Sweaty hands and feet is a pretty common problem. Up to 2% of the population has problems with excessive sweating. It has a significant affect on all aspects of the patient's life. Diagnosis is based on excluding secondary causes and fulfiling certain criteria.
PRIMARY HYPERHIDROSIS MUST HAVE
1. Focal, visible, excessive sweating
2. 6 months duration
3. No apparent cause
TWO OR MORE:
1. Bilateral and symmetric sweating
2. Impairment of daily activities
3. At least one episode per week
4. Onset of less than 25 years
5. Positive family history Hornberger, 2004
First line treatment for primary palmoplantar hyperhidrosis should be with antiperspirants.
Topical aluminium chloride hexahydrate 20% should be tried at night.
when topical antiperspirants are generally ineffective. Iontophoresis is generally the next line of treatment.
The main reason for this post is to point out that Iontophoresis is available at the Skin&Cancer Foundation Victoria in Carlton, Melbourne. They provide a hyperhidrosis clinic with iontophoresis and botox injections.
The patient sits with hands or feet in shallow tray of water ( tap water alone can be done by the patient at home or an anticholinergic drug under medical supervision)
Allow 15 – 20 milli-amps of electrical current to pass through water
- till a tingling sensation is felt
Use for 10 days, 30 minutes each day
Maintenance therapy needed
Mechanism of Action Not fully understood
Blocking of sweat glands/ functional impairment of the sweat
gland/increased threshold nerve impulse/ Decreased pH in the sweat duct
Other treatments are Botox injections into the palms/feet and lastly ETS which is Endosopic Thoracic Sympathectomy. However ETS often leads to compensatory sweating from other locations which may turn out to be worse than before.