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Health condition · Clinically reviewed

Excessively sweaty palms, from topical creams to iontophoresis, botulinum toxin and surgery.

Palmar hyperhidrosis is common, treatable and often unspoken. A stepped medical plan beats endless product-hopping and quietly gives you your hands back.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, British Association of Dermatologists and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including iontophoresis, botulinum toxin and thoracic sympathectomy.

Key facts

Sweaty palms at a glance.

The essentials in plain English - what palmar hyperhidrosis is, why it happens and how it is treated in the UK today. For the wider condition, see our guide to excessive sweating (hyperhidrosis).

  • What it is

    Palmar hyperhidrosis - excessive sweating of the palms driven by sympathetic overactivity, out of proportion to temperature or effort.

  • How common

    A common focal form of primary hyperhidrosis. Around one in three to one in two people affected report a family history.

  • Typical onset

    Usually starts in childhood or the teenage years and continues into adult life without an obvious trigger.

  • Daily impact

    Handshakes, grip, keyboards, tools, paper, phones and touchscreens - social and working life often take the biggest hit.

  • First-line therapy

    Topical 20% aluminium chloride hexahydrate at night, then iontophoresis if that is not enough.

  • Specialist options

    Botulinum toxin injections into the palms, oral anticholinergics and, for selected cases, endoscopic thoracic sympathectomy.

Why this guide matters

A stepped plan, not a lifetime of hiding your hands.

Palmar hyperhidrosis is common, treatable and often unspoken. The three ideas below shape everything else on this page.

  • Topicals and iontophoresis come first

    Aluminium chloride at night, then iontophoresis - safe, evidence-based and the right starting point for nearly everyone.

  • Botulinum toxin is transformative

    For six to twelve months at a time, botulinum toxin injections into the palms give the majority of patients near-dry hands.

  • Surgery is a last resort

    Thoracic sympathectomy works for the palms - but compensatory sweating elsewhere is a real risk that needs a shared decision.

How the diagnosis is made

From clammy palms to a clear plan.

Palmar hyperhidrosis is a clinical diagnosis. This is the sequence a UK GP, dermatologist or hyperhidrosis clinic will usually follow.

  1. 01

    Assessing

    History and pattern

    Focal, symmetrical palm sweating starting in childhood or adolescence, easing at night and worse with stress - classic primary hyperhidrosis.

  2. 02

    Assessing

    Life-impact assessment

    How much it affects work, grip, handshakes, devices and confidence - the Hyperhidrosis Disease Severity Scale gives a quick score.

  3. 03

    Assessing

    Rule out secondary causes

    Generalised sweating, night sweats, weight loss or new medication all point away from primary hyperhidrosis and warrant further checks.

  4. 04

    Confirming

    Targeted blood tests

    Thyroid function and, where indicated, glucose and other endocrine tests to exclude a secondary driver.

  5. 05

    Confirming

    Medication review

    Antidepressants, opioids and some hormonal treatments can cause sweating - a review can be enough to explain the picture.

  6. 06

    Preparing

    Dermatology or hyperhidrosis clinic

    For iontophoresis, botulinum toxin planning or consideration of oral treatment when topicals have failed.

  7. 07

    Preparing

    Thoracic surgery opinion

    Reserved for severe, refractory palmar hyperhidrosis - a shared decision that weighs benefit against the risk of compensatory sweating.

Typical timeline: a first visit to a working plan in weeks, not months.

Symptoms

What palmar hyperhidrosis actually looks like.

The typical mix of constant clamminess, symmetry, cold pale skin and daily-life impact - and the features that tell you it is time to escalate.

  • Constant clammy palms

    Palms feel damp even at rest and in cool rooms - a soft, cool wetness that is not driven by heat or effort.

  • Visible dripping

    Beads of sweat form and can drip from the fingers - papers, screens and metal tools show the marks.

  • Symmetrical pattern

    Both hands are affected roughly equally - a strongly asymmetrical pattern points away from primary hyperhidrosis.

  • Cold, pale palms

    Skin often feels cool and looks pale or slightly bluish - a sympathetic-driven vascular response.

  • Skin maceration and peeling

    Constant moisture softens the skin - peeling, cracking and occasional secondary infection are common.

  • Worse with stress and focus

    Interviews, exams, meetings, driving and public speaking reliably make things worse - the cycle feeds itself.

  • Impact on work and hobbies

    Surgeons, dentists, artists, musicians, teachers, mechanics and keyboard users often notice the impact first.

  • Red flag - unilateral or new-onset

    One-sided sweating, sudden new sweating in adult life or associated systemic symptoms need a medical review.

Treatment

How sweaty palms are treated in the UK.

Topical treatment and iontophoresis first; then botulinum toxin or oral options; then, for selected patients, endoscopic thoracic sympathectomy.

  • Topical aluminium chloride

    20% aluminium chloride hexahydrate (Driclor, Perspirex) applied to dry palms at night - the standard first-line treatment for palmar hyperhidrosis.

  • Iontophoresis

    Palms in a shallow water bath with a mild galvanic current (Idromed, Hidrex). Delivered in a specialist iontophoresis clinic and maintained at home.

  • Botulinum toxin injections

    Subcutaneous botulinum toxin across the palm - highly effective for six to twelve months. Discomfort managed with wrist blocks or topical anaesthesia.

