Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Cognitive Behavioural Therapy for Hyperhidrosis
Excessive sweating may be a symptom of social anxiety. Excessive sweating is a troubling and embarassing anxiety symptom for some social phobia sufferers.
Hand sweating is absolutely normal and occurs during times of stress, and anxiety. Increased production of sweat also occurs with certain drugs including caffeine and 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 DOES play a major role in your life, and treatment is advisable.
The Sweat Free clinic has a very high success rate- in fact 90% -95% of patients can be treated with great success!
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. The majority of 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.
Decreasing trigger factors for sweating can improve but not eliminate excessive sweating. Decreasing caffeine intake can make a tiny bit of difference, but usually not enough to make an impact.
The first step is using Driclor. This topical antiperspirant can be bought at all major pharmacies and works by blocking up the sweat glands on your hands. The success rate for Driclor is pretty poor, but worth a try! In fact it is considered first line management of sweaty hands.
The next step involves a process called iontophoresis. This electrical treatment is done at The Sweat Free Clinic and 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 glycopyrolate and is conducted once a week. The addition of glycopyrrolate into the solution increases the efficacy of iontophoresis to 80-85%.
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.
Hands down it is Glycopyrrolate Iontophoresis. This treatment is super effective, 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.
Yes they can but unlike armpit sweating, Medicare does NOT cover sweat stopping 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.
Sweat stopping treatments works in over 85% of patients with sweaty hands, but side effects such as swelling, pain but most importantly transient muscle weakness and loss of dexterity can occur. It lasts between 3-5 months for the hands, however if used for underarm sweating, results lasts much longer -6 to 8 months.
A surgical procedure called ETS or Endoscopic Thoracic Sympatectomy 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 and 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 risk 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.
No. miraDry can not treat sweaty hands. It is only indicated for the treatment of axillary or underarm sweating. For sweaty hands, the use of Glyco. Iontophoresis is the Gold Standard of treatment.
Permanent solutions include thoracic surgery- this carries the risks of rebound sweating or compensatory hyperhidrosis. Surgery is last line management of sweaty hands.
If you suffer sweaty armpits as well, as sweat hands miraDry maybe right for you.
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.
The Sweat Free Clinic has helped hundreds of patients from all over Brisbane, Gold Coast, Toowoomba, Ipswich, Gladstone, Cairns, Mackay, in fact we have patients from Darwin and Northern NSW.
Treating Sweaty Hands
First try Driclor- 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. More on driclor application
Consider tablets such as anticholinergics. These tablets are prescription tablets. Tablets can work in 15%-20% of cases. More on tablets for sweaty hands
If Driclor and tablets do not work, or if you are experiencing side effects, you can try iontophoresis at the Sweat Free clinic. This treatment is ideal of sweaty hands and feet, but it takes time. It is NOT a permanent fix, but patients will need to continue treatment for life. Best with Glycopyrrolate. Success rate of 50-80%. More on iontophoresis treatment
sweat stopping treatments can be performed if driclor, iontophoresis and tablets fail. Success rate for sweaty hands is approximately 85%. More on sweat stopping treatments injections for sweating
Creams can be used to decrease sweating, we have a special way of compounding anti-cholinergic 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.
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. More on ETS surgery for sweating
Most cases of sweaty hands are NOT associated with other skin conditions, however some patients will have hand eczema and secondary infections. Eczema may involved small areas of peeling on your hands, including the palms and fingers. Very rarely, excessive sweating on your hands can lead to secondary bacterial infection called Pitted Keratolysis.
30-50% of patients with sweaty hands will have sweaty feet and excess sweat production in the underarms, a condition called axillary hyperhidrosis.
Treatment of sweaty hands at the Sweat Free Clinic is less costly than you think!
