Perspiration is one of the main ways that the body keeps cool. But it can be bothersome at times, especially when you are perspiring excessively and in awkward places. Despite being a normal process, perspiration and particularly excessive perspiration does hold some social stigma. While it is quite acceptable to be sweating on a hot day or after a strenuous workout, most of us would prefer not to perspire or at least not to visibly show signs of it at times. One of the more embarrassing experiences is when our hands and palms perspire as it is the main appendage by which we make social contact and function in daily life.
Sweat Glands in the Hands
Millions of sweat glands are located in the skin throughout the body. Eccrine sweat glands are the main type of sweat gland and secretes a thin clear fluid known as sweat. When sweat evaporates from the surface of the skin, it has a cooling effect. In this way the body is able to cool down when it is very hot. The more the sweat, the greater the cooling effect. However, excessive sweating on the hands may not be serving a purpose in temperature control.
Excessive sweating is medically known as hyperhidrosis. It is more likely to occur in the armpits and on the hands and feet. When it occurs on the palms it is referred to as palmar hyperhidrosis. It appears to be a consequence of overactivity of the eccrine sweat glands. Control of these glands is through nerves. The exact reasons why hyperhidrosis occurs is not clear. It is believed to be due to overactivity of the nerves supplying the eccrine sweat glands that occurs for unknown reasons.
These nerves are not under voluntary control but it can be influenced by physical activity, psychological stress, heat and hormones. It is possible that the nerves supplying the eccrine glands may be overreacting to these stimuli thereby leading to excessive sweating. Why certain areas like the hands sweat profusely is unclear. It tends to occur when a person is nervous or stressed yet is less likely to occur with physical activity where cooling may be necessary.
Antiperspirants are available in many different formulations but all contain an aluminum ion which is essentially the active ingredient. These aluminum ions enter the cells lining the ducts of the eccrine glands. In the process water is drawn into the cells thereby causing it to swell. As a result of the swelling, the ducts of the eccrine glands are blocked. This means that the sweat cannot pass out. Although all antiperspirant essentially work in the same way, there may be specific applications for the palms to reduce sweating. Some of these are prescription products while others are available over-the-counter (OTC).
Anticholinergic drugs are widely used for excessive perspiration. It works by blocking the action of acetylcholine, a neurotransmitter released by nerves. In this way anticholinergics are able to block the nerve impulses to eccrine sweat glands. Without the nerve impulses stimulating it, these glands will stop releasing sweat or at least reduce the amount of perspiration. However, this is not the preferred option for treating conditions like perspiration on the palms. Anticholinergics have a host of side effects and it has to be decided whether the benefits outweigh the risks. The effect cannot be targeted on a single area and the side effects may therefore affect many organs and systems in the body.
Botulinum toxin is produced by bacteria known as Clostridium botulinum. It is more commonly known for its ability to reduce wrinkles in cosmetic medicine. However, it does have other applications like for the treatment of excessive perspiration of the palms. Botulinum injections can block the nerve impulses traveling to the eccrine sweat glands. As with anticholinergic drugs, the blocking of these nerve impulses reduces sweat production. It requires several botulinum injections for the maximum benefit. The effects can last for long periods of time after the initial injections, sometimes for as long as 12 months.
Iontophoresis is one of the popular treatments for excessive perspiration of the hands. It uses a low-voltage current to “shock” the sweat glands. The hands are immersed in shallow water and the electrical current is then applied. Over many treatments this reduces the activity of the sweat glands but it is not a cure for sweaty palms. Iontophoresis treatments should be done several times over a week or two. Most patients will derive significant benefit from a series of iontophoresis treatments but the condition tends to recur in time.
Surgical procedures for the treatment of excessive perspiration are reserved for severe cases that are not responding to other forms of treatment. It is considered when the problem of excessive perspiration is affecting a person’s quality of life. This type of surgery involves interrupting the nerves that carry impulses to the sweat glands. The nerves may be cut, clamped or burned. However, there is no guarantee that the procedure will be beneficial and in some cases it can worsen excessive sweating. This surgical procedure is permanent and cannot be reversed. Therefore patients need to be made fully aware of the risks of undergoing surgery for sweaty palms.
Since hyperhidrosis has been linked to anxiety and psychological stress, there may be some benefit in stress management. Counseling, meditation and other relaxation techniques should be considered even before surgery. The effectiveness of these techniques have not been conclusively established as a viable treatment option for palmar hyperhidrosis. However, it is worth attempting since it is non-invasive and does not have any potential side effects as with other treatment options.
There are a number of alternative therapies that may be attempted in the treatment of excessive perspiration on the palms. Acupuncture and homeopathy are two complementary therapies that are widely used in the treatment of palmar hyperhidrosis. Acupuncture has been known to have clinical benefits in blocking nerve impulses but its role in palmar hyperhidrosis need to be investigated further. Most of these treatment options have not undergone clinical trials and the effectiveness has therefore not been established. Nevertheless it may be tried prior to considering permanent measures like surgery.
Hyperhidrosis. Cleveland Clinic
Hyperhidrosis treatment. Mayo Clinic