My daughter struggles with hyperhidrosis of the hands and is extremely self conscious. What treatment options exist?

We've considered surgery on the sympathetic nerve, but I want to know if an effective alternative exists. Prescription med and topical antiperspirant didn't work. Miradry? Off label laser? Botox?

Doctor Answers 14

Treatment options for hyperhidrosis of the palms - Williamsville, NY

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Thank you for your post.

I developed the Center for Excessive Sweating in 1999 for adults and pediatric patients with hyperhidrosis. We provide every treatment for hyperhidrosis that has been described.

You have many options for the treatment of palmar hyperhidrosis and I recommend that you read my ebook about palmoplantar hyperhidrosis. It is a FREE access ebook provided on the ebook section of the link below.

If topical fails, e.g. Hypercare, consider oral anticholinergic medication under the guidance of her pediatrician. This may be helpful in reducing the severity of the hyperhidrosis.

Iontophoresis is tedious but sometimes helps patients with palmar or plantar hyperhidrosis. 

Botox is another good option and we use this routinely in pediatric and adult patients in our Center.

I have performed many micr ETS procedures and this should be the last resort procedure.

The good news is that there are several companies that are investigating the use of miraDry like devices for the palms and feet. They should be FDA cleared in the next several years.

Dr Karamanoukian
Center for Excessive Sweating

Botox can help

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Nerve blocks and then Botox applications can help with hyperhidrosis of the hands and palms
Medications and topical agents can help also

My daughter struggles with hyperhidrosis of the hands and is extremely self conscious. What treatment options exist?

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Botox is a very effective treatment in those areas and can provide months of relief.

Kenneth Hughes, MD

Beverly Hills, CA

Excess sweating of the palms

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Botox can be used to treated excess sweating in many areas, including the area you've mentioned. You should consult with a qualified derm or plastic surgeon who has experience in this condition. Expect a little over 6 months out of every treatment. Most patients who have it are very satisfied in our practice.  There is also surgery to reduce the sweating, but most patient try Botox first.

Hyperhydrosis of the hands

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Botox injections are the only currently available product for sweaty palms.  Miradry is currently approved for permanent elimination of sweat and odor glands in the underarms but they may be coming out with a new applicator for other areas.
My best,
Sheila Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews


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Thanks for your question. This is a question that we get asked often by our patients. When Botulinum Toxin is injected into certain areas of the body, it blocks a neurotransmitter that is responsible for triggering the sweating response in the treatment area. The most common SIDE-EFFECTS include: Swelling, Redness, and Bruising at the site of injection. Duration of the effect is usually six to eight months, with 25% of patients achieving reduction of sweating for over one year. 91% of Botox patients achieve at least a 50% reduction in axillary sweating, measured 4 weeks post injection. Reduction in sweating may begin as soon as the first day, but the full effect will take up to two weeks after the injections. If the desired effect is not achieved, a touch-up treatment may be necessary. Occasionally, in a very small number of people, the injection does not work as satisfactorily or for as long as expected. In some cases, there is no improvement and another form of treatment may be required (1-2% do not respond at all). Over time, some patients (3-5%) may develop resistance to repeated uses of toxin injection or the effect may not last as long as previous treatments.

These are advanced techniques so be sure to get an experienced cosmetic dermatologist consultation for recommendations and treatment options.

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
4.9 out of 5 stars 16 reviews

See article below

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ETS is the last resort, it works well but there is a chance of permanent compensatory HH. BOTOX is excellent, however cost can be an issue. If your insurance covers it, go for it. 

Other treatments include iontophoresis with or without anticholinergics such as glycopyrrolate. 

All the best

Dr Davin Lim 
Laser and aesthetic dermatologist

Hyperhidrosis of the hands

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Botox injections are excellent for hyperhidrosis of the hands. I would also look out for new technology similar to Miradry for the hands. 

Dr. Karamanoukian 
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Sweaty hands

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Robinul will decrease sweating globally and Botox will decrease it just in the hands where it is injected. Both require up keep and none are permanent cures.

Her age and how she uses her hands will factor into a decision. Is there an anxiety component - If so can it be addressed? 

Estee Williams, MD
New York Dermatologist
5.0 out of 5 stars 23 reviews

Prescription vs botox

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 Thank you for your question. I would recommend that you visit with the dermatologist who deals with hyperhidrosis. They can prescribe medications that might be able to reduce the amount of palmer hyperhidrosis that your daughter experiences. If this is well-tolerated, then I would continue with this treatment. Otherwise your other alternative for treating this area is Botox if you want to avoid surgery. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.