Causes and Treatment of Palmar Hyperhidrosis – Sweaty Palms/Hands

What is Palmar Hyperhidrosis?

Sweaty palms, medical term palmar hyperhidrosis, refers to profuse perspiration (excessive sweating) of the palms. Palmar hyperhidrosis is one form of focal hyperhidrosis, meaning profuse perspiration affecting one area of the body. Sweaty palms may be accompanied by profuse perspiration of the feet, forehead, ckeeks, armpits (axillae) or be part of general hyperhidrosis (profuse perspiration throughout the body). Hyperhidrosis refers to profuse perspiration beyond the body’s thermoregulatory (temperature control) needs. A Greek term for hyperhidrosis is diaphoresis.

Symptoms of Palmar Hyperhidrosis

The intensity of symptoms may vary among sufferers and trigger factors should be carefully noted. Common symptoms include :

  1. Perspiration of the hands can vary from mild clamminess to severe perspiration resulting in dripping sweat.
  2. Temperature differences of palmar surface compared to surface temperature of other parts of the body may be noted.
  3. Sloughing (peeling) of skin may be noted in profuse perspiration.
  4. Episodes of profuse perspiration may be followed by periods of extreme dryness on the palmar surface.
  5. Hyperhidrosis often starts in puberty, and family history is often reported (4).

The secondary effects of palmar hyperhidrosis can result in both psychosocial effects as well as difficulty in undertaking certain tasks or handling equipment. Sufferers of palmar hyperhidrosis are often reluctant to partake in socially expected actions like shaking hands or touching loved ones. The embarrassment of dealing with this condition can affect the level of interactivity in both social and work situations. Difficulties with holding objects, gripping equipment or soiling electronic devices like keyboards may affect functioning at work. Daily activities such as writing with a pen or counting cash notes is often difficult.

What Causes Palmar Hyperhidrosis?

Hyperhidrosis is either primary focal or secondary generalized (5).

1. Primary Palmar Hyperhidrosis

Focal palmar hyperhidrosis is usually localized and is referred to as primary (essential, idiopathic), meaning no obvious cause, except strong family predisposition can be found (4,5), and affected persons are otherwise healthy (4). Sweating on other locations as feet, armpits and face may appear. Primary palmar hyperhidrosis is caused by overactivity of the sympathetic nervous system, primarily triggered by emotional causes including anxiety, nervousness, anger and fear (3).

There may be a significant reduction in perspiration during sleep or sedation (3).

2. Secondary Palmar Hyperhidrosis

In secondary palmar hyperhidrosis hands sweat due to an obvious underlying disorder like:

  1. Infections including local infections, tuberculosis and tinea ugunium.
  2. Neurological disorders like peripheral autonomic neuropathy
  3. Frostbite
  4. Arteriovenous Fistulas
  5. Acromegaly
  6. Acrodynia
  7. Complex Regional Pain Syndromes
  8. Pachyonychia Congenita
  9. Primary Hypertrophic osteoarthropathy
  10. Dyskeratosis Congenita
  11. Blue rubber-bleb nevus
  12. Glomus tumor
  13. Secondary palmar hyperhidrosis as part of generalized hyperhidrosis due to (3,5): hormonal causes (diabetes, hyperthyroidism, thyrotoxicosis, menstruation, menopause), metabolic disorders, malignant disease (lymphoma, pheochromocitoma), autoimmune disorders (rheumatoid arthritis, systemic lupus erythrematosus), drugs like hypertensive drugs and certain classes of antidepressants (list of medications causing hyperhidrosis), chronic use of alcohol, Parkinson’s disease, neurological disorders (toxic neuropathy), homocystinuria, plasma cell disorders. Detailed list of conditions causing generalyzed hyperhidrosis.

How Sweat Glands Work

In eccrine glands, the major substance enabling impulse conduction is acetylcholine, and in apocrine glands, they are catecholamines.

Body temperature is controlled by the thermoregulatory center in the hypothalamus and this is influenced not only by  by core body temperature but also by hormones, pyrogens, exercise and emotions (9).

Interesting Details About Physiology of Sweating

Mechanism of Focal Hyperhidrosis

Sweat is produced by the sweat glands that are under the control of the autonomic nervous system, the involuntary neural network. Our conscious effort may be able to exert some influence on the autonomic nervous system as emotions have been noted to increase sweat production. The autonomic nervous system is broadly divided between the sympathetic and parasympathetic nervous system. The sympathetic nervous system is usually seen as the activity system which stimulates functioning of different parts of the body. In cases of primary palmar hyperhidrosis, it is the overactivity of the sympathetic nervous system that is responsible for the excessive sweating. The increased rate of neural impulses to the sweat gland for no known reason stimulates the gland to constantly produce more sweat. There is no histological changes noted in primary palmar hyperhidrosis meaning that the number and size of sweat glands is as normal (4).

