Palmar hyperhidrosis is a violation of the functioning of the eccrine sweat glands located in the skin of the palm surfaces of the hands, which is accompanied by increased sweating. Constantly cold, wet hands disrupt the social interaction of people, in severe cases they become an obstacle to mastering a number of professions. The diagnosis is established on the basis of anamnesis, general examination data, and diagnostic test results. Medical tactics, depending on the severity of symptoms, include the use of antiperspirants, physiotherapy, injections of botulinum toxin type A. If conservative methods of treatment do not give results, an operation is performed.
61.0 Localized hyperhidrosis
The term “hyperhidrosis” literally translates as “increased water release”. Normally, 5-6 mg / cm2 of water per second evaporates through the skin, with pathology ‒ up to 150-200 mg / cm2 per second. In the scientific literature, the term “palmar hyperhidrosis” (hyperhidrosis palmaris) is used to define the disease. Excessive sweating of the hands affects 3% of the world’s population. Pathology is diagnosed equally often in men and women. The incidence of primary palmar hyperhidrosis is 1%. The onset of the disease occurs in childhood. Adolescents and menopausal women have a significant increase in symptoms. 40% of patients have relatives suffering from increased sweating of the skin of the hands.
The functioning of the sweat glands is subject to the influence of various external and internal factors. Establishing the cause of excessive sweating of the hands allows you to choose the most optimal method of treatment, to avoid relapses. Without this, symptomatic therapy can be carried out for life without significant improvement in the condition. The most significant factors in the etiology of the disease are the following:
- Genetic features. Heredity determines the development of both primary and secondary hyperhidrosis. In the first case, genes determine the development of an excessive number of eccrine glands in certain areas of the body, increased sensitivity of sweat glands to nervous stimulation. In the second case, a person inherits a tendency to develop local hyperhidrosis under the influence of provoking factors (metabolic disorders, intoxication).
- Dysfunction of nerve centers. The most important is the change in the activity of the thermoregulation center. It is responsible for the temperature of the skin, the rate of perspiration. There is dysfunction in neurocirculatory dystonia, neurosis, organic brain damage. To identify a specific cause and prescribe treatment, a neurologist’s consultation is necessary.
- Hormonal imbalance. A change in hormone levels in adolescence, menopause provokes an increase in the symptoms of primary local hyperhidrosis. Hormonal imbalance can serve as a trigger for the development of a secondary pathological process. Of paramount importance is the disruption of the thyroid, pancreas (diabetes mellitus), and sex glands.
- Dermatological problems. Diseases such as vitiligo, psoriasis, blue nevus can change the normal level of sweating of the hands. In psoriasis, the level of sweating may increase during the exacerbation of the underlying disease and decrease to normal values when the patient goes into remission. As a concomitant syndrome, wet palms are described in Touraine polyceratosis.
Manifestations of palmar hyperhidrosis can significantly increase under the influence of stress, when eating spices, onions, garlic, other irritating substances, at high ambient temperature. This reaction is especially pronounced in patients in whom, in a calm state, the secretion of sweat on the palms practically does not differ from normal values.
A key role in the development of primary hyperhidrosis is played by the insufficiency of peripheral sympathetic mechanisms of regulation of sweating. The use of special research methods that allow selectively analyzing segmental mechanisms of functioning of the autonomic nervous system made it possible to establish the insufficiency of sympathetic regulation of vascular and motor activity. Patients develop the phenomenon of postdenervation hypersensitivity to endogenous catecholamines. This phenomenon explains the presence of the patient’s constantly cold skin of the hands, as well as increased sensitivity to the action of adrenaline and norepinephrine. A jump in the level of catecholamines in the blood causes a noticeable increase in symptoms.
Isolated palmar hyperhidrosis, along with increased sweating of the face, armpits, feet is a local manifestation of the pathological process. Depending on the leading cause of the pathology , there are:
- Primary (essential, idiopathic) Palmar hyperhidrosis. It is characterized by an increase in the number of sweat glands per unit area of the skin, an increase in their reactivity to nerve impulses of ordinary strength. Genetic predisposition plays an important role, so the first signs of the disease are noted in infancy. Hormonal imbalance, strong emotional shock, severe diseases, injuries contribute to a stable increase in sweating.
- Secondary palmar hyperhidrosis. A consequence of a number of diseases of somatic, neurological nature (polyneuropathy, pathology of the endocrine glands, Raynaud’s syndrome, dysfunction of the thermoregulation center in vegetative-vascular dystonia, erythromelalgia, syringomyelia). Sweating of the hands develops in adulthood, decreases to normal during remission of the underlying disease.
In the practice of a dermatologist, the type of hyperhidrosis and the severity of symptoms play an important role in prescribing a suitable treatment method. The leading criterion for determining the severity of the disease is the amount of fluid secreted by the skin:
- Slightly moist palms. Sweating of the hands is not much different from that in the norm. Excessive sweating increases in response to strong emotions. The disease practically does not disrupt the patient’s daily life, does not affect his ability to work, social adaptation.
- Constantly wet, cold hands. There is a need to constantly use a towel or a handkerchief. There is tension in communication, especially when shaking hands, other types of physical contacts. There are difficulties when working with papers, small objects.
- Cold hands with drops of sweat. Drops are constantly formed on the surface of the skin, drain. All objects that a person comes into contact with get wet or become slippery. There are difficulties with mastering a number of professions. Isolation from society is often observed, depression develops.
