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POLL: What Is Your Go-to Treatment for Severe Palmar Hyperhidrosis?


Botox? Iontophoresis? Let us know what you most often recommend to your patients with severe palmar hyperhidrosis.



What is your go-to treatment for severe palmar hyperhidrosis?

Off-label topicals
Systemic anticholinergics

A recent study study aimed to assess the efficacy and safety of Botulinum toxin type A (BTX-A; Botox) in treating this condition. The research, following PRISMA guidelines, reviewed 6 studies encompassing open-label, controlled trial, double-blind placebo-controlled, and observational designs. The results consistently indicated that BTX-A effectively reduced symptoms of hyperhidrosis with no significant side effects. The treatment significantly improved QoL, decreased sweat rate and production, and did not adversely affect grip strength. Additionally, the prolonged antisudorific effect suggested the potential for long-term management of palmar hyperhidrosis with BTX-A.1

However, this treatment may not be effective in many cases.

Other treatment options, including topical agents, medical devices, systemic therapies, and surgical interventions, are available for palmar hyperhidrosis, given its significant impact on quality of life. Nonsurgical approaches, such as topical antiperspirants, iontophoresis, and systemic agents, are supported by current literature, with topical therapies often beneficial for mild to moderate cases.

As the disease severity increases, systemic oral medication, like anticholinergic drugs, may become necessary, and surgical approaches are considered last-line for severe refractory cases. Recent therapeutic advancements are emerging as promising alternatives in clinical trials. However, the selection of treatment modalities should consider disease severity, benefit-to-risk profile, cost, patient preference, and clinician expertise, with the review providing insights to help clinicians optimize decision-making in managing excessive hand sweating.2

Do you use all or any of these in combination? We want to know. Email us at DTEditor@mmhgroup.com.


1. Rashaan R, Arkoumanis PT. The efficacy of Botulinum Toxin A in treating palmar hyperhidrosis - a literature review. Maedica (Bucur). 2023;18(4):712-717. doi:10.26574/maedica.2023.18.4.712

2. Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management strategies of palmar hyperhidrosis: challenges and solutions. Clin Cosmet Investig Dermatol. 2019;12:733-744. Published 2019 Oct 4. doi:10.2147/CCID.S210973

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