From the Research
The first line of treatment for excessive sweating in the hands and soles (palmoplantar hyperhidrosis) is typically topical antiperspirants containing aluminum chloride hexahydrate, such as Drysol or Certain Dri (20-25% concentration). Apply these products to completely dry skin at bedtime, then wash off in the morning. Start with applications 2-3 times weekly, then reduce frequency as sweating improves. Cover treated areas with plastic wrap overnight to enhance effectiveness. If skin irritation occurs, use hydrocortisone cream and temporarily reduce application frequency. These antiperspirants work by forming plugs in the sweat gland ducts and causing atrophy of secretory cells. For many patients, this approach provides significant relief without requiring more invasive treatments. If topical antiperspirants prove ineffective after 1-2 months of consistent use, second-line options include iontophoresis (using electrical current to temporarily block sweat glands), oral anticholinergic medications, botulinum toxin injections, or referral to a dermatologist for consideration of these alternatives, as supported by studies such as 1.
Some key points to consider when treating palmoplantar hyperhidrosis include:
- Topical aluminum chloride solution is the initial treatment in most cases of primary focal hyperhidrosis, as stated in 2 and 1.
- Iontophoresis is considered a second- or third-line therapy for palmoplantar hyperhidrosis, with efficacy supported by studies such as 3 and 4.
- Botulinum toxin injections are considered a second- or fourth-line treatment for palmoplantar hyperhidrosis, with efficacy and duration of effect supported by studies such as 5.
- Oral anticholinergics, such as glycopyrrolate, may be useful adjuncts in severe cases of hyperhidrosis when other treatments fail, as mentioned in 2 and 1.
Overall, the treatment of palmoplantar hyperhidrosis should be individualized based on the severity of symptoms, patient preferences, and response to initial therapies.