As a guide:
Driclor treatment: $15 for a month
Tablets for sweating: $15-25, a prescription can be obtained thru your GP
Iontophoresis: $149 per month at the Sweat Free Clinic, if you find this successful, you can purchase a similar unit for $800- $1200. This treatment is life long, and the initial outlay, if iontophoresis works, is well worth it. Glycopyrrolate solution iontophoresis adds another $20 per treatment.
sweat stopping treatments injections: PBS/ Medicare Rebate is only for the treatment of underarm sweating, excessive hand sweating is NOT covered under the PBS. Rates will vary, discuss with your Specialist Dermatologist
Creams for sweaty hands: Compounded creams and wipes start from $1 a day. The concentration, formulation and type will depend on many individual factors.
Consultation with a Sweat Nurse Specialist assessor: $25 out of pocket- a Medicare rebate applies.
Consultation with a Specialist: Discuss with our clinic prior to consulation.
For more information on our consultation fees, call reception on 3871 3437.
No referrals are needed.
A referral is needed to visit the Sweat Free Clinic. The first appointment involves an assessment of your sweat pattern, and will determine the course of action thereafter. We may recommend further testing, and a trial of sweat treatments. Testing is covered under Medicare.
We suggest printing out this referral form for your GP to fill out. This will enable us to inform your GP of your tests, and treatments.
Sweat Free Brisbane is unique as we have a full time Hyperhidrosis Nurse Practitioner. You can have the option of visiting this clinic without a GP referral, as our nurse can generate a referral to see our Specialists.
Dr Davin S. Lim
Sweat Free Clinics
Sweaty hands or palmar hyperhidrosis is one of the most commonly 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.
Treatments are readily available, and successful in the majority of 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 sympatectomy 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, sweat stopping treatments just gives remission for 3-4 months. (For axillary hyperhidrosis, the reverse applies as it is PBS listed, and lasts 6-7 months)
Dr Andrew Cartmill
B.Sc., M.B.B.S. (Hons), F.R.A.C.S. (Vasc)
Vascular and Endovascular Surgeon
Sweat Free Clinics, Queensland Vascular Group
In many cases, symptoms of palmar hyperhidrosis are relatively mild and are well controlled without the need for surgery. In more severe cases or after failure of medical therapy, patients are often considered for minimally-invasive endoscopic thoracic sympathectomy (ETS). The aim is to reduce the sympathetic outflow the palms whilst preserving other sympathetic nerve functions.
This is achieved through 2 small intercostal incisions beneath the armpit for endoscopic access to the chest cavity. Unilateral lung deflation is performed under general anaesthesia, to facilitate exposure of the sympathetic chain on each side. For palmar hyperhidrosis, the aim is the interruption of the T3 ganglion only by direct division of the chain. This will prevent sympathetic signals to the hands to reduce sweating, whilst minimising the likelihood of compensatory hyperhidrosis in other regions of the body, which is a risk particularly with higher T2 ganglion transection. The lung is reinflated over a drain tube, which is removed on the first post-operative morning prior to discharge home.
ETS is a very well-tolerated procedure which carries a success rate for eliminating palmar hyperhidrosis of over 90%. The main risk to be considered is the chance of ‘compensatory hyperhidrosis’ which may occur in 25-50% of cases. As expected, not all sympathetic outflow can be eliminated, and compensatory sweating particularly in the chest and abdomen can occur. Usually this is mild, well-tolerated, and much less severe than the palmar sweating the procedure was originally performed for. Indeed most patients who develop this find it much less debilitating than the palmar symptoms prior to treatment. Provided patients are well informed through a comprehensive pre-operative discussion about expectations, this risk is not a major concern. Other risks include small pneumothoraces which spontaneously resolve, bleeding, infection and Horner’s syndrome. This last risk can be caused by interruption of the T1 (Stellate) gangion and is therefore a very rare occurrence.
There is usually minimal pain aside from some transient generalised chest discomfort and surgical site pain. These both rapidly subside. Patients can expect to be in hospital for 1 night after the procedure, and usually return to work duties, schooling and regular activities within a few days.