Only eccrine sweat glands that secrete odourless sweat are involved in focal hyperhidrosis (4). Apocrine glands – scent glands found mainly in axilla and genitalia – are stimulated by sex and other hormones and are not involved in focal hyperhidrosis (4).

There is evidence that these patients have a reduced threshold for emotional sweating but have normal thermoregulatory processes and drug-induced sweating (6).

There is a vicious cycle that can occur with excessive palmar and plantar sweating—the evaporative cooling of the skin increases sympathetic outflow through reflex action, in turn increasing sweat output (10).

Primary hyperhidrosis may involve parasympathetic pathway differences as well (10).

Additional Details About Patophysiology of Excessive Sweating

Investigating Palmar Hyperhidrosis

The first step in the evaluation of hyperhidrosis is to differentiate between generalized and focal hyperhidrosis.

A thorough case taking and medical history is usually sufficient to diagnose palmar hyperhidrosis and any trigger factors (scheduled drugs, narcotics, chronic alcoholism).

Diagnostic criteria for primary focal (including palmar) hyperhidrosis include (4):

  • Bilateral and relatively symmetric sweating
  • Frequency of at least 1 episode per week
  • Impairment of daily activities
  • Age at onset before 25 years
  • Family history
  • Cessation of sweating during sleep

Tests may include:

  • Hematological studies may be necessary to identify thyroid disorders (thyroid function test for T3 and T4 as well as thyroid antibodies) and diabetes (fasting blood glucose or a glucose tolerance test).
  • X-rays and MRI scans will assist for diagnosing tuberculosis, pneumonia and tumors.
  • Superficial electroconductivity can be monitored as any hyperhidrosis reduces skin electrical resistance.
  • Thermoregulatory sweat test uses moisture-sensitive indicator powder to monitor moisture. Changes in the color of the powder at room temperature will highlight areas of increased perspiration.

Conservative Management of Palmar Hyperhidrosis

Conservative management should be coupled with prescribed treatment by a medical practitioner to reduce the symptoms.

  • Counseling may be effective in managing primary palmar hyperhidrosis in cases of mental-emotional etiology.
  • Trigger foods and aggravating factors should be noted if possible and relevant dietary changes should be implemented.
  • Effective prevention of secondary palmar hyperhidrosis is difficult with conservative management and drug therapy or surgery may be required.
  • Excessive physical activity and extremes of heat may be two trigger factors that should be avoided as far as possible.
  • In cases of diabetes, a glucose controlled diet with low glycemic index may improve glucose tolerance which could assist with palmar hyperhidrosis.
  • Abstinence from alcohol and narcotics is advisable if it is the causative factor for sweaty palms.
  • Stimulants such as caffeine and nicotine may aggravate palmar hypehidrosis and should relevant dietary and lifestyle changes should be implemented.
  • Anti-perspirant compounds like aluminum chloride can be applied on the palms to reduce moisture or palmar surfaces. Recent research on an aluminum sesquichlorohydrate foam has shown that it is effective in reducing sweat in palmar hyperhidrosis (2).

Treatment of Palmar Hyperhidrosis

Standard therapeutic protocol may differ among cases of palmar hyperhidrosis depending on medical history and underlying pathology.

  1. Anticholinergic drugs have a direct effect on the sympathetic nervous system although there are numerous side effects.
  2. Treatment should be directed at contributing factors.
  3. Ionophoresis involves the use of electrotherapeutic measures to reduce the activity of sweat glands.
  4. Botulinum injections at the affected area may be useful for its anticholinergic effects.
  5. Surgery should be considered if drug therapy proves ineffective. Endoscopic transthoracic sympathectomy involves resection of the sympathetic nerve supply to the affected area. This prevents nerve stimulation of the sweat gland of the palms. However surgery has a host of complications including exacerbating the problem or increasing generalized hyperhidrosis (3).

Possible Approach to Primary Palmar Hyperhidrosis

Considering the strong evidence (3, 5) that certain emotional states may trigger or aggravate focal hyperhidrosis, including sweaty palms, the first approach should take the psychological component into consideration.

