Sweat Reduction

Palmoplantar hyperhidrosis

Excessive sweating on the hands and feet, known as palmar or plantar hyperhidrosis, is a common medical condition. It typically starts in childhood or adolescence. It is inconvenient, and often highly embarrassing. Handshaking is a highly important social ritual. Sufferers shy away from handshaking, and their social confidence is impaired. Sweaty palms also causes damp and smudged paperwork, and can interfere with gripping devices and instruments.

Palmar hyperhidrosis can be detrimental to many parts of a sufferer’s social, educational, and work life.

Fortunately, treatments are available to control palmar hyperhidrosis.

The first line treatment to try is a roll-on antiperspirant. Clinical strength antiperspirants, e.g. Driclor, are more potent than regular antiperspirants. To minimize irritation, they should be applied at night to a dry palm.

Topical anticholinergic medications can also be used to reduce sweating. 

Iontophoresis is the next treatment. It is effective for the majority of people. It can be carried out in the clinic, or at home. The device delivers a mild and safe electrical current through the skin’s surface, resulting in interruption of sweat production from the treated area. The treatment is initially about 15 minutes three times a week. The frequency of treatment can usually be reduced to about once a week for maintenance. Anticholinergic solution can be combined with iontophoresis.

Treating sweaty palms with
Injectables or surgery

  • If the above fail, botulinum toxin injections to the palms can dramatically reduce sweating. This involves multiple small injections over the surface of the palms, administered by an experienced doctor. The effect lasts approximately 6 months. Whilst this treatment is usually very well tolerated when administered to the armpits (for severe axillary hyperhidrosis), pain from injections is a limitation when treating the palms. A variety of techniques, including regional nerve blocks, can be implemented to minimize discomfort.
  • If all of the above less invasive treatments fail, and the problem is sufficiently bothersome, endoscopic thoracic sympathectomy can be considered. This one-off surgical operation can give a permanent resolution of the problem. It is a surgical procedure where a part of the sympathetic nerve trunk in the back region is destroyed. This carries a risk of compensatory hyperhidrosis (permanent severe sweating on the rest of the body). Therefore, it should only be considered for severe cases of palmar hyperhidrosis, and after exhaustion of other options above.

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