Palm Sweating

ps-main What is Palm Sweating?

Perspiration is a normal and healthy bodily function.  It is controlled by the autonomic nervous system. But in patients with Palmar Hyperhidrosis or palm sweating, the autonomic stimulation of the sweat glands is hyperactive.  In other words, palmar hyperhidrosis is excessive sweating of the hands.  In severe cases of palmar hyperhidrosis, sweat can literally drip down from the hands.  About 1% of adults suffer from some form of hyperhidrosis.

Simple things like application of a small amount of lotion can easily trigger excessively sweaty hands. Sweaty hands can occur due to nervousness, emotional distress, or even being in a stressful situation. Typically, hyperhidrosis of any kind begins in childhood or early adolescence and increases in severity through puberty and into adulthood.  The sweat glands do not discriminate.  Men and women are equally affected by the condition.  People with this disorder are constantly aware of their condition and embarrassed by it.

Symptoms of Palm Sweating

The most obvious symptom of palmar hyperhidrosis is profuse and excessive perspiration of the palms beyond physiological necessity.  People afflicted with palmar hyperhidrosis often complain of cold, sweaty hands, sometimes even dripping with sweat.  Because Palmar Hyperhidrosis is aggravated by stress as minor as shaking hands or holding hands, it has significant social and psychological impact on patients afflicted with this disorder.

Diagnosis of Palm Sweating

Palmar Hyperhidrosis occurs in people who are otherwise healthy.  The problem with sweaty hands can be detected since early childhood.  It can be diagnosed with visual and physical examination of the patient.  No specific medical tests need to be carried out for the diagnosis of Palmar Hyperhidrosis.  In the case of chronic palm sweating, it may occur without any change in mood or weather.

Causes of Palm Sweating

The hyperactivity of the sweat glands in the sympathetic nervous system causes profuse palm sweating.  People who suffer from this affliction may be otherwise healthy.  When a person exercises or becomes excited, the sympathetic nerve is stimulated and adrenaline is pumped into the blood system.  As the heart rate and blood pressure increase, sweating occurs to control the body temperature.

Factors aggravating the problem of palm sweating are:

Heredity: The most important cause of excessive palm sweating is genetic framework.  One must have a tendency towards excess perspiration.  Therefore, during diagnosis, family history for similar ailments can help in treatment.

Other causes:

1) Excessive body heat: The body temperature may always be a little more than normal.  Higher body temperature may be due to certain food habits, metabolism, and habits like smoking, etc.

2) Excitement: Excitement can trigger palm sweating.  This can be very embarrassing in couples and restrict intimacy.  This would adversely affect relationships.

3) Anxiety: Nervousness in meeting someone or taking on a new task can cause excessive palm sweating.

Types of Palm Sweating

There aren’t different varieties of this disease, but the severity of Palmar Hyperhidrosis can differ from patient to patient.

Treatment of Palm Sweating

The approach to treating hyperhidrosis varies from person to person.  There are many approaches to treating palm sweating, depending on the severity of each case.  The most common forms of treatment are:

1) External applications: In some mild cases, application of baby powder can reduce the symptoms to a great extent.

2) Surgery: Sympathectomy is an invasive surgical treatment for interruption of the sympathetic nerves responsible for excessive sweating.  Sympathectomy is surgery to restrict the nerve supply to the sweat glands in the skin.  It is the most effective treatment for palm sweating.  It is also not as risky for palm sweating as it is for general hyperhidrosis of the body.  This is more commonly undertaken in cases of anxiety-triggered palm sweating.