The sympathetic nervous system, which triggers perspiration, may be overactive (8) in some individuals due to emotional states like anxiety, depression or stress. Counseling and stress management can therefore play an integral part in managing palmar hyperhidrosis.

This does not mean that every case of palmar hyperhidrosis is due to a psychological cause. Since most sufferers report an aggravation of symptoms with certain emotional states, it would be prudent to at least investigate how counseling, stress management, meditation and other relaxation techniques can assist a person with at least reducing the severity of the sweating.

This may not be a “cure” for the condition but can be useful in controlling the extent of the palmar hyperhidrosis.

Refer to the question and answer article (‘Cure’ My Sweaty Palms, Hands, Feet) on a patient who found her own way of resolving her sweaty hands and feet condition.

References:

  1. Sweaty palms syndrome may run in families (universityofcalifornia.edu)
  2. Hyperhidrosis causes (emedicine.com)
  3. Hölzle E. Pathophysiology of sweating. Curr Probl Dermatol. 2002;30:10-22.
  4. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol. 1989;20:713-726.

Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

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  • myblogisgreat

    well i want to get treatment for this.

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  • Nina011

    hey myblogisgreat i’ve used Andy Goodman’s Cure My Sweaty Palms method and it worked in like 6 days.. he basically shows you how to make your own iontophoresis device and tells you how to use it properly.. i’m so happy my palms finally don’t sweat anymore

    nina :))

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  • shirley

    I have both palmar & plantar hyperhidrosis.I need an accurate treatment for this dreadful disease without side effects.kindly suggest me the best treatment modality.

  • Jan Modric

    Shirley,
    so far we hadn’t found any other treatment beside that mentioned in the article.

  • Christian

    The Andy Goodman method truly does work. You just have to have enough determination that you REALLY want to put an end to your sweaty hands. Then once you’ve got that inner mindset, know that it will take about 15 minutes a day of treatment, for 5 days in a row, and You’ll be pleasantly surprised. If you can’t commit to that, then there is no magic bullet besides surgery or expensive botox. You can read my story on my blog

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  • Ronak Bhaduri

    suffering fromhyperhidrolisis,plz help

  • Ronak Bhaduri

    i already tried homeophathy but no improvement seen, plz help.is it really curable for ever

  • Dr. Chris

    Hi Ronak

    Hyperhidrosis is not curable but can be reduced significantly with appropriate treatment. It is difficult to say what may be causing it or give any further advice as you have provided very little information.

  • izuata

    how to contact a handfull of hyperhid- rosis cured patient and sufferers.thanks

  • Jan Modric

    To izuata.

    You might want to check some health forums, like medhelp.org , or search online for “hyperhidrosis forum” or so.

  • yousef

    hey
    i’ve got sever condition of hyperhidrosis plz anyone tried any usful treatment just send me the name of it

  • Dr. Chris

    Hi Yousef

    Hyperhidrosis is incurable. Apart from surgery, very few therapies offer lasting relief. Surgery may even aggravate the problem further.

  • nitish

    plz help me i am suffering from fromboth pamal anb feet hyperhydrisis i ihave tried various cure but not get sufficient result plz help me

  • Dr. Chris

    Hi Nitish

    There is no “cure” for the condition and if you have undergone medical treatment for this condition (supervised by a doctor and not self medicating) with no success then you may have to consider psychotherapy. The condition may be related to anxiety, depression or emotional stress and could even be attributed to a past traumatic event. If you find that the sweating is aggravated (although it is otherwise present) by an emotional state, it could give you some indication to the cause. Many patients who do not experience any joy with the medical approach to palmar hyperhidrosis find counseling and stress management useful although it may appear unrelated.

  • Pingback: 'Cure' My Sweaty Palms, Hands, Feet - Cause, Stress, Remedy | Healthhype.com()

  • OSMAN

    does the book ‘sweat no more’by gary townsend really help towards reducing excess sweating by almost 80%. Anyone read about it.

  • nobody in particular

    Much if not most of the excessive sweating will diminish over time, to the point where it’s no longer a problem. Maybe the overactive sweat glands eventually “burn out”? Don’t give up hope. MIND OVER MATTER helsp a lot, so just have some TRUE GRIT and make up your mind that you will calm yourself and NOT be bothered by this problem. The more you worry about it and focus on it, the worse the problem becomes. Good luck.

  • sekhar

    respected sir
    i a sekhar suffering with hyperhydrosis on hands and on foot so i pls request to give me details abt the treatment

  • Dr. Chris

    Hi Sekhar

    Please refer to the treatment options in the article. We cannot offer you anything beyond this. You should speak to your doctor about medication for your condition.

