Palmar Hyperhidrosis
Excessive hand sweating, or otherwise known as palmar hyperhidrosis, can be quite severe that it affects one’s daily normal activities. For most people who suffer from palmar hyperhidrosis, their condition does not only affect them functionally, but psychologically and socially as well.
Sweating is a natural body function to cool the body, but uncontrolled sweating, as in the case of palmar hyperhidrosis, may hamper work-related activities (typing, writing, handling papers, grasping objects, etc.). Ordinary and easy tasks like putting on make-up, buttoning a shirt, and cutting fingernails become extremely difficult. What’s worse is that initiating social contact and maintaining relationships become very uncomfortable as well.
In most cases, hyperhidrosis or excessive sweating has no known cause. While symptoms usually occur after puberty and continue through one’s entire life, it may have started since childhood for some. And in such cases, the condition may have a hereditary cause. Other contributory factors to this condition are emotional distress, anxiety, nervousness, or stress. Surprisingly, for some people, using a harmless skin product such as a skin lotion can also aggravate hand sweating.
Physical activity or a heightened emotional state stimulates the sympathetic nerve system, and adrenaline is sent into the blood system. The adrenaline signals the increase of heart rate and blood pressure, and sweat glands produce sweat to regulate the body’s temperature as a result. This is normal.
But for about 0.1% to 0.2% of the population, these physiological body processes are exaggerated which makes them sweat excessively (regardless of the room temperature), sometimes at unlikely times (even when sleeping!). A hypersympathetic activity of the body best explains excessive sweating for no apparent cause.
Those who suffer from severe palmar hyperhidrosis have cold, wet hands that drip with sweat, which are often causes of embarrassment. They are conscious of their condition and try to hide it from others, either by wiping or hiding their hands behind their pockets. They usually dread handshakes or hand contact. In the long run, all these frustrations build up, and could even lead to social withdrawal.
A treatment option available for those who suffer from excessive hand sweating or palmar hyperhidrosis is thoroscopic sympathectomy. It’s actually a surgical procedure, which involves cutting of a nerve found in the chest. It’s also a treatment for reflect sympathetic dystrophy and hand vascular diseases. However, many are apprehensive with sympathectomy as a viable solution to their condition because of fear of compensatory hyperhidrosis (CH).
Compensatory hyperhidrosis, which occurs after surgery, is a condition where other (non-treated) body parts (e.g. back and trunk) sweat excessively to compensate for the reduced sweating in the treated body part (e.g. palms or armpit). Although there may be reported incidents of CH from patients who have undergone sympathectomy for palmar hyperhidrosis, much has yet to be explored by medical researchers to substantiate the occurrence.
Those who suffer from palmar hyperhidrosis in addition to other medical conditions like hyperthyroidism, menopause or obesity, sympathectomy treatment is not advised. Similarly, individuals suffering from tuberculosis may not be allowed to undergo this treatment.
Excessive Underarm Sweating
Excessive underarm sweating, or known in medical literature as primary axillary hyperhidrosis is one of the most common types of hyperhidrosis (excessive sweating).
Sweating is a natural response of the body to regulate its internal temperature. Sweating happens when the body is exposed to a warm environment, when one is engaged in physical activity, and when anxious or stressed. But excessive sweating for no apparent reason can be embarrassing. In the case of axillary hyperhidrosis, underarm sweat leaves a visible stain on clothes, and often, the underarms are damp and sticky.
There are two types of glands found in the armpit area – the apocrine and eccrine glands. Of the two, the eccrine glands are the ones mostly responsible for producing underarm sweat. Numerous eccrine glands are also found in the entire body, which likewise cause perspiration when the glands are stimulated. Whenever the eccrine glands are stimulated to produce sweat, body cells secrete a fluid that travels the coiled portion of the gland up through the straight duct before it breaks out onto the skin surface.
If you suffer from excessive underarm sweating, a dermatologist can best diagnose the severity of your condition. Be ready to discuss with your dermatologist your medical background, your family’s medical history, and when you first experienced severe underarm sweating. Don’t hesitate to tell your dermatologist how your condition affects you. The extent to which severe hyperhidrosis is affecting your normal day-to-day activities can be measured through a self-assessment questionnaire called Hyperhidrosis Disease Severity Scale (HDSS). Your honest self-assessment report should help your doctor determine the best options available for you.
