Sweaty palms and underarms

Sweaty palms, underarms and feet (hyperhidrosis) are characterized by abnormally increased sweating. This may seem like a minor problem to many, but is often significantly functionally and socially disabling to those affected.

How Does It Manifest?

Individuals with hyperhidrosis of the palms and fingers experience difficulty with hand function, such as writing and driving. They may also experience social awkwardness when shaking hands or avoiding it. Individuals with sweaty underarms may find it socially distressing as this often leaves water stains on their clothing, and this is sometimes also associated with unpleasant odors. 

A common complaint amongst affected individuals is that they get nervous when they start to sweat, and nervousness stimulates more sweating and more anxiety. Certain foods, caffeine and nicotine may also induce hyperhidrosis. Affected individuals may experience adverse effects on their self-confidence and social function.

A woman dripping wet from bathing in the swimming pool, grabbing an orange slice in her right palm.

How does it arise?

Hyperhidrosis is often manifested in adolescence. It is inherited as an autosomal dominant genetic trait. There are medical conditions that are occasionally associated with hyperhidrosis, such as disorders of the thyroid or pituitary glands, menopause, diabetes mellitus, or the use of certain medications.

How is it assessed?

Individuals with bilateral hyperhidrosis normally do not require further investigations. Those with mild to moderate hyperhidrosis may not have clinically apparent sweating during the time of the clinic consultation. The starch-iodine test is an interesting test may be applied to the hands to confirm hyperhidrosis in selected cases. A thin layer of iodine is painted onto both palms and is left to dry for 2 minutes. The palms are then brushed with a thin layer of flour. Individuals with hyperhidrosis will produce sweat, which dissolves the iodine on the palm, and will cause the flour to stain blue hence confirming the diagnosis.



There are various options available for the treatment of hyperhidrosis, including topical antiperspirants, botulinum toxin injection and surgery. These treatments often bring about significant relief to affected individuals.



What medications are available?

Topical antiperspirants containing aluminium chlorohydrate are effective as first-line treatment for the underarms. Aluminium chlorohydrate works by denaturing keratin, a component of the skin, which then occludes the pores of the sweat glands. Three to five days are usually required to observe improvement. Skin irritation occurs in some individuals and they may require other forms of treatment. 

Topical antiperspirant therapy works less well for palms due to frequent contact and washing. Oral anticholinergic medications such as oxybutinine and glycopyrrolate may be used, but are associated with side effects including dry mouth, urinary retention, and constipation.

What is botulinum toxin injection?

Hyperhidrosis is reliably treated with botulinum toxin injection and attain a high degree of satisfaction in most cases. Botulinum toxin blocks the neural control of sweat glands and reduces sweat production. In cases of palmar hyperhidrosis, wrist blocks are performed using local anaesthesia injection for maximal comfort.

Near painless injections are possible at Picasso Plastic Surgery with the additional use of a proprietary pain distraction device at the time of injection. The palms and/or underarms are marked out with a grid pattern of dots spaced 1 to 1.5 cm apart. A small dose of botulinum toxin is injected within the dermis at each dot.

Individuals are advised to avoid vigorous massage or rubbing to the treatment area for 2 hours following the injection, to prevent unintended spread of the botulinum toxin resulting in potential unintended adjacent muscle paralysis. It is possible to return to normal activity after that. The effects of botulinum toxin generally take 1 to 3 days to be observed and will last between 4 to 6 months. Botulinum toxin injections are not permanent, and repeat treatments are required to maintain its effect.

What surgical treatments are available?

Surgery for hyperhidrosis is usually performed under general anesthesia as day surgery cases. This involves inserting an endoscope into the thoracic cavity and using heat energy to selectively remove the sympathetic nerves (thoracic sympathectomy) that are involved in the production of sweat. The results of surgical treatment are permanent in majority of cases. Picasso Plastic Surgery has a network of partner surgeons who are able to provide this service should you request for it.