Palmar Hyperhidrosis – Description, Management, and Prevention.

Description

Excessive, uncontrollable sweating of the hands or palms, is called palmar hyperhidrosis. This medical condition is an extremely stressful, embarrassing, and confidence-wrecking problem. From ruined paperwork to slippery handshakes, sweaty palms can negatively impact your social life, education, and career.

It’s proven and published that palmar hyperhidrosis has the most significant negative impact on patients’ lives of any dermatologic condition. But there are treatments available, the treatments work, and you have a number of choices.

Pathophysiology

Generalized hyperhidrosis may be the consequence of autonomic dysregulation, or it may develop secondary to a metabolic disorder, febrile illness, or malignancy. In its localized form, hyperhidrosis may result from a disruption followed by abnormal regeneration of sympathetic nerves or a localized abnormality in the number or distribution of the eccrine glands, or it may be associated with other (usually vascular) abnormalities.

Essential hyperhidrosis, a disorder of the eccrine sweat glands, is associated with sympathetic overactivity. Essential hyperhidrosis does not appear to be a generalized disorder involving vascular endothelium. Palmoplantar hyperhidrosis may be inherited in an autosomal dominant manner.

Causes and risk factors

Sweaty palms occurs due to overactive sweat glands, and there are many reasons for this to occur.

It can run in families, and it can be associated with other forms of hyperhidrosis or with certain medical conditions.

Associated conditions include:

• Anxiety
• Infections
• Prescription medications
• Substance abuse
• Heart disease,
• Hyperthyroidism
• Lung disease
• Acromegaly (a condition in which the pituitary gland produces too much growth hormone)
• Menopause
• Parkinson’s disease
• Glucose disorders
• Tuberculosis
• Stroke
• Pheochromocytoma (a tumor in the adrenal gland)
• Carcinoid syndrome (a disease that can occur when a carcinoid tumor found in the small intestines, pancreas, liver, or stomach)

The condition affects both sexes equally, but females may be more likely to seek treatment for sweaty palms.

Symptoms of Palmar Hyperhidrosis

Symptoms of hyperhidrosis of the hands may include:

• Excessively clammy and sweaty hands
• Hands that are cold to the touch
• Pale or blush coloring of the hands
• Sweating in the hands from everyday tasks such as writing with a pencil or holding hands with someone
• Abrupt onset of sweating episodes
• Fear of situations that require hand contact
• Swelling of the fingers

What are the complications of Palmar Hyperhidrosis?

Over time, excessive sweating could put you at an increased risk of developing a skin infection. Hyperhidrosis can also impact your mental health.

You may find yourself changing how you act to hide your symptoms from others. Constant sweating may be so severe that you avoid routine actions (such as lifting your arms or shaking hands). You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating.

In some cases, extreme sweating may be due to a severe and life-threatening problem. See a healthcare provider right away if you ever have chest pain or feel queasy or dizzy along with sweating symptoms.

Diagnosis of Palmar Hyperhidrosis

Your doctor will ask you where you experience sweating on your body, the pattern, timing, and whether you have other symptoms such as weight loss, fever, appetite, and hormone levels.

If you don’t have a medical condition as the cause of your sweaty palms, your doctor may do a diagnostic test for you.

Tests may include:

• A starch-iodine test: An iodine solution is applied to the palm and, once dried, sprinkled with starch. In areas of excess sweat, the iodine and starch solution will turn the palms a dark blue color.
• A paper test: A doctor places a special type of paper on the palms to absorb the sweat. The paper is then weighed to see how much sweat has accumulated on the palms.2

A diagnosis of primary sweaty palms requires that the sweat must be excessive and lasting six months or longer without a known cause. Other factors that contribute to the diagnosis include the frequency of sweating (having at least one episode of sweating a week), age (it is most prominent under the age of 25), family history, having sweat occur on both palms, and not experiencing any sweating during sleep (which could be a different condition all together called sleep hyperhidrosis).

How is it palmer hyperhidrosis treated?

