- Best Results1-14 days
- Treatment RecoveryNA
- Procedure TimeVariable
- Skin SpecialistNurse
- Duration of ResultsVariable
- Back to WorkNA
Sweaty Hands Treatments
Sweaty hands or palmar hyperhidrosis is one of the most common areas of excessive sweating. Excessively sweaty hands can be seen in 2-3% of the population. Treatments are readily available. Dermatologists recommend simple treatments such as topical antiperspirants as first line management, followed by creams, iontophoresis, anti-sweat injections & finally surgery.
FactsFacts on Sweaty Hands
- Sweaty hands or palmar hyperhidrosis affects 2-3% of people
- The condition usually affects both hands starting in childhood
- Some patients will have a family history of hyperhidrosis
- The condition can have a significant impact on schooling, work & social life
- Treatments can be effective in reducing excessive sweating
- Iontophoresis is a treatment option for hands & feet
- Iontophoresis for sweaty hands can be effective in up to 80% of cases
- The best results are seen with glycopyrrolate iontophoresis
- ETS surgery has a high cure rate, but compensatory sweating can be a side effect
How common are sweaty hands & what is the cause?
Hyperhidrosis or excessive sweating can affect any area of the body, however, is more common in areas with higher concentration of eccrine or sweat glands. These areas include the hands, feet, face, and armpit. Most cases are idiopathic, that is unknown. Sweaty hands can affect up to 3% of the population. Half of all patients with sweaty hands will have a relative who suffers from hyperhidrosis.
What treatments are available for sweaty hands?
Decreasing trigger factors for sweating can improve but not eliminate excessive sweating. Reducing caffeine intake can make a tiny bit of difference, but usually not enough to make an impact.
The first step is a clinical strength topical antiperspirant. Look for aluminium chloride hexahydrate. This can be bought at all major pharmacies and works by blocking up the sweat glands on your hands. The success rate for topical antiperspirants are around 10-20% but they are worth a try! In fact it is considered first line management of sweaty hands.
The next step involves a process called iontophoresis. This treatment takes 10-25 minutes to perform. 3 sessions are conducted over the week, with relatively high success rates seen. The tap water in Brisbane has a high mineral content and tap water ionto is our first step. For patients who don’t respond as well as they should, we can compound anti-cholinergic solutions into the iontophoresis treatment protocol. This protocol uses glycopyrrolate and is conducted once a week. The addition of glycopyrrolate into the solution increases the efficacy of iontophoresis to 80-85%. Most patients will have a temporary reduction of sweating for 2-7 days.
Tablets such as propantheline bromide can help with sweaty hands, however side effects such as sedation limit the use long term.
Special creams can be compounded for sweaty hands, these creams contain anticholinergic substances which can inhibit sweat production. The concentration of the creams can be individually tailored for each patient, depending on the sweat patterns, sweat severity, side effects and response. The most common formulations contain glycopyrrolate 0.5 to 3%.
Should you have your hands treated?
Hand sweating is normal and occurs during times of stress, and anxiety. Increased production of sweat also occurs with certain drugs including caffeine & energy drinks. The question is, how much sweating is abnormal?
Abnormal sweating of the hands occurs when:
- Sweating affects your schoolwork or occupation
- Sweating affects your personal relationships including holding hands
- You are apprehensive to shake hands because of sweating
- You think of your condition many times a day and maybe embarrassed of this condition
- You limit your hobbies due to excessively sweaty hands
- Excess sweating is uncomfortable
- You carry lots of things with you to try to stop your sweating
If you answer ‘yes’ to any of the above conditions, sweaty hands have a major impact in your life. Treatments can make a difference.
What is iontophoresis for excessive sweating?
Glycopyrrolate iontophoresis is a highly effective treatment with a success rate of over 80%. This treatment uses a state-of-the-art iontophoresis machine to draw an anti-sweating compound DIRECTLY into the sweat glands of the hands. Treatments are safe, take 10 minutes to perform (per hand) and can be spaced a week or two apart. Patients usually have 4-5 treatments over a course of a month. Once your sweating is under control, treatments are spaced every 10-14 days, depending on your remission period.
Disclaimer: For this treatment, book a consultation with Emily Fenton at Skinfluence in Brisbane. She is well versed in my treatment protocols. At the time of writing, Cutis does not offer iontophoresis.
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Can anti-sweating injections reduce sweaty hands?
Yes, they can but unlike underarm sweating, Medicare does not cover Botox treatments for sweaty hands. As a rule, we leave this method of treatment as a last line resort for patients, prior to the consideration of surgery.
Injections are effective in over 85% of patients with sweaty hands. The downside is the cost of this procedure (ranging from $1800 to $2600). Most patients will have a marked reduction in sweating that will last between 4 to 6 months.
Side effects such as swelling, pain but most importantly transient muscle weakness and loss of dexterity can occur. I encourage patients to maintain iontophoresis & only consider Botox for special occasions (due to the costs associated with injections).
Can surgery be effective in treating sweaty hands?
Yes. A surgical procedure called ETS or Endoscopic Thoracic Sympathectomy can help reduce or eliminate sweaty hands. ETS works by ablation of the sympathetic nerves that supply the sweat glands. Destruction of these nerves can cause the sweat gland to stop functioning.
Only certain areas of excessive sweating can be treated with this procedure, as the nerves that supply the hands, armpits & face originate from within the chest. The procedure has a very high success rate and can be performed using a minimally invasive technique. It does however require a general anaesthetic and is performed in hospital. A side effect of this procedure is rebound sweating, a term called compensatory hyperhidrosis. This occurs in approximately 40-60% of patients. Most cases of rebound compensatory sweating are mild to moderate in severity.
