Sweaty palms may not pose a danger to health, but wet hands make social interaction awkward. A surgical procedure can help with severe cases.

She has had sweaty palms since her school days. Whenever she felt anxious, her palms would drip with sweat. When she began driving lessons, perspiration from her sweaty hands made the steering wheel so wet and slippery that Ms Tan Quee Eng decided she had to do something about the problem.

“I couldn’t get a firm grip on the wheel, which made it very dangerous to drive,” said Ms Tan, Nurse Clinician at Singapore General Hospital (SGH). “I was also always embarrassed, because I was worried people wouldn’t like it if I shook hands with them.”

Ms Tan approached the SGH surgeon that she was working with at the time for help. She had heard that Associate Professor Peter Mack, Senior Consultant, Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital (SGH), a member of the SingHealth group​, could perform a surgical procedure known as sympathectomy to permanently stop the heavy perspiration in the palms. A minimally invasive or keyhole procedure done under general anaesthesia, sympathectomy involves destroying the nerves that cause the excessive sweating.

What causes sweaty palms?

According to A/Prof Mack, sweaty palms – or palmar hyperhidrosis – are caused by overactive nerves in the autonomic nervous system, which controls body functions like breathing and sweating. It is not quite clear what causes these nerves to become overactive.

It’s also not clear how common the condition is, although it’s likely that less than 5 per cent of the population suffer from it. In some families, all the members suffer from the condition, suggesting that it can be passed on.

When to consider surgery

Sympathectomy carries some risks and can be performed on most people. But as hyperhidrosis is not a life-threatening condition, “I recommend it only when the sweating is very severe and when it affects the patient’s work or lifestyle," said A/Prof Mack. An electrician whose hands are always wet runs the risk of causing electric short circuits qualifies as a candidate for this surgery, as is the piano student who may have to give up a music career if he is unable to perform properly because his hands keep slipping off the keyboard.

But doctors often offer more conservative treatment for a start. This includes iontophoresis where the hands are dipped in a water bath with an electric current running through to stun the nerve and, more recently, botox injections to paralyse the nerve.

Sympathectomy is considered only when more conservative treatments don’t help someone with a severe case of sweaty palms, said A/Prof Mack. The surgical option is not recommended for children as they often grow out of their sweaty-palm conditions. It is also not for people who have had lung infections or have undergone lung surgery, as scar tissue can make it difficult for a surgeon to perform sympathectomy, which involves operating in the area around the lungs.

“Anyone who wants surgical treatment has to be very clear that we’re treating a social inconvenience and not a health issue,” said A/Prof Mack. “The patient should also be very clear about the complications, such as Horner Syndrome and compensatory sweating in the chest. I’ll proceed with surgery only if he can accept these two things.”

Read on to find out more about sympathectomy (​surgery for sweaty palms) and the risks involved.​


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