Treatment will depend on how severe the sweating is and which previous treatments have been successful.

Topical treatments

Some mild to moderate cases can respond to topical treatments such as aluminium chloride hexahydrate (Driclor).

Driclor should always be applied to skin that is as dry as possible in order to maximise the benefit and minimise potential side effects. Ideally, it should be applied just after a shower prior to bedtime. Dry the area off with a hairdryer on the cool setting then apply Driclor. Wash your hands first thing in the morning with plain water (no soap). If irritation develops, applying a corticosteroid cream intermittently can be useful (this needs to used be under the guidance of a health professional).

Anticholinergic creams such as glycopyrolate (0.5-3%) can also be effective. A compounding pharmacist can make up these creams. Side effects are uncommon. How often the cream is applied will depend on the individual.

Iontophoresis

Iontophoresis may be considered for cases which do not respond to topical treatments. Treatments are individualised. The affected area is immersed in tap water, salty water or glycopyrrolate solution. Then a gentle electric current is passed across the skin surface for 10 to 20 minutes.

Glycopyrrolate iontophoresis has the highest success rate – up to 80% of affected people respond well to this treatment. The time between treatments will vary. Treatments will need to be repeated every 2 to14 days.

Botulinum toxin type A (botox) injections

Botox injections can treat sweaty hands safely and effectively. However, the treatment is not subsidised under Medicare-PBS and the cost limits its wider use.

Most treatment is performed under a nerve block. Approximately 100 units of botox will be needed in each hand. The treatment is usually effective for 3 to 5 months. Side effects include temporary muscle weakness.

Oral medications

Anticholinergic tablets (such as oxybutynin and propantheline bromide) can be useful in treating palmar hyperhidrosis. However, side effects such as constipation, dry mouth and drowsiness are common.

Other medications reported to be useful include oral glycopyrrolate (not available in Australia), propranolol, clonazepam and gabapentin.

Medications can be a viable short-term option for several days to weeks and give people a “break” from their sweating.

Surgery

Endoscopic thoracic sympathectomy (ETS) is a surgical treatment option for various forms of hyperhidrosis. It is conducted by a vascular or neurosurgeon under general anaesthesia. It has a very high success rate for treating palmar hyperhidrosis but carries a significant risk of compensatory or “rebound” sweating. Compensatory sweating occurs in areas such as the back or lower limbs weeks to months after ETS surgery. Compensatory hyperhidrosis can be difficult to treat and usually persists for life.

An in-depth discussion with your vascular surgeon or neurologist is needed prior to considering ETS surgery.

Natural Remedies of Palmar Hyperhidrosis:

Some changes in the lifestyle and daily activities may help in improving the Palmoplantar hyperhidrosis symptoms like:

• Antiperspirants: Deodorants may not stop sweating; however, antiperspirants sprays may help people suffering from Palmoplantar hyperhidrosis to deal with it naturally. Some of the prescribed antiperspirants are aluminum chloride that may plug out the sweat glands.
• Armpit Shields: Pads can be worn in armpits for protecting the garment from getting wet.
• Shoes: Synthetic material shoes can worsen the symptoms and so the natural materials like leather are normally recommended.
• Clothing: The synthetic fibers in cloth like nylon can worsen the symptoms and so loose cotton clothing is advised.

Socks can absorb the moisture in a better way if made up of natural fibers like cotton.

Coping

Dealing with sweaty palms can be stressful for some people. If you’re feeling anxious in everyday situations—such as holding or shaking hands, filing papers, or writing, it can cause social distress and embarrassment. Stress and anxiety can cause you to sweat, which may exacerbate the problem.

In addition to medical treatments, it’s often recommended to consider psychotherapy to help learn techniques and tools to cope. Psychotherapy and cognitive behavioral therapy may help you learn how to successfully reduce the release of cortisol in your body (a hormone that often increases in times of stress). You may also adopt social skills to help you cope in your day-to-day life as you continue to get treatment for sweaty palms.