Palmar hyperhidrosis is a peculiar condition characterized by excessive sweating of the hands, in most cases combined with severe sweating of the feet, and is therefore often referred to as palmo-plantar hyperhidrosis.
The degree of sweating varies and may range from moderate moisture to dripping, it may be a constant condition (ceasing only while sleeping or at rest) or appear, quite suddenly, under certain circumstances.
It may be triggered by high outside temperatures or emotional stress, but it can also appear without any obvious reason. Generally, it worsens during the warm season and improves somewhat under cold weather conditions. Most patients notice that their hands not only become moist/wet, but also cold, the reason for this being twofold: the evaporating sweat withdraws heat energy from the underlying skin surface and the overactive sympathetic nervous system causes contraction of the peripheral vessels leading to reduced microcirculation in the hands (feet). The hands often assume a bluish-reddish hue.
In about 1% of the population suffer from sweaty palms, about 0.2% from very serious hyperhidrosis.
Characteristically, the classical form of palmar hyperhidrosis starts in most cases already in childhood and is generally combined with plantar hyperhidrosis, whereas other types of hyperhidrosis have their onset later in life. In the school child, the sweaty palms and fingers may cause difficulties when writing and during other manual activities, but frequently the psychosocial distress begins in adolescence. The youngster becomes conscious of and embarrassed for his "handicap", avoids direct physical contact with others and, frequently, tries to hide the hands or even avoid social contacts alltogether. For many the condition imposes restrictions regarding their choice of profession, e.g. because unable to manipulate materials sensitive to humidity (paper etc) or because reluctant to customer contact where activities like shaking hands are necessary routines. Against common belief, the sweating does not improve with age, though the individual may "get used" to it and adapts his/her habits to the condition.
This type of focal hyperhidrosis is almost always of genetic origin and rarely caused by underlying diseases (e.g. neurological conditions). Over 25% of the affected individuals have a family history of excessive sweating.
A typical case of palmar (or palmo-plantar) hyperhidrosis does not need any assessment: the diagnosis can be made on the base of anamnestical data (early onset in life in an otherwise healthy individual, characteristic distribution). Assessment may only be required if excessive sweating starts later in adulthood or if the symptoms appear assymetrically (neurological condition?).
A stepwise approach is recommended, though experience teaches that severe variants of hyperhidrosis (wet and/or dripping palms or fingers) will probably not be satisfactorily treated but with surgery.