Palmar Hyperhidrosis:
Aluminium compounds are ineffective and Botox is painful: there are two alternatives.
IONTOPHORESIS: The patient places the hands in a device which passes a mild electrical current into the skin, which can stop sweating for 4-6 weeks. This treatment is provided in physiotherapy or dermatology departments, but machines can be bought for home use (see www.hyperhidrosisuk.org for details).
Palmar hyperhidrosis is most effectively treated by the operation of endoscopic thoracic sympathectomy (ETS). The rationale for this is that the sweat glands are controlled by the sympathetic nervous system and that by destroying the particular ganglion (relay station) for the hands the sweating can be stopped. This ganglion lies inside the upper chest and reaching it requires a special technique using a telescope. The operation was actually first described by the English surgeon Hughes in 1942; it was performed in Vienna in the 1970s but has only become popular in the UK relatively recently (although Alan Cameron did publish two papers in 1984/5).