Sweating and body temperature control
Sweating is a physiological (natural) response that prevents our bodies from overheating. When the ambient temperature is high or when you are exercising, the sweat glands will start producing sweat. Evaporation of these droplets from the surface of the skin will dissipate heat which helps to cool us down.
Due to physiological differences (personal fitness, density of sweat glands etc), some people do sweat more than others. But then, how much is too much? There isn’t a way to say for sure, but it certainly does become discomforting when individuals experience excessive, unnecessary sweating either on specific parts of the body or a larger area. This condition is known as hyperhidrosis and it is estimated that 2% to 3% of the world population is affected by it.
What is palmar hyperhidrosis?
Palmar hyperhidrosis is a condition where an individual experiences excessive sweating to the palm. It is usually ‘symmetrical’ where both left and right palms will be affected. These individuals usually also experience sweaty feet. The condition often starts during childhood or teenage years and usually persists through life. It normally runs in the family which suggests genetic predisposition.
Palmar hyperhidrosis is a medical condition associated with dysregulation of the autonomic sympathetic nervous system which results in over-activation of the sweat glands by a neurotransmitter (an organic chemical that carries signals from nerve cells to other cells) known as acetylcholine. Despite being harmless, sweaty palms can sometimes cause emotional distress and social embarrassment.
“Oh gosh, another social function with plenty of handshakes? Can I just skip it?”
This is probably a very common thought that rings a bell among those with sweaty palms although people generally don’t talk much about it. Interestingly, the sweat glands on the palms and soles are activated primarily by emotional stimuli which explains why when you are anxious, you wet your palms. It does sound like a double whammy to some with sweaty palms, as the fear of social embarrassment by itself could further worsen the sweating process.
Is palmar hyperhidrosis treatable?
For those of you with sweaty palms, fret not. There are numerous treatments available although it is worth noting that there will be inter-individual variations when it comes to effectiveness of each treatment option.
These are over-the-counter (OTC) or prescriptions medications that are applied to the skin. Patients are generally advised to try these medications first due to their ease of use, safety, affordability and wide availability. OTC antiperspirants contain low dose of metal salt, usually aluminium that forms a plug to occlude the sweat ducts. These dermal medications generally work best for those with mild condition. For those who fail to respond to the OTC medications, prescription antiperspirants containing either 6.25% or 20% aluminium chloride hexahydrate can be considered.
Like the anti-perspirants, it is a safe therapy and is particularly useful for those who do not respond to anti-perspirants. Treatment involves the placing of hands/feet in a tray of water and the application electric current to the skin through water. It works by temporarily blocking the sweat glands although the exact mechanism of action remains unknown. Initial therapy should be closely monitored/properly instructed by healthcare professionals to ensure the correct technique before patient can begin treatment at home using appropriate iontophoresis equipment. When used correctly, iontophoresis appears to be effective in managing of sweaty palms and soles in 85% of patients.
Oral anticholinergic drugs such as glycopyrrolate and oxybutynin can block the nerves that innervate the sweat glands. However, they are not commonly used because of the associated side effects which can be rather problematics at times. These include blurred vision, dry mouth, headache and urinary retention. Healthcare professionals will generally consider the use of these oral agents when patients failed to respond to therapy using antiperspirants and iontophoresis. Other oral medications that may be used include beta-blockers and benzodiazepines.
This treatment involves the injection of small amount of botulinum toxin (nerve toxin) using fine needle into each palm. This toxin can block the release of acetylcholine from the nerves hence temporarily reduce sweat production. Numerous studies have shown this method to be effective for the treatment of sweaty palms and it is considered if other therapies have failed. The use of local anaesthesia/analgesia may be required as palm injection can cause significant pain. Botox injection can be expensive.
In severe cases where all non-surgical treatments have failed, a surgical option known as endoscopic thoracic sympathectomy can be considered. As mentioned above, the sympathetic nerves control sweating, and the cutting of these nerves that innervate the sweat glands on the palm can stop the process
As you can see, there many treatment options available for your naughty sweaty palms. If you need help, please do not hesitate to speak to your pharmacist or doctor for more information.
- Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 1977; 186:34.
- Goh CL. Aluminum chloride hexahydrate versus palmar hyperhidrosis. Evaporimeter assessment. Int J Dermatol 1990; 29:368.
- Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274.
- Mack GW, Shannon LM, Nadel ER. Influence of beta-adrenergic blockade on the control of sweating in humans. J Appl Physiol (1985) 1986; 61:1701.
- Moran KT, Brady MP. Surgical management of primary hyperhidrosis. Br J Surg 1991; 78:279.
- Naumann M, Lowe NJ, Kumar CR, et al. Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study. Arch Dermatol 2003; 139:731.
- Ricchetti-Masterson K, Symons JM, Aldridge M, et al. Epidemiology of hyperhidrosis in 2 population-based health care databases. J Am Acad Dermatol 2018; 78:358.
- Richards RN. Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet. J Cutan Med Surg 2009; 13:253.
- Schnider P, Moraru E, Kittler H, et al. Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients. Br J Dermatol 2001; 145:289.
- Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51:241.
- Sugimura H, Spratt EH, Compeau CG, et al. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137:1370.
- Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol 2009; 61:242.
- Walling HW. Systemic therapy for primary hyperhidrosis: a retrospective study of 59 patients treated with glycopyrrolate or clonidine. J Am Acad Dermatol 2012; 66:387.
- Wolosker N, de Campos JR, Kauffman P, Puech-Leão P. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg 2012; 55:1696.