Mr Usman Jaffer discusses both sympathectomy and Botox in the context of treatment for palmar hyperhidrosis. Sympathectomy is a highly effective procedure but there is a risk of compensatory sweating, i.e. excessive sweating in other body parts. This procedure is often more beneficial in those with more severe symptoms. Botox is also a very effective treatment but may need to be repeated, sometimes as often as every 3-6 months. Furthermore, Botox injections can be painful and may weaken or paralyse small muscles in the hand. A third option is tap water iontophoresis, which is effective but requires multiple treatments. Therefore, this option may have lower compliance but is worth considering.
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