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Palms wet enough to smudge paper, slip off a phone and make you avoid a handshake. Of all the places excessive sweating occurs, this is the one that responds best to treatment — including, where it comes to it, surgery that works.
Palmar hyperhidrosis is excessive sweating of the hands that happens without heat or exertion. Clinically it is a straightforward condition. Its effect on daily life is not, and is routinely underestimated by people who do not have it.
That last category is the reason people eventually seek help. The sweating itself is harmless; what it does to how you move through the world is not.
Sweating is controlled by the sympathetic nervous system, a chain of nerves running alongside the spine. In palmar hyperhidrosis the section of that chain supplying the hands signals the sweat glands to work when there is no reason to.
It is not caused by anxiety, though anxiety makes it worse — and the relationship usually runs the other way round, with years of wet hands producing the social anxiety rather than the reverse. It commonly runs in families, and typically begins in childhood or adolescence.
Where sweating began suddenly in adulthood, occurs at night, or affects the whole body, it may be secondary to another condition and is assessed differently.
Treatment works through steps. Most people try two or three before considering surgery, and some never need to.
Applied to the palms at night, on dry skin. Cheap, worth trying first, and effective for milder cases. Can irritate the skin, which is managed by adjusting how often it is used.
The hands rest in shallow water while a weak current passes through. It suits palms particularly well, needs repeated sessions to build an effect, and can then be maintained at home with your own device. Effective for many people and entirely reversible.
Tablets blocking the nerve signal to the sweat glands. They work on the whole body rather than the hands alone, which is both why they help and why the side effects — dry mouth, blurred vision — limit the dose some people can take.
Effective, lasting several months before repeating. Worth knowing that injections into the palm are considerably more uncomfortable than into the underarm, and can cause temporary weakness of grip — which is why it is used less for hands than for underarms.
Surgery on the nerve chain itself. The most effective treatment available for palmar sweating, and the one with a permanent trade-off — both covered below.
ETS interrupts the section of the sympathetic chain that carries the sweat signal to the hands. It is performed by a surgeon who works on nerves, and is among Dr Mathew Tung's listed procedures.
It is done under general anaesthetic through two very small incisions in the side of the chest, using a camera rather than an open incision. The relevant part of the sympathetic chain is then either divided or clipped.
Both sides are usually treated in the same operation. Most people go home the same day or after one night, and return to desk work within a few days.
For palms specifically, ETS is the most reliable treatment there is — the hands are usually dry immediately, and satisfaction among people who have it is high. It is markedly more effective for palms than for underarms or feet, which is why it is offered mainly for this site.
You should hear this before deciding, not afterwards. After ETS, many people sweat more elsewhere — typically the back, chest, abdomen or thighs. This is compensatory sweating, and it happens because the body's cooling has been redirected rather than removed.
This is the single most important thing to weigh, and it is the reason ETS is a considered decision rather than a first step. Any surgeon who does not raise it with you has not given you what you need to decide.
ETS tends to suit people who:
It suits people less well where sweating is mainly elsewhere, where it is mild, where an underlying cause has not been excluded, or where the expectation is of sweating stopping everywhere rather than on the hands.
A consultation is not a commitment to surgery. Most of it is spent establishing what kind of hyperhidrosis you have, what you have tried, and whether the simpler options have been given a fair run — which for a good number of people is where it ends.
For palms, ETS is highly effective and the hands are usually dry immediately after the operation. What it does not do is stop sweating elsewhere — and in many people sweating increases elsewhere instead.
Where the nerve chain is clipped rather than divided, reversal has been attempted, but results are unpredictable and it should not be relied on. Where it is divided, it is permanent. Treat the decision as permanent either way.
Some degree of it is common — most people experience it. For most it is mild. For a minority it is severe enough to outweigh the benefit, and there is no reliable way to predict which group you will be in beforehand.
No. Antiperspirants, iontophoresis, medication and injections help a great many people. Surgery is for cases where those have not worked and the sweating is genuinely limiting.
Anxiety worsens it, as it does for everyone. But primary hyperhidrosis is not caused by anxiety — more often the years of managing wet hands produce the social anxiety rather than the other way around.
No. You can book directly. It helps to note what you have already tried, for how long, and whether sweating affects your feet or underarms as well.
Hyperhidrosis · Excessive underarm sweating · Neuropathic pain · Neurosurgery
Whether or not surgery is the answer, a consultation establishes what kind you have and whether the simpler options have had a fair run.
