Sympathectomy or Botox for palmar hyperhidrosis?

Is it better to have sympathectomy done or Botox for palmar hyperhidrosis? Really good question with lots of interesting things to discuss. Important to say that this is a personalized decision for individual people and really important to weigh things up with the individual in mind. Now, the technical issues to do with palmar hyperhidrosis are that yes, sympathectomy is effective, but obviously the downside is that you will get compensatory sweating most likely in other body parts. So, in patients where it is, you know, you find it difficult opening a door because your hand is so sweaty because the door knob slips. I mean, that would be a really good indication to do it, generally speaking. if your symptoms not too severe then you know perhaps that needs to be a very much more personalized discussion to have. In terms of the hand, Botox is also effective, very effective, but there are some things to consider. The treatment will have to be repeated probably possibly even as frequently as three to six monthly because the Botox wears out. The other thing is that the skin and fibrous tissue in the hand is very closely tethered down so there's no real space to inject so injections are painful more painful than other parts of the body because there's no fat in the palm of the hand. The third thing to mention is that the small muscles of the hand if they're exposed to Botox will become paralyzed or weakened so that's another important thing to consider in terms of palmahydrosis, hyperhidrosis and treatment with Botox. There is a third option which is tap water iontophoresis and that is also effective but requires multiple treatments and people find it difficult potentially to comply or adhere or you know be as involved with treatment as they should do to get maximum benefit but it's certainly an option to consider.