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Palmar and plantar HH

By Dr Davin Lim
Laser and Aesthetic Dermatologist
HH expert

Treating sweaty hands and feet is difficult, and there is no easy solution. The most successful treatment is called Glycopyrrolate Iontophoresis using a reliable iontophoresis machine and a consistent Glycopyrrolate solution.

Glyco - ionto uses a solution that you soak your hand and or feet in. A current draws the glycopyrrolate solution (this is an antisweating solution that stops your sweat glands from producing sweat) into the eccrine units of your hands- feet. Here are some facts on Iontophoresis-

  • Direct or Pulse current can be used to deliver ions to the eccrine or sweat glands
  • Pulse current or PS is more comfortable than direct current, but both are equal in efficacy.
  • Tap water iontophoresis can be effective in 30% of patients. Brisbane water is not ion rich, so adding a teaspoon of salt can make this treatment more effective.
  • Glycopyrrolate iontophoresis can be effective in up to 90% of patients
  • This process needs to be repeated every 3-14 days- yes variability is marked!!!
  • Each treatment session takes between 8-20 minutes, depending if hands and or feet are treated
  • Side effects are rare, but include temporary dry mouth and blurred vision
  • Using a good unit such as the Idromed 5 PS will give you EXACT parameters so that future treatments can be replicated.
  • This treatment is extremely variable. Some patients get over 2 weeks relief with one 10 minute treatment, others only 2-3 days.
  • We advise a trial of the Glyco- Ionto before embarking on purchasing a machine.

So, what about sweat reduction injections and sweaty hands and feet? sweat reduction injections are great, however there is one prohibitive fact that limits its use – the costs. Unlike treating sweaty underarms where there is a Medicare and PBS item rebate (patients only pay $440 for the treatment), Dermal fillers for hands and feet are NOT covered under Medicare. Treating both hands cost $2500 and may only last 3-4 months. IMO this is not the treatment of choice (due to the costs). Pain is not an issue, as I always use a super strong gel together with nerve blocks and ice. Cost is the rate limiting fact.

This leaves us with surgery- surgery can be very effective in treating palmar HH or sweaty hands. The success rate is up to 95%, however there is a catch. More than 50% of patients can develop compensatory HH or sweating elsewhere. This is unpredictable and can range from mild to severe. This treatment is the very last resort.

What about miraDry? This can only be used for underarm treatments, and not sweaty hand – feet.

What machine do we advocate for Iontophoresis? There are only two brand that hospitals use- Fischer MD2 units and the Idromed 5 PS. We prefer the Idromed because it is more user friendly, and delivers pulse current. PS or pulse current delivers current that is more ‘gentle’, so children (and adults) do not feel the current or shock, compared to traditional direct current.

Sweat Free is currently selling the Idromed 5 PS at wholesale pricing on eBay Australia.

More information on iontophoresis and sweating

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