Why do the palms and feet sweat excessively?

Sweaty hands (hyperhidrosis palmaris)

There are a number of treatment approaches to address this problem. They range from conservative, local measures to surgical intervention.

  • Local, external treatment methods: Creams, tinctures or powders are applied to the directly affected areas. However, the effectiveness is only limited to a few hours
  • Systematically administered teas (sage tea)
  • Iontophoresis: temporary closure of the sweat glands using direct current
  • Treatment with botox: painful injection of heavily diluted botulinum toxin under the skin, whereby up to 50 injection points per hand must be determined, the effect lasts for a maximum of 6 months
  • Surgical therapy with the so-called ESB, the endoscopic sympathetic nerve blockade


If the conservative therapeutic approaches with baths, tinctures and botox are also unsuccessful, surgical treatment options must be recommended in the presence of grade 2-3 hyperhidrosis, as this is the only sustainable treatment option. Unfortunately, this form of treatment is often used very late and the suffering of the affected patient is prolonged, although in the long term this therapy option achieves by far the best results.


Endoscopic sympathetic block (ESB)

During this operation, nerve parts (the sympathetic trunk), which are responsible for sweating in the hands, among other things, are blocked, thus minimizing the problem of sweaty hands. The procedure is also very suitable for treating the axillary form of hyperhidrosis.


The operation is performed under general anesthesia with a 5-millimeter lens and two small incisions on the chest on the affected side. The sympathetic trunk is located in the area of ​​the rib heads next to the spine and blocked with a small titanium clip at the level of the 4th thoracic vertebra (ESB4). If you sweat heavily with emphasis on the armpit, a second clip can also be placed at the level of the 5th thoracic vertebra (ESB5). The method is not suitable for treating increased sweating of the feet (plantar hyperhidrosis). Nevertheless, in such cases, when treating axillary or palmar hyperhidrosis, an improvement in the situation on the feet is also observed in 30 percent.


Other procedures are also described in which the boundary cord is clipped or severed in several places below the 2nd thoracic vertebral body. However, these older techniques have significantly more undesirable side effects in comparison and have discredited the excellent method for several years. In particular, so-called compensatory sweating - a massive increase in sweating on one side on the back or chest while the hand on the operated side is dry at the same time - is very uncomfortable for the affected patient. This can be prevented with a very high degree of certainty with the ESB4 procedure.


The use of a clip instead of severing the nerve ensures a potential reversibility of the effect of the operation by removing the clip and allowing the nerve to regenerate if, in exceptional cases, the desired success should not be given. In the hands of experienced surgeons, the nerve block on one side is a very short and uncomplicated procedure that can be performed on both sides in 30 minutes under anesthesia. The operation is performed without placing any drains and the patient can leave the hospital the day after the operation.