Management Challenges and Solutions for Palmar Hyperhidrosis

Women are at higher risk of hyperthyroidism than men, although both sexes can be affected, with risk greatest in patients with a family history of Graves disease or other thyroid disorders.7 In patients with hyperthyroidism, epidermal thinning is the most commonly reported skin manifestation.8 Other skin anomalies include softness, excessive perspiration (ie, hyperhidrosis; pictured), and warmth, causing skin to feel like that of an infant.3 Itching, generalized pruritus, chronic urticaria, vitiligo, and diffuse skin pigmentation have also been reported.8 Dermal changes most commonly result from autoimmunity, rather than from hormones directly affecting the skin.3
Women are at higher risk of hyperthyroidism than men, although both sexes can be affected, with risk greatest in patients with a family history of Graves disease or other thyroid disorders.7 In patients with hyperthyroidism, epidermal thinning is the most commonly reported skin manifestation.8 Other skin anomalies include softness, excessive perspiration (ie, hyperhidrosis; pictured), and warmth, causing skin to feel like that of an infant.3 Itching, generalized pruritus, chronic urticaria, vitiligo, and diffuse skin pigmentation have also been reported.8 Dermal changes most commonly result from autoimmunity, rather than from hormones directly affecting the skin.3
A review provides an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision making.

Several topical therapies, oral therapies, and surgical interventions can be used to manage palmar hyperhidrosis, yet challenges exist with each of these approaches, study research published in Clinical, Cosmetic and Investigational Dermatology reports.

An established management approach to palmar hyperhidrosis is the use of topical therapies, such as topical antiperspirants containing aluminum chloride hexahydrate. The challenge with topical aluminum chloride hexahydrate is the short-term duration of effect. Occlusive methods, such as vinyl gloves, may be helpful in cases in which aluminum chloride hexahydrate retains a limited effect. Iontophoresis, which uses an electric current to optimize delivery of an ionized substance, is another first- or second-line management strategy that can be used to manage palmar hyperhidrosis. Although effective, particularly in cases where antiperspirants are ineffective, iontophoresis presents with compliance issues resulting from the amount of time and space it takes to use such a device.

Injectable botulinum toxin is another nonsurgical management strategy for palmar hyperhidrosis as a first- or second-line therapy. Although effective in many cases, women who are pregnant and patients with hypersensitivity to botulinum toxin should not receive the treatment. Administration of botulinum toxin with accompanying pain relief strategies is important to help reduce treatment-related pain in palmer surfaces.

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Systemic oral therapies, which have not yet been approved by the US Food and Drug Administration, may be helpful for cases unresponsive to topical nonsurgical strategies. According to the literature, the next lines of treatment of palmar hyperhidrosis include oral oxybutynin and glycopyrrolate, specifically in cases where satisfactory results were not achieved with topical approaches. Methantheline bromide and oral anticholinergics are also potential management options in some cases. Surgery is often used as a last-line option in carefully selected patients. Complications after surgery include gustatory sweating, dry hands, phantom sweating, altered taste, and bradycardia, among others.

“In practice,” the authors wrote, “disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise are all important considerations when designing an individual treatment plan” in patients with palmar hyperhidrosis.

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Reference

Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management strategies of palmar hyperhidrosis: challenges and solutions. Clin Cosmet Investig Dermatol. 2019;12:733-744.