ETS is recommended if medical treatments such as creams, iontophoresis and tablets are ineffective. A vascular surgeon performs this procedure, Dr Andrew Cartmill in Brisbane is my go-to specialist.
Can Miradry treat sweaty hands?
No. Miradry cannot treat sweaty hands. It is only indicated for the treatment of axillary or underarm sweating. For sweaty hands, the use of glycopyrrolate iontophoresis is advisable. Miradry has been out for eight years now. I was the first physician to use this device in Australia. Though the success rates in treating excessive sweating of the axillae approaches 60 to 80%, the side-effect profile is much higher than liposuction of the eccrine glands. Miradry has been working on another device for sweaty hands & feet. I am unsure when it will be released.
Permanent solutions include thoracic surgery- this carries the risks of rebound sweating or compensatory hyperhidrosis. Surgery is last line management of sweaty hands.
Who to see for treatments?
This is the definitive guide to treating sweaty hands. First of all ask the question: Does excessive sweating impair any aspect of your life including school, work, social situations or cause you any emotional concerns? If the answer is ‘yes’, seek treatment.
Discuss treatment options with your medical dermatologist. In Brisbane, Emily Fenton, Nurse Practitioner at Skinfluence can guide you. My colleague Dr Leona Yip, dermatologist, can provide some guidance. In Melbourne, the Skin & Cancer Foundation has a HH or Hyperhidrosis Unit.
This is my treatment algorithm-
- Firstly, try aluminium chloride hexahydrate 15 to 20%. It can work in 10-20% of cases. The success rate is not high, but if it works, this is cost effective and relatively convenient.
- Consider tablets such as anticholinergics. These tablets are prescription tablets. Tablets can work in 15%-20% of cases. Propantheline bromide or oxybutynin are commonly prescribed tablets.
- Iontophoresis is a sensible treatment option. This treatment can be done with tap water, salty water or fortified with glycopyrrolate. It is not a permanent fix, but patients will need to continue treatment for life. Success rate of 50-80%.
- Creams can be used to decrease sweating; we have a special way of compounding anticholinergic creams and wipes to help decrease the activity of your sweat glands on your palms. These creams can be applied to sweaty hands daily, and work in 50% of cases. Google DermDry, a Canadian company that supplies 1% glycopyrrolate wipes.
- Botox can be considered. I do perform this procedure, it’s limitation is the cost & duration of effectiveness.
- ETS or endoscopic thoracic surgery is effective in over 90% of cases. The risk of rebound sweating elsewhere (called compensatory hyperhidrosis) makes this a last line treatment. See Dr Andrew Cartmill for this treatment. He is a vascular surgeon in Brisbane.
Disclaimer: I do not treat medical dermatology patients. I do give second opinions, but I do not get involved in management. Discuss options with your dermatologist.
What are the costs associated with treating sweaty hands?
Cost will vary considerably depending on the treatments. As a guide:
- Antiperspirant treatment: $15 for a month
- Tablets for sweating: $15-25, a prescription can be obtained thru your GP
- Iontophoresis: $90 to $160 per month, if you find this successful, you can purchase a similar unit for $800- $1200. This treatment is lifelong. If iontophoresis works, it is well worth it. Glycopyrrolate solution iontophoresis adds another $20 per treatment.
- Anti-sweat injections: PBS/ Medicare Rebate is only for the treatment of underarm sweating; excessive hand sweating is not covered under the PBS. Typically, Botox injections cost $1800 to $2600. It only lasts 4-6 months.
My suggestion is to see Emily Fenton at Skinfluence in Brisbane. She is well versed in my treatment protocols, including glycopyrrolate iontophoresis. Dr Leona Yip is another dermatologist at West End that can help you.
Davin’s Viewpoint on Treating Sweaty Hands
Sweaty hands or palmar hyperhidrosis is one of the most encountered areas of sweating. This condition starts off in childhood and has a significant impact for the patient. Children’s schoolwork can often be affected due to the excess sweat production, and often need more time in exams. Work, relationships, and social interactions such as a simple handshake can be stressful to the patient. It can’t be overstated the importance of treating palmar sweating.
This condition is very common, affecting 2-3% of the population, however in Asian population studies up to 5% of the population are affected. In fact, my wife suffers from this condition. My brother-in-law has had ETS surgery with good effect.
For patients who have palmar HH, the algorithm is pretty straight forward. Iontophoresis with tap water, then glycopyrrolate, then consider ETS surgery. Botox works well, however unless you have overseas health insurance this treatment is not financially viable for most, as it costs between 6 to 8 thousand per year. Dr Andrew Cartmill is a vascular surgeon who I refer most of my patients to.
Treatments are readily available, and successful in many patients. I approach treating sweaty hands in the following way- a combination of antiperspirants, creams, and iontophoresis sorts out 50-80% of patients. Sweat stopping treatments can help an additional 20% of people, however I don’t usually perform this procedure on children, and never perform this before iontophoresis. Our team works closely with Vascular surgeons, and if all else fails, a procedure called ETS, or endoscopic thoracic sympathectomy has a very high success rate. I rate ETS as a better procedure than sweat stopping treatments, as ETS has a very high cure rate, and sweat stopping treatments just give remission for 3-4 months. (For axillary hyperhidrosis, the reverse applies as it is PBS listed, and lasts 6-7 months)
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