The treatment of palmar hyperhidrosis - a systematic review

Int J Dermatol. 2022 Nov;61(11):1303-1310. doi: 10.1111/ijd.15937. Epub 2021 Oct 15.


Background: Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management.

Methods: A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017.

Results: Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients' symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement.

Conclusion: There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Botulinum Toxins, Type A* / therapeutic use
  • Cholinergic Antagonists / therapeutic use
  • Humans
  • Hyperhidrosis* / drug therapy
  • Hyperhidrosis* / surgery
  • Patient Satisfaction
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Sympathectomy / adverse effects
  • Treatment Outcome


  • Cholinergic Antagonists
  • Botulinum Toxins, Type A