From the Research
Hyperhidrosis of the palms is primarily caused by overactivity of the sympathetic nervous system, which triggers excessive stimulation of the eccrine sweat glands, often due to genetic predisposition or secondary causes like hyperthyroidism, diabetes, or anxiety disorders. This condition, known as primary palmar hyperhidrosis, typically begins in childhood or adolescence and involves hypersensitivity of the sweat glands to normal stimuli rather than an anatomical abnormality 1. The sympathetic nervous system normally activates sweating in response to heat, exercise, or emotional stress, but in hyperhidrosis, this response is exaggerated specifically in the palms, leading to persistent dampness that can interfere with daily activities like handshaking, writing, or using electronic devices.
Causes of Palmar Hyperhidrosis
- Genetic predisposition
- Secondary causes like hyperthyroidism, diabetes, menopause, anxiety disorders, or certain medications
- Hypersensitivity of the sweat glands to normal stimuli rather than an anatomical abnormality
Treatment Options
- Topical antiperspirants containing aluminum chloride
- Iontophoresis (which uses mild electrical current)
- Oral anticholinergics like glycopyrrolate
- Botulinum toxin injections
- Endoscopic thoracic sympathectomy surgery in severe cases
The exact mechanism of palmar hyperhidrosis isn't fully understood, but it appears to involve the limbic system, including the amygdala and anterior cingulate cortex, which mediates emotional sweating 2. Studies have shown that patients with limbic encephalitis have diminished emotional sweating on the palms, suggesting the importance of the limbic system in regulating sweating 2. Treatment options should be tailored to the individual patient, taking into account the severity of the condition and the patient's medical history, with topical treatment recommended as first-line treatment for axillary and palmoplantar hyperhidrosis 1.