Palmar and Plantar Hyperhidrosis

One particular kind of procedure is the treatment of excessive sweating in the hands and feet-palmar and plantar hyperhidrosis. Two units per site were injected with a total dose of 100 units for each palm for palmar hyperhidrosis, but because of the pain, high-intensity vibration devices, cool packs, liquid nitrogen or regional anesthesia nerve blocks may be required. Application of EMLA does not prevent the pain of a needle penetrating the skin with its extremely dense sensory invasion.  Given that the majority of the pain occurs during the piercing of the skin itself, the smaller the hole created, the less the pain is likely to be.  Cryo-analgesia, i.e., numbing of the tissue by cooling, is an alternative technique for palmar hyperhidrosis.  Jet injectors have also been used.  With this technique the botulinum is directed through a hole four times smaller than that of a 30 comfortable G needle (Med-Jet).

An ice cube held in gauze applied just prior to each individual injection of toxin may be a very effective form of anesthesia.  Alternatively, topical lidocaine under occlusion for an hour followed by ice packs may be used, or a Bier’s block.