Palmar Hyperhidrosis

Topical Agent and Oral Agents for palmar hyperhidrosis.

Drysol® is an inexpensive prescription treatment that works well for some patients.  Given its low cost, it should be tried by everyone.  I typically recommend patients begin by applying it every other night but once it is working well, most patients for whom it works cut back to 2 x weekly or so.  Since drysol will mark up the sheets, make sure the sheets can be bleached.  For many patients, burning of the skin keeps one from using it.

Oral agents are sometimes used for palmar sweating but are generally not useful.  This is because these causing drying everywhere and in general the side effects are too extreme for the benefit.  Sometimes, patients will use a low dose of these medications to extend the benefit of botulinum toxin when it starts to wear off.  The most common medications are glycopyrrolate and oxybutynin.  Generally, Dr. Loftus will only give patients a trial of these medications when required for insurance coverage of better agents.

Botulinum Toxin

Botulinum toxin treatment of hyperhidrosis is truly life changing for many hyperhidrosis patients.  Dr. Loftus has been using this treatment for over 20 years.  Starting therapy will range from 100 – 200 units of Botox® brand botulinum toxin depending on hand size and concern about finger muscle weakness.

If covered by insurance, typically Botox® brand is the only one covered.  While the treatment fee itself is out of network, Dr. Loftus will use the patient’s specialty pharmacy to get the Botox® itself in network if this affects the cost of the treatment to the patient.  The medication fee is the larger fee.  Dr. Loftus may be the only doctor in the Houston area willing to use insurance for hyperhidrosis patients.  Unfortunately, fewer patients have insurances that will cover palmar hyperhidrosis compared to axillary hyperhidrosis.