Primary Palmar Hyperhidrosis
The patient considered for treatment of this problem has usually had a history of excessive sweating of the palms of the hands for at least three years, which has been confirmed by clinical observation and an iodine starch test.
The starch test is carried out using an iodinated starch power, which is dusted on the surface of the area with iodine and then dusting with starch (e.g., cornstarch). This, in contact with the sweat, turns a dark purple and a map is drawn to indicate the positive areas of each hand. There is no discomfort with this portion of the procedure and the purple color will easily wash off with alcohol. A map of the planned injection sites are drawn on a paper map as well as the hand.
Injections are then carried out with sterile, safe botulinum toxin type A (Botox®) by Allergan, in the areas found positive on the starch test. Injections are carried out with a #30 (tiny) needle, usually about 2.0 cm apart, and about 50 units, or whatever indicated, is the total used in each surface, using approximately 20 injection sites. While both axillary areas may be treated if desired after the starch test, we often inject one area at a time. With this protocol, the dose for the other side can be regulated depending on the result on the first side. The dose may be increased if the anhidrotic effect is too small, or reduced if any side effects are too unpleasant.
Before injections, a topical analgesic, such as Quadricaine or L•M•X4™, is applied to the area. This is done about thirty minutes before the injections. In addition, the surface is cooled by placing it under a cool pack to help further numb the area. If particularly painful, regional anesthesia can be used with 5 cc. of 1% lidocaine.
The risks and potential problems with the procedure include discomfort with the injections (which gradually decreases but which may last ten days). There occasionally is some swelling which is best treated by applying ice to the area if noted. There occasionally may be some temporary weakness but this is usually minimal. If sweating continues in some areas, it is an indication of the need for more Botox® then, and at any subsequent injections. We like each patient to evaluate their results as:
Follow-up in the office is mandatory in two and four week interviews initially. It may take two weeks to see the full effect. If more Botox® is indicated, this can be carried out at the two week return visit. The second hand can also be done at this time. I understand results usually last six months, and occasionally can last two years. The median is ten months. < previous | next > | print page | home | back to top | contact us |