In most cases, excessive underarm sweating can be effectively managed by using topical agents such as deodorants and antiperspirants. Deodorants act to control bad odor, while antiperspirants slow down the production of sweat by the glands in the armpit area.
The most common active ingredient in anti-perspirants (and deodorants) is aluminum chloride. According to Dr. Eric Hanson of the University of North Carolina’s Department of Dermatology, the aluminum ions (from antiperspirants) are absorbed by the cell linings of the eccrine gland ducts found at the opening of the top skin layer (epidermis). These ions are drawn into the cell along with water until it swells, squeezing the ducts closed such that sweat can’t pass out. A cell can only absorb so much fluid, or until it reaches its equilibrium. At this time, the water will have to revert back out of the cell through a process called osmosis, and swelling will subside. When this happens, anti-perspirants may be re-applied.
As a point of reference, over-the-counter antiperspirants usually have 10 to 25% concentration of the active ingredient (aluminum chloride). While the FDA requires no more than 15 to 25% of the active ingredient in antiperspirants, it should decrease sweating by at least 20%. Obviously, no prescription topical agents or antiperspirants are available in the market that has a higher percentage of concentration of the active ingredient than that allowed by the FDA. It is still best to discuss other alternative treatments available with your doctor if over-the-counter antiperspirants prove ineffective for you.
Some people who excessively sweat may need higher concentrations of aluminum chloride to prolong the swelling of the cells and eventually shrink the sweat glands so that they don’t produce sweat than is really necessary.
Hyperhidrosis Treatment
Treatment choices that are offered to people suffering from primary hyperhidrosis can be classified into two treatments: Non-surgical (topical antiperspirants, iontophoresis, systemic medication) treatment and surgical (endoscopic thoracic sympathectomy, excision of axillary tissue) treatment.
Botulinum toxin injection is supposed to be minimally invasive and has become an accepted therapy for patients who do not react favorably to more conventional forms of treatment. This treatment therapy is normally done prior to resorting to surgery. Different therapeutic alternatives also vary in their length of efficacy. Side effects and response speed differ depending on the anatomic area treated. Topical therapy for focal hyperhidrosis or generally called antiperspirant treatment can be carried out with chemicals of several different classes. These classes comprise of astringent agents, topical anticholinergics, local anesthetics, and aluminum and other metallic salt solutions.
Most of the population in developed countries uses easily available over the counter antiperspirants for cosmetic and hygienic control of underarm sweating and odor. Individuals suffering from moderate to severe hyperhidrosis on the other hand require stronger remedies. Prescription medication and specially compounded solutions are commonly required for hyperhidrosis sufferers. Unfortunately these cures do not always give the desired effect.
Various topical agents analyzed are not easily obtainable commercially or do not have United States Food and Drug Administration endorsement and approval for the cure of hyperhidrosis. Only aluminum chloride has the approval of the USFDA for hyperhidrosis treatment. The preliminary treatment usually made for hyperhidrosis is normally non-invasive and does not necessitate any surgical procedure. There are commercially available ointments and salves (i.e., Drysol) that work as astringents and they have a tendency to dry up the sweat glands.
On the other hand, a different and acceptable cure for hyperhidrosis is iontopheresis. This is a hyperhidrosis treatment wherein electrical stimulation is used to lessen sweating. This procedure is normally done on the hands. Patients put their hands in a bath or basin of water wherein an electrical current is passed. This procedure stuns the sweat glands and tends to decrease the secretion of sweat for periods ranging from six hours to about 7 days.
One of the latest cures offered for hyperhidrosis is the injection of botulinum toxin or more commonly known as Botox. It is injected into the area where excessive sweating is experienced. This is a toxin that affects and sort of paralyzes the nerve endings. This toxin eventually reduces the transmission of the nerve impulses to the sweat glands which in turn results to reduce perspiration. It would normally require quite a few injections in the palms of the hands or armpits to complete the procedure. The effect of the procedure is observed to range from 1 month to 6 months. Continual injections are practically needed to sustain an acceptable level of dryness.
