Palmoplantar Hyperhidrosis--Sweaty Palms and Soles

When excessive sweating occurs in both palms without any apparent cause and remains for more than six months, it is known as palmar hyperhidrosis. The same occurrence on the soles is known by the name plantar hyperhidrosis. As both occur simultaneously in individuals and the treatment modalities are almost
similar, both are considered together as palmoplantar hyperhidrosis.

. The sweating occurs on both sides and disappears during sleep. Sweaty palms and soles may be accompanied by sweaty armpits or axillary hyperhidrosis and sweating on the face and scalp.

The exact cause of palmoplantar hyperhidrosis is not known. Experts believe that a familial tendency of the sweat glands to over react to stimulation by the autonomic nervous system is the main underlying cause for the sweaty palms and soles. Though stress may increase the sweating, palmoplantar hyperhidrosis is
different from the emotional sweating of the forehead and clammy hands.

Generalized Hyperhidrosis:
Can be caused by certain medications, drug abuse, heart problems, lung failure, fever, infections, cancers, endocrinal and metabolic disturbances as seen in thyroid over activity or diabetes, neurological diseaseslike Parkinsonism.

Regional Hyperhidrosis:
Any central or spinal diseases which damage the peripheral nerves may cause cessation of sweating at some areas of body with compensatory sweating at other sites. This is typically seen in stroke and

peripheral neuropathies.

Focal Hyperhidrosis:
Frey’s syndrome (occurring after parotid gland surgery where patient gets sweating on one side of the face while eating or even on thinking about food), gustatory sweating (sweating after eating), social anxiety disorder, sweat gland tumors and some neurological disorder or tumors

Negative Effects of Sweaty Palms and Soles

Sweaty palms and soles causes embarrassment in public and students find it very inconvenient while writing – difficulty in holding a pen, and wetting the papers and books. Persistent clamminess predisposes the palms and soles to fungal and bacterial infections. Tinea pedis and pitted keratolysis are common complications of plantar hyperhidrosis. The feet especially may become malodorous.

Patient Education:
Patients should be educated in the pros and cons of treatment modalities available so that they can make an informed decision on the choice of the most appropriate treatment options.

Tap water Iontophoresis
using galvanic current is the first line of treatment in palmoplantar hyperhidrosis. Usually 3-4 treatments of 20-30 minutes each is required every week. Sweating reduces after 8-10 treatments. Maintenance therapy is indicated once every 1 to 4 weeks, depending upon the individual responses

Treatment with aluminum chloride hexahydrate
10-25% solution is the standard topical treatment for sweaty palms and soles. The solution is applied to dry palms and soles at bed time and washed off after 6-8 hours. This is continued daily till the sweating becomes normal or controlled. Then an application of once in 1-3 weeks will suffice to maintain the control.

of irritation occurs after iontophoresis or aluminum chloride hexahydrate solution, betamethasone valerate cream can be used twice daily for a few days.

In case the treatment with iontophoresis topical application fails, intradermal injection of botulinum toxin is the next choice of treatment. This provides relief for 6 to 12 months. The injection can be quite painful and requires proper anesthesia.

Systemic anticholinergic medications can reduce sweating, but also cause side effects like dry eyes, dry mouth, urine retention etc.

If the conservative treatment fails, then surgery is a permanent solution for palmoplantar hyperhidrosis

Bio feedback techniques, yoga, meditation, acupuncture, hypnotherapy, herbal medications etc. also have

been reported by some to be useful in sweaty palms and soles, but have no proven value amongst treatment options as of now.