Sweaty palms

Angiologists are often presented with sweaty palm and feet problem.

Sweaty palms and feet are a dominant sweat disability.


Sweaty palms and feet are a dominant sweat disability.
Medically termed Hyperhidrosis, excessive sweating is the result of over activity of sweat glands. It is quoted as occurring for feet in 12% and 1% for palms of the population aged over 15 years. It appears to be equal between the sexes. Though benign, hyperhidrosis presents the patient with significant psychological and social concerns.

There are two classical types:

The first type,
usually nocturnal, is secondary to some internal pathology.

This type of hyperhidrosis must be carefully ruled out prior to arriving at a diagnosis of primary hyperhidrosis because it is commonly associated with an underlying medical problem or use of certain medications.
While secondary hyperhidrosis may present as localized, it is often characterized by a more generalized pattern of sweating that occurs during both daytime and nighttime hours.


The second type, is more often primary and emotional.

This condition is the cause of much embracement both socially and professionally : in particular in those who daily handle sheets of paper (secretaries, schoolchildren, designers, architects...) or hold solid objects in their hands (gymnasts, tennis players...). Micro technical industries (watchmakers, precision instrument manipulators) are also concerned as the sweat from the workers can oxidize the metallic parts they handle.
These persons change their clothes several times a day because of large perspiration stains, or avoided shaking hands or touching their friends because their palms were always moist. They could also stop playing music because the excessive moisture on their hands damaged the strings of their instrument.
Furthermore, excess sweating of the feet is often associated with an unpleasant smell, maceration of the toes and web spaces, with, as a result, bacterial and fungus infections, plantar warts by sweat environment.
 
Angiologists are often presented with sweaty palm and feet problem.
Most patients have the hyperhidrosis localized to their hands and feet.

Although thoracoscopic sympathectic trunkotomy and botulinum toxin injections may be effective, they can produce serious side effects, some of which may be irreversible. Surgery is only rarely necessary, and there are numerous surgical pitfalls, which include recurrence of hyperhidrosis, almost certain impotence, compensatory sweating, permanent neurological damage from anoxia, and worst. Botulinum toxin, which is recommend requires 24-36 painful injections per foot or hand and can produce also serious effects as muscle weakness. Even this horrendous procedure gives only 11 months' relief, and antibody formation may reduce long term efficiency. The cost of BTX therapy is approximately $700 to $1,000 per course of treatment.

Iontophoresis is easy to perform, cheap, effective in many, free of hazardous side effects, and well accepted by almost all patients.
The equipment consists of batteries device that supplies the current, it allow variability in the intensity of the current from 0 to 20 mA, plastics trays in which are placed two electrodes covered by grids, also in plastic, to prevent direct contact of the skin with the electrodes. The hands or feet in the trays are partly submerged in warm water through which a mild electric current is run. The treatment can be carried out in two anatomical areas simultaneously. At the start the intensity is slowly increased. This intensity is applied for 20mn.
The patient is asked to remove all metallic objects (rings, chains, bracelets...) and to keep the treated parts still and submerged throughout the treatment; a sudden withdrawal from the water would beak the circuit resulting in a most unpleasant but harmless electrical discharge. The frequency of treatments, first week treatments on D1, D2 & D4 (D1= 1st treatment day), second week treatments on D7 & D10, third week treatment on D15, fourth week treatment on D22, in practice, an almost complete session of sweating can be achieved after the fourth treatment.
After the seventh treatment session, further sessions will only be needed if sweating restarts, as a form of maintenance therapy and therefore infrequently.

Contra-indications to this treatment are pregnancy, cardiac pacemakers, and metal orthopaedic implants.