Besides the above-mentioned treatments, many drugs and remedies have been used with varying degrees of success. These include sedatives (for patients with stress induced hyperhidrosis) and medications that have an effect on our central nervous system. A family practitioner or internist is usually the one who makes the diagnosis and initial treatment for hyperhidrosis. Hyperhidrosis cases that do not respond accordingly to simple treatment regimens are often referred to a specialist such as a dermatologist or neurologist. As a rule of thumb, surgery is only considered when the less invasive medical treatments have been exhausted.
Hyperhidrosis Doctor
Chronic cases of extreme sweating, or medically known as hyperhidrosis, will require treatment from an experienced medical professional. You’ll find our information about hyperhidrosis helpful in understanding your needs and the right treatment for your condition.
Before scouting for a hyperhidrosis doctor, you’ll need to assess first the severity of your problem. If you’ve tried a hyperhidrosis treatment in the past, determine if it’s the right one for you. Your honest self-assessment should give you an idea of the type of doctor you’d prefer to see.
Our Physician Finder database will help you locate a competent physician to help you with your condition. Physicians listed in the database all specialize in the treatment of hyperhidrosis. Their names and contact information are provided for your easy access. The database also highlights those who are abreast with the latest research in the field, plus, the most promising and new treatments available.
Before that first appointment with your physician, plan a most fruitful consultation. Below are some of our practical tips:
1. Be open. Your doctor will best understand the seriousness of your condition if you can be honest about how hyperhidrosis has affected you, not only physiologically, but also socially and emotionally. Talk to your doctor and your relationship is off to a good start!
2. Enroll in clinical trials. Treatments are free of charge, and, other than “shopping” for the best options available, you’ll find satisfaction in knowing that you help further the cause of scientific research. Be ready to discuss with the physician your experience and the effect the treatment had on you.
3. Plan your visits. When you have to go to a general practitioner for instance, the physician, being a family doctor, may not have enough time to address in detail your special concerns. It helps to prepare the most essential questions in advance, so you don’t miss out on important details that you need to ask from your physician.
4. Assess the severity of your condition. It should help you decide in choosing a physician best suited to address your needs. Remember, hyperhidrosis is not just a physiological condition. If for instance, your social relationships have waned, that even your self-esteem is greatly affected, needless to say, you’ll need a more sensitive doctor. Also, in case surgical treatment has been decided as the best option, your doctor should also be sensible enough to prepare you psychologically before the procedure.
In the event that you’ve finally decided to choose a surgical treatment over other conservative treatments available for hyperhidrosis, it’s best to consider a surgeon who specializes in hyperhydrosis cases. Online, you’ll find surgeons in your area that specialize in hyperhidrosis. It’s important to find a surgeon who is experienced enough in handling chronic hyperhidrosis and its treatment. A good success rate is a big plus.
As a final note, your first meeting with the surgeon should be a good chance for you to get a good sense of his professional experience and personal sensibility. Your gut feeling should tell you if he’s the right one.
Iontophoresis Hyperhidrosis
Iontophoresis is the procedure of passing an ionized substance through intact skin through the use of a direct electrical current. It’s a common treatment for hyperhidrosis, and a variation, tap water iontophoresis, is used by many dermatologists to treat the hyperhidrosis (excessive sweating) of the palms and soles. Treating axillary hyperhidrosis through tap water iontophoresis is more difficult to administer, but still possible. Clinicians also use iontophoreiss to administer drugs such as anticholinergics to areas affected by the skin condition.
To date, there are two types of iontophoresis devices that are currently seeing use in the United States: (1) The Drionic Iontophoresis unit, and (2) the Fischer Model MD-1a Iontophoresis unit. These two iontophoresis devices have received approval for treating hyperhidrosis from the United States Food and Drug Administration.
The use of electricity to treat human diseases has been studied for more than two centuries, not long after its discovery in the 18th century. It’s been mentioned in a few studies that Pivati introduced the use of iontophoresis in the treatment of arthritis in the 1740’s. Further studies in the following two hundred years have confirmed the efficiency of the procedure in administering drugs through a patient’s skin.
The use of iontophoresis to treat hyperhidrosis gained popularity in the 20th century:
1936 – Ichikasa realized that drugs administered through iontophoresis resulted in reduced sweating activity in the affected area.
1940’s – In a study independent from Ichikasa’s, Takata and Shelley successfully obtained anhidrosis (the reverse of hyperhidrosis) through iontophoresis with tap water.