- Cold hands with dripping sweat. Extreme severity of pathology. This condition is not life-threatening, but the patient’s quality of life is drastically reduced. When examined, sweat flows abundantly from the surface of the skin in large drops. Professional realization and social adaptation are disrupted.
The patient’s hands are cold to the touch, moist. The amount of perspiration produced varies widely. The skin of the palms is noticeably pink, the lines and furrows are deep, clear. Sweating manifests itself during wakefulness, completely disappears at night during sleep. Moisture has to be constantly wiped with a napkin or towel. Gloves and mittens get wet quickly. Wet spots remain on paper, textiles, and other surrounding objects. The first thing that patients with this problem note is communication difficulties. Difficulties arise when it is necessary to reach out for a handshake, with close people who want close physical contact. Slow dancing, intimate interaction, sex become a cause of stress for both partners, no matter how trusting the relationship is.
Difficulties are caused by manipulating various tools. The surface of objects is moistened, becomes slippery. This makes it impossible to play the guitar, other musical instruments, complicates the process of writing, working at the computer, increases the risk of injury with sports equipment such as dumbbells, barbells, rackets, balls, training on bars, rings. For people with palmar hyperhidrosis, the road is “closed” to jewelers, dentists, seamstresses, and many other professions where it is impossible to do without the use of small metal tools.
According to the American Academy of Dermatology, a violation of socialization is observed in 80% of patients with idiopathic hyperhidrosis. First of all, this is typical for teenagers, when it is important for a young person to accept peers, establish relationships with representatives of their own and the opposite sex. Every second such patient is forced to seek help from a psychotherapist to overcome difficulties in communicating with people, to stop the manifestations of depression with the help of antidepressants. In case of significant severity of symptoms, patients with secondary hyperhidrosis may be forced to change their profession and, in many ways, their habitual lifestyle.
At the initial appeal to the dermatologist about the “pouring” sweat from the palms, the patient may be assigned a list of laboratory and instrumental studies. The purpose of the extended diagnosis is to confirm the presence of local excessive sweating of the palms of the patient, to identify diseases that can cause the development of palmar hyperhidrosis. Tests are performed to confirm the diagnosis:
- A Minor sample. The peculiarity of palmar hyperhidrosis is its limited nature. The pathological change affects a strictly defined area of the skin with clear boundaries. The test is carried out as follows: a Lugol solution is applied to the skin, and when it dries, the problem area is powdered with starch. Actively released sweat moistens starch and causes its active staining with iodine.
- Gravimetric method. It is used to determine the amount of liquid released per unit of time. To do this, filter paper is placed on the palm of the patient, which is pre-weighed. After the time has elapsed, the paper soaked in sweat is re-weighed.
The list of diagnostic tests to exclude secondary hyperhidrosis is determined by the attending physician. The age of the appearance of excessive sweating, acute and existing chronic diseases, and other factors are taken into account. In addition to the dermatovenerologist, doctors of other specialties can be involved in the diagnosis: endocrinologist, neurologist, therapist, psychotherapist / psychiatrist, hematologist, oncologist.
It is better to entrust the choice of the most effective method of treatment to a dermatocosmetologist – this will allow you to get the result much faster than by trial and error. You should start with the simplest and most accessible means. Surgical operation is prescribed only if no other methods have improved the person’s condition. Treatment of hyperhidrosis can be carried out in the following ways:
- The use of antiperspirants. Conventional hygienic or medical antiperspirants based on aluminum hexachlorohydrate can be used. The limitation of the method is the presence of cuts and abrasions on the skin of the palms. A sufficient effect can be obtained with moderate palmar hyperhidrosis. The low effectiveness of drugs for topical use with a pronounced degree of palmar hyperhidrosis is explained by the fact that the active substance that should get into the pores is simply washed off by the protruding sweat.
- Botulinum toxin injections. Botulinum therapy used in injectable cosmetology effectively combats excessive sweating. The effect of one procedure can last up to six months. The limitation is the high cost of injections, since about 120 units of the drug are needed per palm.
- Iontophoresis. A physiotherapy procedure that is carried out both in medical institutions and at home with the necessary equipment. The course of procedures is able to normalize sweating of problem areas for up to 6 months. Maintenance procedures must be performed periodically. This is the simplest, most effective and affordable method of treatment.
Neurosurgical sympathectomy. During sympathectomy, nerve fibers are crossed or clipped, along which impulses go to the sweat glands of the palms. Already on the operating table, the patient’s hands become warm and dry. Complications of the operation: Horner’s syndrome, damage to the pleura and lung tissue with the development of pneumothorax, damage to motor nerves with impaired limb mobility. In 64% of cases, compensatory hyperhidrosis of the back, chest, head and other parts of the body develops after surgery. The degree of severity of the compensatory reaction may be such that it is necessary to perform a repeat operation and remove the clips placed on the nerve trunks of the upper extremities.
Prognosis and prevention
In the case of secondary hyperhidrosis, it is possible to achieve a noticeable improvement in the condition during the treatment of the disease that caused the development of excessive sweating of the palms. The primary pathological process will not be completely cured. All therapies are symptomatic. With their help, you can stop local manifestations, normalize a person’s work and social life. Methods of disease prevention have not been developed. There are a number of recommendations aimed at preventing increased sweating in the palms. These include the refusal to wear gloves in the warm season, conducting thermal physiotherapy on the problem area, using cosmetics with oils and petroleum jelly.