatient procedures result in speedy recovery and minimal scarring with immediate results.Endoscopic Thoracic Sympathectomies are best performed by a well-trained thoracic surgeon. The procedure takes place under general anesthesia,  and typically lasts 30 minutes. Once the instruments are removed, the tiny incisions are closed with glue. Sweat relief is immediately noticed by the patient upon waking up from anesthesia. Most patients can resume physical activity, and return to normal activities within 48 hours of surgery.While endoscopic thoracic sympathectomies are extremely effective for most forms of hyperhidrosis, it was specifically designed to treat palmar hyperhidrosis or sweaty palms. Endoscopic Thoracic Sympathectomy treatment has been proven to cure hyperhidrosis or excessive sweating in 95-99% of all cases of hand sweating

 Side Effects
Although ETS is a viable alternative for many patients, it is important to understand the potential side-effects of the surgery. In addition to the normal risks associated with most surgeries, ETS side-effects are very specific to the surgery and should be discussed in detail with your physicians. Any surgery under anesthesia carries risks from anesthetics in addition to possible local wound infections. Both are extremely rare with this minimally invasive technique for ETS.

  • Compensatory sweating
    In approximately 50% of patients who undergo ETS, a condition called compensatory sweating may occur. It is the most common side effect and is characterized by increased sweating on the back, abdomen and/or thighs. In a small number of patients, (<5%) compensatory sweating is problematic and may require oral and/or topical medication. The newer surgical technologies that we offer may reduce the incidence of compensatory sweating.
  • Horner’s Syndrome
    In rare instances (.03%), patients may experience droopy eyelids, constricted pupils, and absence of sweating in the face following ETS, and is usually temporary.
  • Gustatory Sweating
    Eating or smelling certain types of foods can cause facial sweating after ETS. This happens in a small number of patients following the operation, but usually does not appear to be a major problem.
  • Neuritis and Neuralgia
    Following surgery, a very small number of patients experience a nonspecific pain in the back between shoulder blades. It is caused by an irritation of the nerve endings and usually resolves spontaneously. It can be treated with non-steroidal anti-inflammatory drugs.

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