Treating excessive sweating hands with injections
Excessive sweating of the hands, also called palmar hyperhidrosis, is a common problem, which is quite disturbing to the sufferer. Those affected complain that their jobs are affected, they hate shaking hands, and that it is really embarrassing.
Sometimes excessive sweating is genetic, and will run in a family.
Small injections with a very fine needle are used to resolve the excessive sweating problem.
The consultation for excessive sweating assessment
History-taking is very important in the treatment of excessive sweating. The following should be explored:
Is there a genetic component? ie are there others in the family who have excessive sweating?
Has the patient had treatment before?
Were they happy with treatment every time?
Did the effect of toxin injections last well?
Which area came back first?
Which areas of the body are affected by excessive sweating?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Are there any other areas of excessive sweating, including back, underarms or feet.
Have they every had any complications with injections for excessive sweating before eg muscle weakness or perceived increase in sweating elsewhere.
What is the patient’s occupation and hobbies, the potential complication of muscle weakness in the hands needs to be discussed.
The doctor may decide to do an iodine starch test, where she will first wipe the affected area with betadine wipes and then pour some cornstarch powder in the area. This will show exactly where the sweating problem exists.
Choosing the dose for excessive sweating
The doctor will assess the sweating and decide on the best dose after taking a history and examining the patient. In particular discussing with the patient re their budget.
There are a couple of options for dosage for excessive sweating of the hands. A larger or smaller dose may be chosen, the difference will be the longevity that is obtained.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
In general, we recommend the higher dose treatment.
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) will be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Ice is always used to decrease pain and to reduce the risk of bruising.
Patients may use Penthrox for excessive sweating treatments
Nitrous oxide (Happy Gas) is available for use for injections for excessive sweating of the hands.
What happens during the excessive hand sweating treatment itself?
EMLA can be applied to the underarm and covered with gladwrap for 45 mins prior to the procedure
The area will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject multiple sites in the palm of the hand and along the fingers in a grid-like pattern. Then pressure with gauze will be applied.
The procedure itself takes less than 20 minutes.
How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Risks with Excessive Sweating Injections
In general, treatment of excessive sweating is very low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: One side may be better treated than the other, this is usually because the patient has asymmetrical sweating to start with..
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
There is a low risk of muscle strength being affected in the hands. This is important if the patient’s occupation could be affected (eg musician)
There is a possibility of a perceived increase in sweating in other areas of the body.
Who is unsuitable for treatment of excessive sweating?
Most people with a excessive sweating are suitable for this treatment.
Instructions for care afterward
No heavy exercise that day.
What to expect after excessive sweating of hands treatment?
The effect will not start to occur for 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked if required for 4 weeks. If at that time, further treatment is necessary, it should be performed. The starch iodine test may be necessary.
What if I get asymmetry of sweating or I am still sweating at some time before the 4 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry.
What do I do if at 4 weeks post treatment one side is better treated than the other?
At your 4 week review appointment, this will be investigated and further treatment may be administered.
How long will the treatment last
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
At a higher dose, some patients may get 8 months to 1 year out of the treatment.
At a smaller dose, re-treatment may be required several months earlier than above.
When should I have my next treatment for excessive sweating
When the sweating recurs or at 1 year, whichever occurs first.
How much does it cost for excessive sweating of the hands