1968 – Levit published his ideas on a practical device that administered iontophoresis to patients, further boosting the procedure’s popularity.
Studies have also shown that the skin’s sweat glands provide the least amount of electrical resistance during an iontophoresis procedure, indicating that drugs mainly enter the patient’s skin through these channels. While iontophoresis have been used by dermatologists in attempts to treat other medical conditions (such as scleroderma and vitiligo), hyperhidrosis seems to be the only medical condition readily treated by the procedure, owing to its widespread popularity and high success rate.
Iontophoresis delivers a charged molecule across the skin. This is done by placing it near an electrode of the same charge as itself, while another electrode of opposite charged is placed on another part of the body. While this explains how drugs are transported across the skin, it does not explain how tap water iontophoresis reduces sweat output. Exactly how this is done is still a mystery, although several theories have been suggested.
One early theory suggested that iontophoresis plugged sweat gland ducts, since iatrogenic miliaria developed when iontophoresis was administered on the back, chest, or arms of patients. Microscopic analysis did show keratin plugs blocking sweat ducts, but light and electron microscopy found no such blockages in a patient treated for palmar hyperhidrosis.
It would seem that iontophoresis may cause an impairment in a sweat gland’s function instead of a blockage. Other theories suggest that the procedure raises the threshold for transmission of sympathetic nerve impulse, or that it changes the physiology of cellular secretory system. Neurotransmitter levels in the eccrine gland or surrounding microciruclation remain unchanged after iontophoresis, however, so the subject still remains open to debate.
Iontophoresis treatment regimens vary with the device used, the areas of the body to be treated, and whether the procedures will be done at home or at the clinic.
Overactive Sweat Glands
Excessive sweating at night is called sleep hyperhidrosis, more commonly known as “night sweats.” An individual suffering from night sweats may also experience excessive sweating during the day, although this is not always the case.
Sleep hyperhidrosis can affect anyone regardless of age, but it is more commonly seen in early adulthood (when sweat glands have become more active). Generally, sleep hyperhidrosis is safe, except that it causes distress and discomfort during sleep. It disrupts normal sleep patterns when one is frequently awakened due to drenched sleepwear and sheets.
Research shows that occurrence of excessive sweating is due to some genetic factors. Biology plays a role as well. For instance, women over 40 affected by menopause (or perimenopause) related hormonal changes, can suffer from night sweats. Similarly, pregnant women can experience night sweats due to hormonal changes. In both cases, excessive sweating shouldn’t be a cause for alarm, or be seen as a symptom of an underlying medical condition.
How does one know if excessive perspiration is actually caused by an underlying medical condition? Obviously, one sweats more in a warm environment, during exercise or in response to situations that elicit strong emotions – situations that make them nervous, angry, embarrassed or anxious. Thus, diligent efforts should be taken in keeping the place cool, well ventilated, and clean. Wearing of cool, comfortable sleepwear is also important. Certain foods and drinks that trigger the body to perspire more should be avoided. It also helps to reduce stress, or if at all possible, stay away from stressful situations. Try to control or eliminate all these external factors first. If severe “hot flashes” still occur then, it should be wise to seek medical attention.
Sweat glands release salty liquid through the process of perspiration. It’s a normal and essential body process controlled by the sympathetic nervous system to remove toxins from the body and to regulate body temperature. Perspiration usually occurs under the arms, on the feet, and on the palms of the hand. In some cases, sweating may occur around the face, or worse, all over the body. One is born with about two to four million sweat glands, and not until puberty do these glands become fully active. Interestingly, women have more sweat glands. Men may have fewer sweat glands than women, but their glands are more active.
If sweating gets out of control and become a source of distress and discomfort, several treatment options are available. There are some oral medications to choose from, but patients sometimes complain of certain side effects. Some experience dry mouth, drowsiness, and urinary retention. In the case of “hot flashes” caused by menopause, hormonal treatment will suffice to control the condition. There are also medical procedures that could help relieve the patient from this condition for more lasting results. A unique treatment is the use of electrical current (iontophoresis) to control the activity of the sweat glands. A device known as Drionic is used daily for seven days and results of the procedure last for up to one month. For chronic cases, surgical procedure will have to be done to remove some of the overactive sweat glands.


