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Sweaty Palms (Palmar Hyperhidrosis)

 

Excessive hand sweating is the most common type of hyperhidrosis. It is caused by heightened activity in the sympathetic chain of nerves, part of the autonomous nervous system that involuntarily controls activities in the body. The sympathetic chain is located in the chest cavity.

Excessive hand sweating can range from mild to very severe, and may be genetic in origin. Sweaty palms usually begin early in childhood and can get worse in the late teenage years and early adulthood. It does not get better over time or go away with age. Most people with severe sweaty palms do not benefit from conservative treatment with medications, iontophoresis, or biofeedback, although health insurance companies may dictate that these remedies be tried first. For severe palmar hyperhidrosis, the best option may be a surgical procedure called endoscopic thoracic sympathectomy (ETS).

ETS Surgery

ETS Surgery The most successful treatment for excessive sweating of the hands (palmar hyperhidrosis) is a minimally invasive procedure called endoscopic thoracic sympathectomy (or ETS).

ETS SurgeryETS is very effective. In most patients, it is a permanent procedure that should be considered for severe palmar hyperhidrosis only. Our team reports that at at least 98 percent of his patients with palmar hyperhidrosis have found relief from excessive sweating of the hands with ETS. Patients experience immediate relief; they wake up from surgery with warm dry hands. ETS also eliminates facial blushing and facial sweating in patients who also experience these problems. In rare occurrences, 1 to 2 percent of patients undergoing ETS, hand sweating may recur. Most of these recurrences are mild, but if they are severe, a repeat operation may be necessary.

Palmar hyperhidrosis is considered a medical condition with serious physical and psychological complications when not treated. Therefore, ETS is usually covered by health insurance because it is considered a medical necessity, not a cosmetic procedure. However, your policy may require you to try more conservative methods first, such as medications or iontophoresis (see below). You should check with your individual health insurance coverage to determine your benefits.

Other Treatments for Sweaty Palms

Iontophoresis
This treatment involves placing the hands in two pails of water that contain a conductor. A device (brand names Drionic®, Idrostar, MD-1A) applies a low electric current to the hands. As the current passes through each hand, minerals in the water clog the sweat glands, limiting the amount of sweat released. Each session lasts 20 minutes and is repeated four to six times per week. Frequent treatments are necessary. Some people have experienced good results with this treatment while others see no effect.

Oral medications
There are no medications for the specific treatment of primary hyperhidrosis. However, the condition can be treated with some success with systemic anticholinergics. Ditropan® (generic name: oxybutynin) is one that has been the most promising, but the dry mouth and drowsiness associated with it cannot be tolerated by some patients. Robinul® (generic name: glycopyrrolate) is sometimes effective but also causes dry mouth or a dry throat. These two medications also can cause dilated pupils, constipation, urinary retention, and heart palpitation. Beta-blockers (Inderal) have systemic anti-sympathetic effects that are helpful in decreasing the body's sympathetic response. They have been useful in some cases of stress-related hyperhidrosis. They also decrease palpitation and tremors and are mostly useful when taken two hours before a stressful situation. Anti-depressants (Zoloft®) and anti-anxiety medications can be effective. Depression does not cause hyperhidrosis, but hyperhidrosis can cause depression. Probanthine® (generic name: propantheline bromide), which is often used to treat high blood pressure and some arrhythmias, causes a systemic decrease in sympathetic response. It should only be administered after a patient undergoes a thorough physical examination.

Topical Treatments
Topical agents, such as Drysol (or other antiperspirant brands of aluminum chloride with ethyl alcohol) or Odaban can also be used for palmar hyperhidrosis. These agents are generally applied to dry hands at night. However, such topical agents are generally not effective for palmar hyperhidrosis.

Laser Ablation
Laser ablation is not effective in controlling primary hyperhidrosis.

Weight Loss
Hyperhidrosis can be aggravated by obesity, so weight loss can help. However, most people with hyperhidrosis do not sweat excessively due to obesity.

Complementary Therapies
Relaxation techniques, hypnosis, and biofeedback offer limited success for sweaty palms.

"To Your Health" Blog
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