Sweaty Palms | Palmar Hyperhidrosis
Dr. Prem Pillay, Senior Specialist
Neurosurgeon and Hyperhidrosis/Sweaty Palms Expert Singapore
WHAT IS SWEATY PALMS?
Sweaty palms refer to excessive sweating of the palms and is also known by the medical term Palmar Hyperhidrosis.
People with this problem may also have sweaty armpits and sweaty feet.
Sweaty Palms, armpits and feet are a disorder or disease of the Nerve system of the body specifically the autonomic nervous system. It is best diagnosed and treated by Nervous system specialists such as Neurosurgeons.
WHY DOES SWEATY PALMS OCCUR?
This is not caused by any injury, or eating the wrong food or an infection caught from another person. It is caused by an over activity in a part of the nervous system which starts in childhood. The over activity occurs in part of the brain called the hypothalamus and is transmitted to the hands and the feet through a relay system called the sympathetic nervous system.
WHO GETS SWEATY PALMS?
This condition can occur in anyone. It is more common in certain ethnic groups including Chinese and Israelis. However, it can occur at any age and gender. It usually starts in childhood often becoming more obvious in the teenage years. It can run in families with brothers and sisters sharing the problem. However, the gene is not a strong one and the likelihood of an affected person’s children having the same problem is not high.
HOW IS SWEATY PALMS MEDICALLY TREATED?
Medical treatment for massive sweating consists of agents to dry up the hand and which have to be topically applied. Once such agent is called Aluminium Hydroxide. It is not a cure and has to be used daily. It can be effective for mild sweaty palms but is not so effective for severe sweaty palms. The hands may feel tight after use.
Pills for sweaty palms tend to have side-effects including blurring of vision, dryness of the mouth and difficulty in passing urine. Most doctors do not recommend them. Iontophoresis is an electrical treatment for sweaty palms which can reduce sweating for a few days. The treatment will have to be repeated. It can be useful for students just before their examinations. However it is not a cure for sweaty palms.
CAN SWEATY PALMS BE CURED?
Yes, sweaty palms can be cured by an operation called Mini-Endoscopic Sympathectomy (MES) This is a minimally invasive procedure and has a single small opening about 3mm in size . This operation interrupts the abnormal increased signals to the hands by precisely coagulating with a laser or special superior to laser probe, a nerve relay station called the T2, or T3 ganglion in the sympathetic ganglion. This operation is recommended for those who are genuinely troubled by sweaty palms at work (smudging of papers, slipping of fingers on keyboards or hand held devices and tools and even electrical shocks from appliances and outlets) and socially (shaking hands with others and showing confidence is affected) and who have not found medical treatment useful. MES is the latest method for the minimally invasive treatment of sweaty palms. Older operations include video-endoscopic thoracic sympathectomy (VES, VATS or ETS) which require multiple openings in the chest and open surgery requiring longer incisions such as cervical and trans axillary sympathectomy.
HOW IS THE MES OPERATION DONE?
The operation is done under general anaesthesia. A tiny nick (about 3mm in diameter) is made in each armpit. It is through this nick that the mini-endoscope (similar to a telescope) is introduced. Through the endoscope and a camera generating high quality video images onto a high definition screen the Neurosurgeon locates and lesions the T2 or T3 sympathetic ganglion. Both right and left sides of the sympathetic nerve system are treated to address the sweating of the right and left hands (and armpits where indicated) The surgery for both sides takes approximately 1 hour. At the end of the surgery a single stitch is used to close the nick in the armpit.
HOW LONG DO I HAVE TO STAY IN HOSPITAL?
Generally you come into hospital on the day of surgery. The operation is often done early the next morning and you can be discharged later that same afternoon once you have recovered from the anaesthesia. The other option is to be admitted to Day Surgery in the late morning, have the MES in the afternoon and be discharged the same night.
WHEN CAN I RETURN TO WORK AFTER SURGERY?
You can return to work the next day after surgery if you want to. Your single stitch in each armpit will be removed about 1 week after surgery.
HOW MUCH PAIN AND DISCOMFORT IS THERE AFTER SURGERY?
The incisions in your armpit are very small with this method. Pain and discomfort is therefore very much less than the older methods. Also the very small nick in the armpit leaves an almost inconspicuous scar.
WHAT IS THE SUCCESS RATE FOR MES SURGERY?
The success rate is approximately 98% for MES surgery for sweaty palms.
REFERENCES
1.Protocols of the Singapore Brain Spine Nerves Center for Sweaty Palms Microsurgery
2.Thoracoscopic Sympathectomy for Hyperhidrosis
PK Pillay et al. Stereotact and Functional Neurosurg 1994;63:198-202
3.Protocols of the Dept of Neurosurgery, The Cleveland Clinic Foundation and Hospital, USA
