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Palmoplantar Hyperhidrosis : Causes, Symptoms, Treatment, Complications, Diagnosis

What is Palmoplantar Hyperhidrosis?

Palmoplantar hyperhidrosis is a condition characterized by the excessive sweating of the hands. It is caused due to the heightened activity in the sympathetic nerve chains, part of an autonomous nervous system, which controls the body activities involuntarily. Excessive sweating can be from mild to severe and can be genetic too. Palmoplantar hyperhidrosis or sweaty palms start in early childhood and can become worse during the teenage years or early adulthood. It does not become better with time or with age. Many people with Palmoplantar hyperhidrosis or sweating palms do not derive benefit from the treatment with iontophoresis or medications. The surgical procedure, called thoracic sympathectomy or ETS may be the best option for the treatment of severe palmoplantar hyperhidrosis. Though it is not life-threatening condition, it is uncomfortable and may cause embarrassment and psychological trauma.

What is Palmoplantar Hyperhidrosis?

Symptoms of Palmoplantar Hyperhidrosis

The symptoms of palmoplantar hyperhidrosis include the following:

  • Wet or clammy hand palms
  • Wet or clammy feet soles
  • Frequent swelling
  • Noticeable sweating, which soaks through the clothing
  • Painful and irritating skin problems like bacterial and fungal infections.

Palmoplantar hyperhidrosis or the excessive sweating usually interferes with the day-to-day activities. For instance, the patients having this medical condition have moist and wet hands that interfere with grasping any object. It also leads to the excess sweat of the foot, making the shoes and socks wet and this results in enhanced foot odor.

Causes of Palmoplantar Hyperhidrosis

The primary causes of Palmoplantar hyperhidrosis are more related to nervousness, anxiety and emotional stress. Although neurologic but infectious, endocrine and other diseases may also cause Palmoplantar hyperhidrosis. Emotions and heat may cause it in some people but people experience sweat all the time regardless of the weather or mood.

The secondary causes of Palmoplantar hyperhidrosis are as listed below:

Diagnosis of Palmoplantar Hyperhidrosis

Palmoplantar hyperhidrosis is diagnosed by physical examination of the patient. Initially, the doctor may rule out the underlying conditions like low blood sugar and overactive thyroid. Patients are asked about the sweating patterns, the frequency of the sweating episodes, and whether there is sweating during sleep.

The doctor may ask for a Thermoregulatory sweat test, wherein a powder is applied. When there is excessive sweating at the room temperature, the color of the powder changes. Thereafter, the patient is exposed to high humidity and high heat in the sweat cabinet that triggers sweating in the whole body. When exposed to high heat, people who do not suffer from this disease do not sweat in the palms excessively, however, patients suffering from hyperhidrosis do. This helps the doctor in determining the seriousness of the condition.

Treatment of Palmoplantar Hyperhidrosis

Natural Remedies of Palmoplantar Hyperhidrosis:

Some changes in the lifestyle and daily activities may help in improving the Palmoplantar hyperhidrosis symptoms like:

  • Antiperspirants: Deodorants may not stop sweating; however, antiperspirants sprays may help people suffering from Palmoplantar hyperhidrosis to deal with it naturally. Some of the prescribed antiperspirants are aluminum chloride that may plug out the sweat glands.
  • Armpit Shields: Pads can be worn in armpits for protecting the garment from getting wet.
  • Shoes: Synthetic material shoes can worsen the symptoms and so the natural materials like leather are normally recommended.
  • Clothing: The synthetic fibers in cloth like nylon can worsen the symptoms and so loose cotton clothing is advised.

Socks can absorb the moisture in a better way if made up of natural fibers like cotton.

