Palmoplantar hyperhidrosis

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


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


If the above fail, botulinum toxin injections to the palms, administered by an experienced doctor, can dramatically reduce sweating. This involves multiple small injections over the surface of the palms. 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 used to improve discomfort.


If 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. However, due to the risk of compensatory hyperhidrosis (permanent severe sweating on the rest of the body), this should only be considered for severe cases of palmar hyperhidrosis, and after a suitable trial of other options above.

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