Palmar Hyperhidrosis: Restore Your Confidence with the Right Treatment
“My hands would get so sweaty, even in an air-conditioned room. Whenever I was chatting with friends and wanted to hold their hands, I felt I had to warn them first that my hands were sweaty.”
Living with Excessive Sweating
Hyperhidrosis is not typically triggered by heat or exercise. It is a medical condition in which the body produces sweat far beyond what is physiologically necessary. At times, perspiration may soak through clothing or leave the palms noticeably wet. While this may appear minor to others, for those who experience it daily, the condition can interfere with everyday activities and gradually erode self-confidence.
This Patient Story features “Ms. Bell - Khemjira Lekngam,” who has been experiencing excessive palm sweating since high school. She noticed frequent sweating of her palms, but did not realize it was an abnormal condition until she was in university.
“When I was a child, I usually handwrote on paper. I was not aware that I had the illness then, since my classroom had no air conditioning. But when I enrolled in university, despite being in air-conditioned classrooms, my hands were always damp. It led me to develop a subconscious habit of wiping my hands on my blouse. No one else seemed to have the same problem. That was when I realized something was out of the ordinary.”
Sweat: A Problem That May Seem Small but Has a Big Impact
Ms. Bell’s decision to seek treatment was not based solely on sweaty palms, but also on how it affected her confidence and day-to-day life.
“When I took lecture notes on my iPad, even in an air-conditioned classroom, my hands would get so sweaty that I could hardly write legibly. I was aware it affected my ability to concentrate on studying. Whenever I chatted with friends and wished to hold their hands, I couldn't help warning them that my hands were sweaty. It affected my confidence a bit.”
After Ms. Bell realized that her symptoms were not normal and were increasingly affecting her daily life, she began actively researching the condition and available treatment options. Someone she knew later recommended that she seek care at MedPark Hospital.
What Causes Excessive Sweating?
Dr. Sasipas Chontong, an endocrinologist, describes this condition as hyperhidrosis, which is often associated with certain underlying medical conditions, such as:
- Hyperthyroidism
- Diabetes
- Non-diabetic hypoglycemia
In some cases, certain medications may trigger the conditions, including some antidiabetic drugs, specific pain medications, and antidepressants. For this reason, doctors must carefully assess whether any of these factors may be contributing to a patient’s symptoms. In Ms. Bell’s case, however, her medical history did not suggest one of these conditions, and she was not regularly taking medications. Dr. Sasipas therefore ordered blood tests to further investigate the cause, with particular focus on hyperthyroidism.
“Hyperthyroidism typically leads to easy sweating in an amount similar to that after running. However, other symptoms usually accompany hyperthyroidism. Sweating is not the sole symptom. We did blood tests to screen for hyperthyroidism, and they were negative.”
Since none of the typical causes applied to the patient, Dr. Sasiphat searched for the right solution that would be most effective and appropriate for Ms. Bell’s specific condition.
Restore Confidence with Bilateral VATS Sympathectomy
Ms. Bell's treatment began with medication. Her symptoms improved during the early phase of treatment; however, the amount of sweating remained excessive, and the medication eventually became less effective. Dr. Sasipas explained that:
“There are several approaches to treating excessive sweating, including oral medications and localized therapies. For example, if someone experiences excessive sweating in the palms or underarms, we may recommend Botox injections to reduce the activity of the sweat glands. However, Botox needs to be repeated regularly and does not provide a long-term cure. The patient took oral medication for about one to two months but did not see any improvement. At that point, I felt it was time for surgery and referred the patient to Dr. Supitchar.”
After learning about Ms. Bell’s symptoms, Dr. Supitchar Vongmanee, a highly experienced cardiothoracic surgeon, evaluated the underlying cause of her condition:
“At this point, we need to identify the true underlying cause — whether it is due to overactivity of the nerves or whether there is another hidden condition involved, as Dr. Sasipas mentioned, such as a thyroid disorder or other endocrine abnormalities.”
He explained that overactivity of the sympathetic nerve chains in the chest region, which run along both the left and right sides of the spine, triggers excessive sweating of the hands. When this part of the nervous system is overstimulated, it leads to sweat production beyond what is physiological.
This condition is treatable with Bilateral VATS Sympathectomy, a minimally invasive thoracoscopic procedure that disrupts the relevant sympathetic nerve pathways. Dr. Supitchar clearly explains each step of the operation, so Ms. Bell can fully understand the process, from inserting a thoracoscope and surgical instruments to locating the sympathetic nerve chains and cutting the specific segments that control sweating in the hands and underarms. The procedure is typically performed on both left and right sides simultaneously and usually takes less than an hour. After receiving this detailed explanation, Ms. Bell felt much more reassured about proceeding with the surgery.
“His explanation helped me better understand the procedure and gave me greater confidence, reassuring me that it wasn’t as scary as I had imagined.”
Say Goodbye to Sweaty Hands and regain confidence.
“I’m satisfied with the results. My hands no longer sweat excessively. However, there have been some minor side effects. I’ve noticed increased sweating in other areas, such as my legs and calves. Personally, it hasn’t been enough to interfere with my daily life.”
Dr. Supitchar explained the possible side effects. “The main risk of any thoracic surgery is that the lungs could be injured, such as a puncture or air leak. These complications might require a prolonged hospital stay or the placement of a chest tube, although the likelihood is quite rare. Another risk, which is more common, occurring in about 10% of patients, is that after the surgery successfully resolves the problem in the hands, some patients may start experiencing increased sweating in the feet.”
Ms. Bell shared that at first, she was somewhat apprehensive because she wasn't sure if she would get better. However, both doctors were very kind. They reassured her that she would recover. Now she feels much more at ease. Daily activities are no longer bothersome as they once were. She feels more confident and comfortable in social situations.
“I wish to share with anyone who experiences excessive sweating in the hands or in any area that makes daily life difficult. Surgery is one of the best treatment options, and it can truly cure the condition. That said, if it hasn’t significantly affected your daily life or the people around you, I think it’s worth reflecting on whether you want it completely gone or if you feel it is tolerable. From my experience, though, I would still recommend surgery.”