Other Treatment Procedures for Palmoplantar Hyperhidrosis

Other treatments for Palmoplantar hyperhidrosis depend on how severe is the sweating and whether the earlier treatments have been successful or not. The treatment method for Palmoplantar hyperhidrosis includes:

Topical Treatments for Palmoplantar Hyperhidrosis:

The mild and moderate cases of Palmoplantar hyperhidrosis may respond to the topical treatments like aluminum chloride hexahydrate or Driclor. Driclor should be applied to a dry skin to get the maximum benefit and to reduce the side effects. Ideally, this should be applied after a shower and before bedtime. Dry the area completely and then apply it. In the morning wash your hand with plain water. If you develop irritation, then apply a corticosteroid cream. Anticholinergic creams like glycopyrrolate are effective too. Side effects of these are not common.

Iontophoresis for Treating Palmoplantar Hyperhidrosis:

This is considered for those cases of Palmoplantar hyperhidrosis that do not get a positive result from the topical treatments. The treatments are individualized. The affected area is put in salty water, tap water, and glycopyrrolate solution. Thereafter, a gentle electric current is given to the skin surface for about 10-20 minutes. This treatment for Palmoplantar hyperhidrosis has the highest rate of success. 80% of patients respond very well to the treatment. The time between the treatments varies. Treatments should be repeated within 2-14 days.

Botox Injections:

Botox injections can cure Palmoplantar hyperhidrosis or the sweaty hands effectively and safely. Most of the treatment is performed to block the nerve. 100 botox units approximately are required in every hand. This treatment for Palmoplantar hyperhidrosis remains effective for 3-5 months. There may be temporary side effects like muscle weakness.

Oral Medications for Palmoplantar Hyperhidrosis:

Anticholinergic tablets like propantheline bromide and oxybutynin are useful for treating palmoplantar hyperhidrosis. The side effects like dry mouth, constipation, and drowsiness are quite common. Medications like propranolol, glycopyrrolate, gabapentin, and clonazepam are common. Medications are an option for a short time period.

Surgery for Treating Palmoplantar Hyperhidrosis:

Endoscopic Thoracic Sympathectomy or ETS is the surgical treatment for Palmoplantar hyperhidrosis. It is conducted by a neurosurgeon or vascular surgeon under general anesthesia. Its success rate is quite high but it has quite a high rate of risk of rebound or compensatory sweating. Compensatory sweating happens in the lower back or limbs after the surgery. Before opting for surgery for Palmoplantar hyperhidrosis, you should have an in-depth consultation with the surgeon to understand the risks, benefits and side effects.

Complications of Palmoplantar Hyperhidrosis

When it is not treated properly, then certain complications may arise such as the following:

  • Nail Infections: Nail infections particularly the toenail infections are quite common complications if palmoplantar hyperhidrosis is not treated.
  • Warts: Skin growths due to HPV can also occur as a complication of palmoplantar hyperhidrosis.
  • Bacterial Infections: The bacterial infection between the toes and around the hair follicles is also common.
  • Heat Rash as a Complication of Palmoplantar Hyperhidrosis: Itching skin rash, which causes a prickling or a stinging sensation develops when the sweat ducts are blocked and perspiration gets trapped.
  • Psychological Impact of Palmoplantar Hyperhidrosis: A patient’s job, self-confidence, and relationships are affected due to this condition. Some people become depressed, anxious, socially withdrawn, and emotionally stressed.


Palmoplantar hyperhidrosis may cause embarrassment and discomfort. One may face trouble working or enjoying the recreational activities due to wet feet or hands. They may feel anxious and become self-conscious or withdrawn. So, apart from talking with a doctor, you should consult a medical social worker or a counselor to cope with the psychological impact of the symptoms of palmoplantar hyperhidrosis.


  1. Mayo Clinic. (2021). Hyperhidrosis (Excessive sweating). https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/symptoms-causes/syc-20367152
  2. International Hyperhidrosis Society. (2023). Treatments for Hyperhidrosis. https://sweathelp.org/hyperhidrosis-treatments.html
  3. WebMD. (2021). Palmoplantar Hyperhidrosis: Excessive Sweating of Hands and Feet. https://www.webmd.com/skin-problems-and-treatments/palmoplantar-hyperhidrosis
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 28, 2023

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