For symptomatic treatment, many commercial topical applications are available. Most of them contain aluminum salts . Drysol and Hydrosal gel are the most commonly employed "medical grade" antiperspirants, and they should be applied at night before bed to completely dry palms. These medications act by blocking the openings of the sweat ducts. Skin irritation from aluminum salts is most common in the axillae, and uncommon on the palms.
Iontophoresis causes blockage of the sweat duct at the level of the stratum corneum by directing a mild electrical current through the skin. Although iontophoresis with plain tap water is relatively free of side effects, the necessity for repetitive frequent treatments is a drawback. Treatment can be made more effective by the addition of aluminum chloride or glycopyrronium bromide . For hyperhidrosis of palms or soles, the success rate is in the 80% range.
Systemic anticholinergics, such as glycopyrrolate and oxybutynin have been used with variable improvement in patients with hyperhidrosis . Unpleasant adverse effects include dryness of mouth, blurring of vision, dizziness, constipation, and urinary retention.
Injection of botulinum toxin A or B into the palms has been shown to be effective and safe for the treatment of palmer hyperhidrosis [3,8]. Botulinum toxins work by blocking the presynaptic release of acetylcholine. Side effects include pain at the injection site, dry skin, hematoma, and transient handgrip strength reduction, all of which are temporary . Duration of effect is typically around 6 months. Botulinum toxin treatment can be expensive, and some private insurance plans pay for the treatment.
Endoscopic thoracic sympathectomy may be considered for the rare patient with intractable palmar hyperhidrosis resistant to conservative measures . Video-assisted endoscopic thoracic sympathectomy further improves the success rate with low recurrence . Sympathectomy abolishes eccrine sweating in all areas supplied by the postganglionic fibers. Complications include wound infection, hemorrhage, pneumothorax, recurrent laryngeal nerve palsy, brachial plexus injuries, post-sympathetic neuralgia, Horner's syndrome, gustatory sweating, and compensatory hyperhidrosis in non-denervated areas .