From the Research
The first line of treatment for excessive sweating in the hands and soles (palmoplantar hyperhidrosis) is topical antiperspirants containing aluminum chloride hexahydrate, typically at concentrations of 10-20%. These should be applied to dry skin at night when sweat production is lower, left on for 6-8 hours, and washed off in the morning. Treatment should be continued nightly until sweating is controlled, then reduced to 1-2 times weekly for maintenance. Aluminum salts work by physically blocking sweat ducts and causing atrophy of secretory cells in the eccrine glands.
Key Points to Consider
- If aluminum chloride is ineffective, iontophoresis (using electrical current to temporarily block sweat glands) would be the next step, followed by oral anticholinergics like glycopyrrolate 1, 2, 3.
- Botulinum toxin injections (option A) are considered a second or third-line treatment due to cost, need for repeated treatments, and pain associated with multiple injections 4, 5.
- Sympathectomy (option B) is a last resort due to its invasiveness and risk of compensatory hyperhidrosis 1, 2, 3.
- Cholinergic drugs (option C) would worsen sweating, and sweat gland ablation (option D) is rarely used 1, 2, 3.
Treatment Approach
The treatment approach for palmoplantar hyperhidrosis should prioritize the least invasive and most effective options first, reserving more invasive procedures for cases where initial treatments fail. This approach is supported by the most recent and highest quality studies, which emphasize the importance of a stepwise treatment strategy 3.