Sweaty_Hand

What to Do When You’re the Sweaty-Handshake Dude

The options range from topical ointments to electric shocks, and all the way to irreversible surgery

As we enter that magical time of year when your underwear glues itself to your butt with the determination of an affectionate barnacle, we’re taking a closer look at sweat. What is it? What does it want? From sweatshops and anxiety to the literal drippy stuff itself, this week is all about the perspiration. Now let’s get sweaty.

For some, having sweaty hands is a minor inconvenience. For others, having sweaty hands is a life sentence — one that involves constant humiliation, isolation and condemnation. Case in point: On this subreddit devoted to those suffering from excessive sweating, discussions about suicide and depression stemming from the condition are just as prevalent as those about curing this debilitating ailment.

In a recent post, one commenter writes (sic) that excessive sweating “has totally ruined my life, and it’s causing me trouble at work. I can’t go a minute without sweating. In the wintertime, I freeze from unnecessary sweating. I can’t date. I’ll never get married. I can’t have kids. My life is fucked, and I absolutely deserve it.” In another post, a commenter explains that they were forced to give up their love for playing piano and guitar due to their constantly dripping hands.

Fortunately, there are many treatment options for hyperhidrosis (aka excessive sweating), especially on the hands. I asked Malcolm Brock, medical director at the John Hopkins Center for Sweat Disorders, to run me through them, but first, Brock explains that there are two kinds of excessive sweating: One caused by genetics, which often runs in the family, and another caused by other medical conditions or medications. That being the case, he recommends checking in with your doctor to rule out any other problems before undergoing treatment for straight-up hyperhidrosis.

Also, while the following treatments provide more long-term results, in a pinch, dermatologist Anthony Rossi says his patients come up with all kinds of quick remedies, like having constant access to baby powder or storing tissues in their pockets so they can squeeze them right before giving a handshake. One redditor on the hyperhidrosis subreddit approves of the latter approach, adding that they often pretend to wipe their nose with tissues (or a handkerchief) before wiping their hands so as to avoid suspicion. Another redditor recommends getting a small desk fan that blows on your hands while you work, which can help keep things dry momentarily. As for long-lasting options…

Topical Medications

Brock says that the simplest way to treat excessive sweating on the hands is to have your doctor prescribe a cream containing aluminum chloride, adding that Drysol is a popular option. “These work by blocking the sweat ducts,” he says. Drysol is particularly popular on the hyperhidrosis subreddit — one commenter even boasts about finally being able to wear gray T-shirts after using the product. Brock does mention, however, that patients with more severe cases of hyperhidrosis might require more intensive options, which brings us to our next treatment…

Iontophoresis

According to Brock, iontophoresis has been used to treat excessive sweating on the hands and feet since the 1940s. It involves sending mild electric currents through water and into the skin, which are believed to block the sweat glands (although, doctors aren’t entirely sure why it works). One study found that the procedure helped 91 percent of patients with excessive sweating on the hands and feet.

The one problem with iontophoresis is that it can be incredibly time consuming: Patients normally have to use the device, which can be prescribed, several times each week for 30 minutes at a time, depending on how much they sweat. In fact, on the hyperhidrosis subreddit, one commenter explains that they’ve been doing iontophoresis four or five times each week for the past five years to keep their sweating down (they recommend watching Netflix or YouTube during the process).

Systemic Medication Therapy

Brock mentions that medications called anticholinergics are frequently used to help treat hyperhidrosis, especially in people who have little success with topical medications and iontophoresis. These medications essentially work by blocking the chemical messenger acetylcholine while it travels to receptors responsible for triggering sweating.

Brock does add, however, that anticholinergics haven’t been studied in clinical trials specifically for hyperhidrosis, since these drugs are more commonly used to treat various other conditions, ranging from urinary incontinence to muscle contractions associated with Parkinson’s disease. Still, doctors are pretty confident in the use of anticholinergics for hyperhidrosis, since they have a safe history.

Botox

In addition to helping men look less grumpy, Brock says Botox has become increasingly useful for treating hyperhidrosis, since it can last for anywhere between four months and a whole year. Similar to anticholinergics, Botox works by blocking a neurotransmitter that stimulates the sweat glands. That said, Brock does warn that sweating tends to recur with Botox, which means multiple treatments are necessary, and too much Botox in the hands can lead to chronic weakness. In other words, this is a quick fix, but also a risky one.

Surgery

Called endoscopic thoracic sympathectomy, this procedure involves cutting or clamping the sympathetic chain, eliminating excessive activity by the sympathetic nerve, which triggers excessive sweating. Needless to say, this should be a last resort for several reasons, one being that Brock says patients who undergo this procedure can develop compensatory sweating on the legs and back — and what good are sweat-free hands when you start sweating buckets everywhere else? “What people should remember is that this procedure is permanent, so once you cut that nerve, there’s no successful reversal procedure,” he adds.

Surgery does work incredibly well, though, and Brock even points me toward a study he performed in which half the patients who underwent the procedure either reduced their antidepressants and anti-anxiety medications or stopped taking them altogether, since they felt that much better about their sweat-free selves. And that’s definitely worth a non-damp high five.