Palmar Hyperhidrosis Management

Causes and Associated Conditions

Hypohidrosis can occur in certain skin conditions, such as congenital ichthyoses, due to plugging of sweat ducts by hyperkeratosis, as noted by the British Journal of Dermatology 1, 2
Medication-induced hyperhidrosis can occur as a side effect of certain anticancer agents, presenting as palmar-plantar erythrodysesthesia syndrome (PPES), according to the Annals of Oncology 3, 4, 5

Oral anticholinergic medications, such as glycopyrrolate, can be used to treat palmar hyperhidrosis, with monitoring for side effects including dry mouth, blurred vision, and urinary retention, as recommended by the Annals of Oncology 3
Iontophoresis is a safe and effective treatment for palmar hyperhidrosis, involving passing a mild electrical current through water and the skin surface, typically requiring 3-4 sessions per week initially, then 1-2 maintenance sessions weekly, as reported by the Annals of Oncology 5
Botulinum toxin injections (onabotulinumtoxinA) can be used to treat palmar hyperhidrosis, but may cause temporary weakness in hand muscles, as noted by the Annals of Oncology 5
Behavioral modifications, such as avoiding triggers and wearing moisture-wicking materials, can help manage palmar hyperhidrosis, as suggested by the Annals of Oncology 5
In cases of hypohidrosis, regular topical skincare and avoiding extreme temperatures are recommended, as advised by the British Journal of Dermatology 1, 2
Caution is needed when using anticancer treatments, with specific protocols including topical steroids and dose adjustments, as recommended by the Annals of Oncology 3, 4, 5

Nerve blocks should be considered before botulinum toxin injection for the palm to minimize pain during administration 6

Avoid mechanical stress to hands and feet, such as minimizing prolonged walking, heavy carrying without cushioned shoes, and activities that increase friction, as recommended by the American Cancer Society, based on research published in the Annals of Oncology 7
Wear moisture-wicking socks, such as silver-fiber cotton or bamboo socks, which conduct heat away and have antibacterial properties, as suggested by the British Association of Dermatologists, based on a study in the British Journal of Dermatology 8
Use supportive, properly fitted footwear with adequate length, appropriate width, and sufficient toe room, as advised by the International Diabetes Federation, based on research in Diabetes/Metabolism Research and Reviews, and also recommended by the British Association of Dermatologists, based on a study in the British Journal of Dermatology 8, 9
Apply urea-based emollients (10% cream) to maintain skin barrier and prevent fissuring, but avoid application between toes, as recommended by the American Cancer Society, based on research published in the Annals of Oncology, and also suggested by the British Association of Dermatologists, based on a study in the British Journal of Dermatology, and the International Diabetes Federation, based on research in Diabetes/Metabolism Research and Reviews 7, 8, 9, 10

Do not confuse primary focal hyperhidrosis with secondary causes, such as hyperthyroidism, medications, or menopause, or medication-induced palmar-plantar erythrodysesthesia syndrome from anticancer agents, as warned by the Mayo Clinic, based on a study in the Mayo Clinic Proceedings 11