Primary palm and sole (palmoplantar) hyperhidrosis

If initial treatment with an antiperspirant is not successful for primary palmoplantar hyperhidrosis, consider referring to a dermatologist who provides iontophoresis treatment with tap water or an anticholinergic drug (eg glycopyrronium [glycopyrrolate]).

The mechanism by which iontophoresis reduces sweating is not known. Hands and feet are placed on moistened pads in the iontophoresis unit for 15 to 30 minutes. Batteries generate a low electrical current to stimulate ions to migrate across the skin barrier to the opposite sign electrode. Tap water iontophoresis initially needs to be used daily, but with time a single treatment may be effective for 1 to 2 weeks.

Iontophoresis is contraindicated in patients with pacemakers or other implanted electrical devices, or metal implants.

Patient response to iontophoresis treatment, and cost of iontophoresis home units varies; patients may prefer to trial the treatment at a specialised dermatology clinic (if possible) before purchasing an iontophoresis home unit.

Botulinum toxin injections are not routinely used for primary palmoplantar hyperhidrosis because of the significant cost and pain of injections.

If all treatments for primary palmoplantar hyperhidrosis fail, surgical sympathectomy may be considered as a last resort; however, this procedure is associated with a high risk of recurrent focal hyperhidrosis and compensatory sweating in previously unaffected areas.