The goal of this method is to eliminate the constant autonomic stimulation of the palmar sweat glands.  At the same time other sympathetic nerve functions have to be maintained.  Secondly, one has to make sure that procedural trauma to the surrounding tissue is minimized.  Using two microscopic incisions the overactive nerve which stimulates excessive sweating is cut off.

iontophoresis 3) Iontophoresis: Iontophoresis (or Drionics) is a non-invasive procedure by which direct electricity is passed through the skin using water.  Iontophoresis is a method for trans-dermal drug delivery.  The procedure uses water to conduct an electric current to the skin which combats production of sweat.  Current is applied typically for 10-20 minutes per session initially, followed by two to three sessions per week as a maintenance program of treatment.  This is done with a gap of two to three weeks depending on the severity of the affliction.   Although this procedure appears potentially painful, it is not so.

4) Oral medications: Oral anti-cholinergics like glycopyrrolate are known to reduce sweating, but they are not used frequently because of side effects like blurred vision and dry mouth.

5) Antiperspirants: Antiperspirants containing aluminum chloride are used to treat this disease.  If these don’t work, doctors recommend aluminum chloride hexahydrate, a prescription-strength version of aluminum chloride.  But this is not as effective for palm sweating as it is for underarm sweating.  Also, it may cause side effects like inflammations, and then an anti-inflammatory medication would be needed.  The main problem has been the achievement of physiologically safe inhibition of perspiration.  Hence this method is not commonly used.

6) Botox: Botulinum toxin (Botox), a muscle poison which is used as a btx cosmetic treatment for wrinkles, has actually been used in treatment of muscle spasms, headaches and excessive sweating.  The injections are uncomfortable, but use of a very small needle makes them tolerable.  Palm injections cause more pain so it requires methods to numb the hands in order to make the injections less painful.  But there are effective methods to provide pain relief during the procedure like local anesthetics, nerve blocks, ice and pressure.  The results of Botox treatment are temporary and need to be repeated.

The Dermatology Online Journal Volume 12 Number 6 states that “Needle-free anesthesia prior to palmar HH treatment with BTX-A has emerged as a new technique that may offer new hope for palmar and plantar HH sufferers.  To avoid painful injections, recently painless jet devices are used, which eliminate the need for using needles.  Needle-free devices are used to inject all types of liquid (anesthetics, corticosteroids) by painless intra-dermal projection without the use of a needle or contact with the patient’s skin. They penetrate skin with high-pressure fluid.”

7) Herbal remedies: Concha Ostreae, Fructus Tritici Levis, Semen Ziziphi Spinosae, etc are being used by the Chinese to successfully treat palmar hyperhidrosis.

Living with Palm Sweating

People with palmar hyperhidrosis are constantly aware of their condition and they have to live with it.  It is neither organ-threatening nor life-threatening, but it can have a major adverse impact on the quality of the patient’s life. This problem also stains clothes, ruins romance and complicates business and social interactions, makes the person a recluse, etc.

In some very severe cases, the person’s palms will sweat excessively at inappropriate times like while they are resting, sitting, or sleeping.  It can also have serious practical consequences, making it hard for people to do simple tasks like holding a pen, gripping a car steering wheel, or shaking hands when they meet someone.  Extremely sweaty hands cause the patient to avoid shaking hands when meeting people.  They feel the need to wear gloves constantly in order to hide their ailment when such social or professional interaction is required.

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Timely treatment of palmar hyperhidrosis is essential.  This apparently simple problem of palm sweating, because of the effect on ones life, could lead to other disorders like Anxiety/Panic Disorders, low self-esteem and psychological disorders, behavioral problems, etc.

talcum-powder Prevention of Palm Sweating

There is no known preventive measure for palmar hyperhidrosis or palm sweating, but some measures can be taken to reduce the severity of the symptoms so that this affliction does not affect the day-to-day life of a person.  The measures are:

1) Regular use of talcum powders, antiperspirants, deodorants to keep the palms as dry as possible, especially in moist weather.

2) Using less cooking oil, butter, lard, etc in ones meals.

3) Avoid using moisturizers and creams.

4) Avoid whole fat milk.

5) Avoid doing extremely strenuous exercises.

According to American Academy of Dermatology, Iontophoresis is the most non-invasive method of treating cases of Palmar Hyperhidrosis.  It has had a success rate of 83% according to their study.