Hyperhidrosis - Palmar

Palmar hyperhidrosis (excess sweating of the palms) is a common condition. It may occur in isolation or be associated with excess sweating from the axilla, the feet and elsewhere. There are a variety of treatments. You might also want to read our information leaflet on axillary hyperhidrosis which explains some other aspects of the condition.

Sweat is a solution of water and salts produced by glands immediately under the skin and cools the body by evaporation during exercise and in warm surroundings. The activity of these glands is normally controlled by the nervous system. In a small number of people (less than 1.0% of the population), this control mechanism fails to function normally causing excessive sweating, even when body temperature is normal. This condition is known as hyperhidrosis.

Occasionally, hyperhidrosis occurs as a result of abnormal hormone levels and these will be measured as part of the assessment of people with this condition. In most cases, no reason for the excessive sweating will be identified by these tests.

Excess sweating may occur anywhere but usually affects the hands, armpits, scalp, face, and/or feet. Although some people may find this excess sweating embarrassing, it is not a dangerous or life threatening condition.

Treatment

The principle means of treating this condition are the use of potent antiperspirants, Iontophoresis and (rarely) surgery

Antiperspirants

The most effective antiperspirant is Aluminum Chloride - Anhydrol Forte or Drichlor- which may be prescribed for you by a doctor in the clinic or your General Practitioner. This is applied in the evening 2-3 times per week and washed off in the mornings. In some cases, it causes skin irritation. The treatment must be repeated regularly for life. This agent cannot be used on the face or scalp. You can read about this medication on the HPRA website (http://www.hpra.ie/img/uploaded/swedocuments/LicenseSPC_PA0278-007-001_07092016115039.pdf)

Iontophoresis

This treatment is suitable for people who find that the excess sweating mainly occurs from the palms or soles of the feet. An electrical machine is used which uses electrical current to drive ions from tap water into the skin. You can buy this machine and use it at home. The treatment is used every day initially (for an hour or so) and then a few times per week. It is effective is some people in dealing with the problem but not in everyone. It has little risk of side effects.

You can read more about iontophoresis and purchase a idrostar(TM) iontophoresis machine on the Morehampton Clinic website. They can be contacted by telephone on 01 269 3921 or via their website sweating.ie. You can watch a video showing this machine in use on YouTube

 

 

 

Surgery (Endoscopic sympathectomy)

The surgical procedure used in the treatment of severe hyperhidrosis is called endoscopic thoracic sympathectomy (ETS) or TTEC (trans thoracic electrocoagulation )

Surgery may be considered in those who find other treatments ineffective. However, complications are common and this procedure is now rarely used for the treatment of palmar hyperhidrosis.

During the procedure, the nerves that supply the sweat glands in the hands and axilla (armpit) are permanently divided within the chest cavity. Patients are admitted as a day case. Under general anaesthesia, each lung is collapsed in turn. Through 5mm incisions in the chest wall, two or three incisions (5-10mm) are made in the skin under each arm. Ports are inserted through these incisions and using a small camera and the nerves are divided using electrocautery.

Complications

Although this is a safe procedure in most patients, complications can occur in a small number of people. While the axilla and the arm will be dry, compensatory increase in sweating from other parts of the body (compensatory hyperhidrosis) may be quite troublesome. This occurs in up to 50% of patients and is troublesome in up to 20%.

In addition, if the branches of the nerves that supply the face are damaged during the operation, this may cause visible drooping of the eyelid (Horner’s syndrome). While uncommon (<1%), this may be permanent.

Occasionally, the lung may fail to reinflate and it may be necessary to place a small drainage tube into the chest for a short time after the surgery. As with any surgery, bleeding or infection may occur but this is not common.

Injury to the nerves along the ribs may cause pain which may be persistent or even permanent.

The heart and major vessels are close by and if these are injured, which occurs rarely, your life may be at risk.

Postoperative instructions

After the procedure, you may have some mild discomfort. Some people may have pain (or altered sensation - numbness or tenderness) along the line of one or more ribs due to bruising of the nerves. While this will usually settle, it may persist for months in some cases or even be permanent. Dissolving stitches are usually used to close the wounds so there are no stitches to be removed. You may need to take some simple pain killers following the procedure which will be prescribed for you before you leave.