What causes clammy hands?

Causes of Clammy Hands

The primary cause of clammy hands is hyperhidrosis, which affects approximately 2.8% of the US population and is characterized by excessive sweating beyond what is needed for normal thermoregulation. 1

Primary Hyperhidrosis

Primary hyperhidrosis is the most common cause of clammy hands, characterized by:

• Excessive sweating that is usually bilateral, symmetric, and focal, commonly affecting palms, soles, and axillae 1
• Overproduction of sweat by eccrine sweat glands without an underlying medical condition 2
• Possible central abnormality in the hypothalamic sweat center that controls the palms, axillae, and soles 3
• Often begins in adolescence and can persist throughout life 4
• Frequently triggered by emotional stimuli (stress, anxiety) or heat 3

Secondary Causes of Clammy Hands

Secondary causes must be ruled out before diagnosing primary hyperhidrosis:

• Underlying medical conditions:

  • Hyperthyroidism 2
  • Pheochromocytoma 2
  • Myeloproliferative disorders (e.g., essential thrombocythemia, polycythemia rubra vera) 5
  • Autoimmune conditions 5
  • Small and large fiber neuropathy (found in almost 50% of patients with erythromelalgia, which can present with hot, red hands) 5

• Medication-related causes:

  • Certain anticancer agents can cause palmar-plantar erythrodysaesthesia syndrome (PPES) 5
  • Common culprits include 5-fluorouracil (6%-34%), capecitabine (50%-60%), doxorubicin (22%-29%) 5
  • BRAF inhibitors (vemurafenib, dabrafenib, encorafenib) can cause palmoplantar keratoderma 5
  • Multikinase VEGFR inhibitors (sorafenib, cabozantinib, sunitinib, regorafenib) 5

Environmental and Behavioral Factors

Environmental and behavioral factors that can exacerbate clammy hands include:

• Frequent hand washing with detergents and hot water, which damages the skin barrier 5, 6
• Use of irritating soaps containing iodophors, antimicrobial ingredients (chlorhexidine, chloroxylenol, triclosan) 5
• Alcohol-based products without moisturizers 5
• Hot water exposure, which increases sweating 6
• Occlusive glove wearing without underlying moisturizer application 5
• Emotional stress and anxiety, which activate sympathetic nervous system 3

Dermatitis and Skin Barrier Dysfunction

Skin barrier dysfunction can contribute to clammy hands:

• Irritant contact dermatitis (ICD), which accounts for 80% of occupational skin diseases 5
• Allergic contact dermatitis (ACD) from preservatives, surfactants, and antimicrobial ingredients 5
• Chemical and physical irritants that cause keratinocyte release of proinflammatory cytokines 5
• Detergent-based substances that reduce moisture in the stratum corneum and strip away protective lipids 5
• Lipid-emulsifying detergents and lipid-dissolving alcohols causing acute loss of surface lipids 5

Common Pitfalls in Management

When managing clammy hands, avoid these common pitfalls:

• Using disinfectant wipes containing harsh ingredients like N-alkyl dimethyl benzyl ammonium chloride for hand cleaning 5
• Excessive cooling with ice or cold water immersion, which can lead to tissue damage and ulcerations 5
• Using powerful fans continuously near extremities, which can cause windburn-like effects 5
• Applying gloves when hands are still wet from hand washing or sanitizer 6
• Using very hot water for hand washing, which damages skin barrier 6
• Increased duration of glove occlusion without underlying moisturizer 6

Treatment Approaches

For those seeking to manage clammy hands, treatment options include:

• Topical treatments:

  • Aluminum chloride applications for axillary hyperhidrosis 2
  • Moisturizers immediately after hand washing 6
  • Barrier creams (humectants) 6

• Procedural treatments:

  • Tap water iontophoresis for palmoplantar hyperhidrosis 2, 4
  • Botulinum toxin injections, which provide efficacy for 3-9 months 2, 7
  • Surgical options (curettage, liposuction for axillary hyperhidrosis; sympathectomy for palmar hyperhidrosis) when conservative methods fail 2, 4

• Systemic treatments:

  • Anticholinergic medications like glycopyrrolate (1-2 mg once or twice daily) 7
  • Clonidine (0.1 mg twice daily) as an alternative 7