It’s one thing if your palms get sweaty once in a while when you’re nervous. It’s another thing entirely to regularly endure excessive hand sweating that’s embarrassing and interferes with your work and social life.
But that’s just what between 1 and 3 percent of Americans with a condition called palmar hyperhidrosis experience, according to research. And some experts argue that because people frequently don’t recognize it’s a medical condition — with various treatment options to boot — or are reluctant to disclose the issue, it’s likely underreported.
Criteria for diagnosis considers not only the severity of sweating and how long it’s persisted — for at least six months or more without an apparent cause — but how frequently the issue arises and how disruptive it is to the individual. “Really what it comes down to is interference with everyday activities and everyday interactions,” says Dr. John McConaghy, vice chair of the department of family medicine and associate director for the family medicine residency program at the Ohio State University Wexner Medical Center. It can make you reluctant to shake hands with someone else if your palms are drenched, or even make signing or handling documents a cumbersome chore, leaving a different kind of unintentional water mark on the paper.
This common type of primary focal hyperhidrosis, which can also occur in other parts of a person’s body, such as the armpits, soles of one’s feet and scalp, differs from hyperhidrosis that generally involves excessive sweating not specific to one area of the body. Primary focal hyperhidrosis, which affects both sides of the body symmetrically (or in the case of palmar hyperhidrosis, both palms), usually isn’t caused by an underlying medical issue.
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But secondary hyperhidrosis, which involves excessive sweating and isn’t isolated to one area like the palms, results from medical problems or medications. So it’s important, experts say, to get a proper diagnosis and rule out other issues that may cause hyperhidrosis, which can range from anxiety to hyperthyroidism to medications, such as antidepressants or insulin, as well as alcohol (with sweating worsening as more is consumed) and spicy foods.
Although it’s frequently young professionals who come to McConaghy for help in dealing with palmar hyperhidrosis, the condition typically begins in childhood. Often parents will tell Dr. A. Yasmine Kirkorian, a pediatric dermatologist at Children’s National Health System in Washington, D.C., that their kids can’t hold their pen at school, they’re dripping sweat onto the paper; or, for example, a child can’t participate in a dance class, because other children don’t want to hold the child’s hands.
What’s happening under the skin to cause the issue isn’t precisely understood. But most people who have it report a family history of hyperhidrosis, which suggests some people may be genetically predisposed to sweat more than others. “Often people with this condition have family members with it,” says Kirkorian, who is also an assistant professor of dermatology and pediatrics at George Washington University School of Medicine & Health Sciences.
Fortunately a number of options exist to treat the condition. The first step, though, is to let a doctor know if heavy sweating — on your palms or elsewhere — is interfering with your life, experts say, to get a better handle on the issue. Especially if the onset of heavy sweat is sudden or begins when a person is older, clinicians say it’s key to determine if underlying causes are to blame and proceed accordingly.
Although there’s still a relative dearth of data on treatments for hyperhidrosis, there are a few options clinicians commonly recommend to address palmar hyperhidrosis, as outlined in a recent article co-written by McConaghy and published in the journal American Family Physician. Those include:
Topical 20 percent aluminum chloride, or Drysol, is recommended as a first-line treatment for hyperhidrosis, including palmar: “Really one of the most common and most effective treatments … I have found success with that quite a bit,” McConaghy says. The solution is applied nightly to the palms (and any other affected area) until the sweating severity decreases, and then it’s applied less frequently, as needed, to keeping sweating under control.
One ding noted in the article on hydrosis management: “This solution can result in skin irritation, but it can be diluted to decrease irritation if necessary.” As an alternative to the prescription product, over-the-counter antiperspirants can also be used. “Bedtime is actually the best time for antiperspirants,” Kirkorian says. Applying an antiperspirant then, when your sweat glands aren’t as active as they are in the morning, maximizes effectiveness. “Some patients feel that the topical antiperspirants are too greasy for the palms. However, since they are applied at night before bed, that is not a concern for everyone,” Kirkorian says. Generally, it’s applied three to five nights in a row until you’ve noticed a decrease in sweating, and then two to three nights a week after that, she says.
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Botox injections in the hands. Depending on how profusely a person is sweating from their hands, this may be considered as a first- or second-line treatment. Botox is the most studied hyperhidrosis treatment, according to McConaghy and Dr. Daniel Fosselman, also at OSU Wexner Medical Center, who co-authored the article on hyperhidrosis management, and it’s been shown to consistently decrease severity of sweating. Botox, or OnabotulinumtoxinA, is approved by the Food and Drug Administration for underarm hyperhidrosis, but it’s also been found to be effective for reducing sweating in other areas, including the palms.
“OnabotulinumtoxinA is a natural, purified protein with the ability to temporarily block the secretion of the chemical that is responsible for ‘turning on” the body’s sweat glands,'” notes the International Hyperhidrosis Society, which outlines treatment options at sweathelp.org.
Besides the pain from injections, Botox can cause temporary weakness in the hands or loss of grip strength. As with other treatments, ongoing management is needed — i.e. future injections — and you’ll want to check on cost. It’s only occasionally covered, Kirkorian says, and that’s highly dependent on the insurance plan you have. After initial Botox injections get sweating under control, follow-up injections are needed after around six months, though clinicians say dryness can last from three months to more than a year.
Iontophoresis. Although how it works isn’t well understood, it involves placing one’s hands (or feet, if affected) into a shallow bath of water through which a mild direct electrical current ( not like the electricity that could shock from an outlet) passes. “It’s really good for palmar (hyperhidrosis),” Kirkorian says. The medical device, which can only be obtained with a prescription from a health provider, typically costs around $500 to $1,000 out of pocket. “Often it’s not covered by insurance,” Kirkorian says; but there’s no ongoing cost after the initial investment.
Medication. When other treatments don’t work well, oral prescription drugs called anticholinergics like oxybutynin and glycopyrrolate (Robinul) are sometimes recommended to prevent stimulation of the sweat glands, and reduce sweating. But these can come with uncomfortable side effects and are often reserved for when other measures fail. “The most common side effect is really the dry mouth and a lot of the abdominal cramping that goes along with it,” McConaghy says.
Surgery. Where all other options fail and severe sweating problems persist, some patients may undergo surgery that involves going into the chest and cutting or clipping the sympathetic nerves. It’s a permanent solution and a major procedure. “That’s absolutely last resort, and that’s not done very often,” McConaghy says. According to the International Hyperhidrosis Society, endoscopic thoracic sympathectomy, or ETS surgery, “frequently causes serious, irreversible compensatory sweating (excessive sweating on large areas of the body or all over)” along with other debilitating effects like an extreme drop in blood pressure, arrhythmia and heat intolerance.
While clinicians are reluctant to recommend surgery for palmar hyperhidrosis, experts say people who suffer life-disrupting sweaty palms should talk with a doctor about the problem and ways to address it.
[See: 7 Tips for Coping With Sweaty Feet.]
Commonly, that will entail trying multiple types of treatment, often together. “But the vast majority of my patients do have a decrease in sweating that allows them to have a normal quality of life, be able to engage in relationships, where they hold their significant other’s hand, they can use a pen, they can hold onto paper without soaking through,” Kirkorian says. And, as some patients have found out firsthand: “That’s been life-altering.”
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Sweaty Palms: When It’s More Than Just an Infrequent Annoyance originally appeared on usnews.com