  • surfsider

    hello. i have it on the hands and feet.

    my feet are worse than hands however.

    why is the ETS surgery so controversial. Some people seem to have great results and others have bad side effects?

    Why can’t the doctors agree on what level to clamp or cut T2 T3 or T4?

  • Dr. Chris

    Surfsider,

    Results vary among individuals and often there is a rebound effect on another site. Previously, many ETS procedures were done in haste without thoroughly investigating and completely excluding secondary hyperhidrosis. Like any condition, palmar hyperhidrosis has to be approached on an individual basis and similarly the results may vary significantly among different people. Ablation of anywhere between T2 to sometimes as low as T6 – T9 may have to be considered depending on the areas of the upper limb affected, if its not only the palms. Individual anatomical variations may mean a slight difference in level of nerve supply to the area so there is no “one size fits all” approach.

  • surfsider

    Dr.

    Thanks. But what happens to the rest of the sympathetic nervous system when part of it is destroyed or clamped? I heard of patients complaining of being emotionless and having no energy afterwards. In my case, it is the hands and feet. The feet are a little worse. I’ve talked to almost every leading surgeon who does this and they all have a diff philosophy. As a patient it’s confusing.Also, Is the clamping really reversible? Thanks for your time.

  • Dr. Chris

    Hi Surfsider

    “Emotionless and no energy” – I do not want to say that it is psychological but I would not put much credence into these claims.

    As you would have noticed in the terms and conditions, we are only here to guide readers and not offer specific medical advice or debate the merits of one therapy over the other. A surgeon (or the various surgeons you have spoken to) are in a better position to answer your questions as this is their field of expertise plus they would obviously know you case history.

  • surfsider

    what do the nerves that are cut or clamped in ets surgery control besides sweating?

  • MD.N. ALAM

    dear sir
    from my child stage i always feel very embrassing for my sweaty&cold palms (both hand palm and feet). that time when i meet dr they said it is no problem at all.but i really feel embrassing this situation specially while to hand shake to other or writing anything.i m now 32 unmarried.can u advise me how natural treatment or easy treatment for remedies.
    kindly advise me and to my mail id.
    thanking you
    Alam

  • Krishna Roy

    My son aged 14 years is having sweaty palm causing embarasement and disturbing.Please advise for natural cure.I don’t want for any alopathic and homeopathic treatment.Need a natural treatment.Joga or any other mental stress free activity can help in this regard. Kindly advise

  • Dr. Chris

    Hi MDN Alam

    You should speak to your doctor about the possibility of using some of the medication mentioned above. This may help control the extent of your problem, along with the use of drying powders and so on. If medical treatment is unsuccessful, then you should consider surgical options. We do not offer advice on “natural remedies” for this condition. You should speak to a complementary health practitioner for more advice.

  • Dr. Chris

    Hello Krishna Roy

    We do not provide advice on any “natural” treatments that have not been clinically proven to be effective. You should speak to a reputable naturopath in you area who may be able to advise your further. If the problem is stemming from stress and generally nervous disposition, then relaxation techniques like meditation, yoga and so may be beneficial. You should first have a doctor assess his case and then discuss your conservative management options with the doctor. It would not harm to try yoga, etc but it is always better to first get a medical opinion.

  • RedCam

    Surfsider,

    I have struggled with Hyperhidrosis since the 3rd grade. I am now 25 and it is something that I live with everyday. I can relate to a lot of situations in dealing with this illness.

    I have always heard of procedures and surgeries but have never truly considered them because of the price and embarrassment. However, there was one home remedy that seems to be a temporary fix especially for my hands.

    There is a product called Certain Dry which can be found as most Walgreens/Jewel stores. It is a liquid antiperspirant which contains a high level of aluminum chloride. Simply pour some of the liquid in two plastic bags or latex gloves which ever you have. Wear them sealed before you go to sleep and remove in the morning.

    The effects can lead to itchy hands but the results are worth the effects. The dryness in my hands lasted about 3 months before I had to apply again. As a result I noticed a decrease in sweat on my feet and arms. I hope this helps and please pass this information along.

    Ty

  • Andrew Hall

    no, no, no… antiperspirants with high amounts of aluminium chloride are super unhealthy, so is botox btw. I don’t know why are these still used when you can just use electro anitperspirant, it’s clean, healthy, and works perfectly!!!