  • Oral anticholinergics

    Oxybutynin or glycopyrronium taken by mouth - useful when topicals and iontophoresis fall short. Dry mouth and eyes are the main limits.

  • Beta-blockers and clonidine

    Off-label oral options that dampen the sympathetic drive - occasionally helpful for stress-triggered sweating alongside other treatments.

  • Endoscopic thoracic sympathectomy

    Keyhole surgery that interrupts the sympathetic chain - definitive for palms, but carries a real risk of compensatory sweating on the trunk and back.

  • Behavioural and practical support

    Absorbent handkerchiefs, glove liners, grip aids, stylus use and stress-management strategies - small changes that add up in daily life.

  • Specialist hyperhidrosis clinic

    Dermatology and thoracic-surgery input, plus the patient-led Hyperhidrosis UK Support Group - a coordinated plan works best.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, dermatologist or hyperhidrosis clinic knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summaries. Hyperhidrosis.

  • British Association of Dermatologists (BAD). Patient information leaflet on hyperhidrosis.

  • International Hyperhidrosis Society. Clinical guidelines on primary focal hyperhidrosis.

  • European guidelines on the treatment of primary focal hyperhidrosis.

  • Hyperhidrosis UK Support Group. Patient resources and lived-experience guidance.

Red flags

When sweaty palms need a closer look.

Most palmar hyperhidrosis is primary and can be managed in primary care or dermatology. These features suggest a different story.

  • New sweating in adult life

    Palmar sweating that begins after the teenage years is more likely to be secondary - a medical review is worth arranging.

  • One-sided or asymmetrical sweating

    Strongly unilateral sweating points away from primary hyperhidrosis and may reflect a nerve or spinal cause needing assessment.

  • Generalised sweating and night sweats

    Whole-body sweating, drenching night sweats or unexplained fever need investigation for infection, thyroid disease or lymphoma.

  • Weight loss or systemic symptoms

    Unintended weight loss, palpitations, tremor or heat intolerance suggests thyroid or other endocrine disease.

  • Medication-triggered sweating

    Antidepressants, opioids, some hormonal treatments and withdrawal states can all cause sweating - review before escalating treatment.

  • Recurrent skin infection

    Repeated bouts of cellulitis, fungal infection or painful cracking on the palms deserve dermatology input alongside sweat control.

  • Severe mental-health impact

    Avoidance of work, study or relationships because of sweating is common and treatable - flag it early rather than push through.

  • Post-sympathectomy compensatory sweating

    New heavy sweating of the trunk, back or thighs after thoracic sympathectomy - a recognised complication that needs specialist review.

  • Sudden change in pattern

    A clear change in a long-standing pattern of sweating, especially with other symptoms, should not be assumed to be primary hyperhidrosis.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - a nightly topical, iontophoresis when needed, well-timed botulinum toxin and a slow, well-informed decision about surgery.

A quiet reminder

You do not have to just live with it.

Most people with palmar hyperhidrosis get real, lasting improvement from a stepped medical plan. The Hyperhidrosis UK Support Group is a good place to start.

  1. 01 Routine

    Build a nightly topical habit

    Dry palms fully, apply aluminium chloride at bedtime and wash off in the morning. Consistency for six to eight weeks matters more than intensity.

  2. 02 Escalate

    Add iontophoresis early

    If topicals are not enough after two months, iontophoresis in a specialist clinic and then at home is often the game-changer.

  3. 03 Plan

    Time botulinum toxin around life

    Six to twelve months of relief per treatment - schedule around exams, weddings, interviews or busy work seasons.

  4. 04 Decide

    Take surgery slowly

    Thoracic sympathectomy can be transformative but is not reversible. Understand compensatory sweating before you commit.

Frequently asked

Everything we get asked about sweaty palms.

Quick answers on causes, topicals, iontophoresis, botulinum toxin and surgery.

  • What are excessively sweaty palms?

    Palmar hyperhidrosis is a focal form of primary hyperhidrosis in which the palms sweat far more than needed for temperature control. It usually starts in childhood or the teenage years, is symmetrical, eases during sleep and often runs in families.

  • Is it caused by anxiety?

    Anxiety and stress make palmar hyperhidrosis worse but they do not cause it. The underlying driver is an overactive sympathetic response in the sweat glands of the palms. Treating the sweating often calms the anxiety around it, and vice versa.

  • What is the first treatment to try?

    A topical 20% aluminium chloride hexahydrate product such as Driclor or Perspirex, applied to dry palms at night. It works for many people if used consistently for six to eight weeks, and it is inexpensive and safe.

  • How does iontophoresis work?

    You place your palms in a shallow tray of tap water while a small galvanic current is passed through the skin using a device such as Idromed or Hidrex. Initial sessions are done in a specialist iontophoresis clinic and maintenance is then done at home.

  • Are botulinum toxin injections into the palms painful?

    The injections themselves are uncomfortable because the palm skin is sensitive. Wrist blocks, cooling and topical anaesthesia make the procedure manageable and it is usually well tolerated when performed by an experienced specialist.

  • Should I have surgery for sweaty palms?

    Endoscopic thoracic sympathectomy is highly effective for the palms but carries a real risk of compensatory sweating on the trunk, back and thighs. It is a shared decision with a thoracic surgeon and is reserved for severe cases that have failed less invasive options.

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