If you have cold, clammy hands that do not seem to improve no matter what you do, you may have a medical condition known as palmar hyperhidrosis. Individuals with this condition sweat excessively in the palms. Patients with palmar hyperhidrosis can be negatively impacted to a significant degree by their condition, experiencing difficulties in occupational and social situations.

Previously, the traditional methods of treating hyperhidrosis were either ineffective—in the case of topical antiperspirants—or invasive—in the cases of the excision of the sweat glands, arthroscopic shaving of the glands, and endoscopic transthoracic sympathectomy. Botox treatments are usually suggested after treatments like topical therapy and tap water iontophoresis have failed to produce satisfactory results.

How does Botox help reduce excessive sweating of the palms?

When Botox is injected intradermally, the toxin acts to chemically denervate the eccrine sweat glands within the treated area, so that sweat production is reduced. Botox does this by cleaving the SNAP-25 protein that is crucial to the process of acetylcholine release at nerve endings. Although it may sound confusing, this effectively blocking signal transmission to the sweat glands.

Upon treatment with Botox, the patient will begin to note an improvement in their condition within a week of the injection. In a study analysing the use of Botox to treat palmar hyperhidrosis, there was an extremely high efficacy rate, a virtually negligible failure rate, and 93% of patients were satisfied with Botox treatment. This patient satisfaction rate with Botox was also found to be higher than the satisfaction rates of other nonsurgical treatments for palmar hyperhidrosis, such as topical agents. In the patients of these studies, the Botox treatment often lasted for an average of five to seven months before retreatment was required. The severity of the condition did not seem to have an impact on treatment efficacy or the duration of action.

Which patients should not be treated with Botox?

Patients with hyperhidrosis secondary to an underlying disease, patients who have undergone previous surgical debulking of the sweat glands, and/or patients with severe blood-clotting disorders may not be eligible for a Botox treatment. If a patient has an infection at the proposed injection site or a systemic infection, Botox treatment should be delayed to a time after the infection has cleared.  Lastly, individuals with an existing medical condition that may interfere with neuromuscular function, such as Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or myasthenia gravis, should not receive Botox treatments. 

How do you administer Botox to treat palmar hyperhidrosis?

Because the palmar area has many nerve endings, injections to the palms can be particularly uncomfortable to the patient, and this can be a deterrent for undergoing Botox treatment for some patients. To aid in this respect, a variety of anesthetic methods can be used to reduce patient discomfort, including topical lidocaine cream, oral and intravenous sedation, nerve blocks, and Bier’s block. Administering Botox to the palm requires great precision and skill because improper injection can cause pain during the procedure and muscle weakness afterwards.

To administer, the Botox powder (100 units total per palm) should first be diluted with 3–4ml of 0.9% non-preserved saline and then drawn up in a syringe. Using a 30-gauge needle, inject Botox into the deep dermis near or at the junction with the subcutaneous tissue. Injection depth is of particular importance when treating the palms: the practitioner must take care not to inject too deep as that may lead to muscle weakness that, in turn, results in decreased grip strength and manual dexterity. Inject Botox in three injection sites per digit and in a series of 45–50 injection sites spread 1–1.5cm apart in the palm.

Immediately after the procedure, the patient should be observed in a clinical setting for signs and symptoms of side effects, and any reactions to treatment that the patient experiences after treatment should also be reported. The efficacy of the treatment will be confirmed through a follow-up with the patient within two weeks of initial treatment. Patients are advised to come in for repeat treatments once the effects begin to wear off.

What are the potential side effects of using Botox for treating sweaty hands?

The most commonly reported complication of this treatment is muscle weakness. This effect is usually mild and only noticeable in situations where maximal finger opposition is required, such as when opening a sealed jar. Muscle weakness is a transient effect that will usually wear off after a few weeks post-treatment. Other temporary effects of Botox injections include soreness at the injection sites, which can last for one or two days.


Anxiety over sweaty hands may seem frivolous at first, but research into this matter has shown that the condition can have a real negative psychological effect that impacts the well-being of patients with palmar hyperhidrosis. That is why efficacious and safe therapies that can work in the long-term must be developed for this condition. Botox is indicated to provide long-lasting relief from the symptoms of excessive sweating and can be considered a treatment option before opting for more drastic treatment measures like surgery.

Comments (0)