Percutaneous Stereotaxic Thermocoagulation (PST) for Palmar Hyperhidrosis(excessive sweating of the hands)


自主神經系統分成交感和副交感神經系統,而人的汗腺是由交感神經系統所支配。手掌多汗症(Palmar Hyperhidrosis )乃因交感神經功能亢進引起,導致兩側手掌流汗量比正常人多且異常。

What is the cause of Palmar Hyperhidrosis (excessive sweating of the hands)?
The autonomic nervous system is divided into the sympathetic and parasympathetic nervous system. The sweat glands are predominantly controlled by the sympathetic nervous system. Excessive hand sweating is caused by hyperfunction of the sympathetic nervous system.


What are symptoms of excessive palmar sweating?
Excessive palmar sweating is made worse by heat or emotional stimuli. Excessive palmar sweating often leads to a fear of shaking hands and soiling of papers. Patients may have difficulty with work or leisure activities that require a dry grip. Patients report that excessive sweating often results in social problems on a both personal and professional level. Palms are generally excessively dry when they are not sweating profusely. During cold weather, vessels in the palm constrict and hands become cold.



Palmar hyperhidrosis is characterized into three levels of severity
1.     Mild
a.     Palms are damp
b.     Minimal interference with daily living
c.      Patients are aware of their increase in sweating and sought medical treatment but did not have to take any social precautions and had no lifestyle impact
2.     Moderate
a.     Palmar sweat can soak through a handkerchief
b.     Moderate interference with daily living
c.      Patients who had to take social precautions, such as providing an extra shirt in axillary hyperhidrosis or having to constantly hold a small hand towel in palmar hyperhidrosis, but with no lifestyle impact
3.     Severe
a.     Sweat drips from palms
b.     Severe interference with personal and professional life.
c.      Patients who not only took social precautions but had a major impact on lifestyle, such as avoiding social functions, change of job and emotional strain



How common is palmar hyperhidrosis?

In Taiwan, prevalence of palmar hyperhidrosis in the general population is 0.5% (1 in 200 people). Study suggests that palmar hyperhidrosis may have a genetic component. Seventy-two percent of the patients diagnosed with palmar hyperhidrosis have a family history of hyperhidrosis.

From a survey of 1000 patients with palmar hyperhidrosis:
·        When one first-degree relative has palmar hyperhidrosis, a person has 46% chance of having the condition
·        When two first-degree relatives have palmar hyperhidrosis, a person has 54% chance of having the condition
·        When both parents have palmar hyperhidrosis, a person has close to 100% chance of having the condition

What treatments are available for palmar hyperhidrosis?

1. 局部擦劑(antiperspirants):利用鋁鹽阻塞汗腺出口,如Drysol, Xeracaluminium chlorhydrate)只對極輕微手汗能達到止汗目的。
Topical Antiperspirants such as aluminum chloride (Drysol, Xerac). Treatment may be effective for mild sweating.

Oral medications such as Diazepam (Valium) to reduce stress and anxiety, or Clonidine to reduce sympathetic nervous system outflow.  Treatment may be effective for mild sweating.

Iontophoresis temporarily block sweat glands. Treatment is generally 20 to 30 minutes per day, 3 times per week. Benefit is noted within 2 to 4 weeks after treatment. Reduction in sweating is maintained by ongoing treatment. Potential side effects include dry, cracked hands, skin redness and discomfort.

Botulinum toxin injection under the skin spaced 1 to 1.5 cm apart. TBenefit is noted within 7 to 10 days after the treatment and can persists for 6 months. Reduction in sweating is maintained by repeated injection. he pain during injection into palms and soles can be significant. Temporary muscle weakness is a common complication. Treatment can be costly because 50 to 100 units of onabotulinumtoxinA are required per hand per treatment.

Endoscopic thoracic sympathectomy (ETS) involves surgical interruption of the thoracic sympathetic nerve chain. Surgery is performed under general anesthesia. A concerning adverse effect of ETS is development of compensatory sweating in 28.7% of the patient. Compensatory sweating is when excessive sweating occurs in other parts of the body such as chest, abdomen, back, thigh, and calf.  Other potential complication of ETS include Horner's syndrome, paresthesia (abnormal sensation such as tinkling or burning), pneumothorax (air in chest cavity leading to lung collapse), hemothorax (blood or fluid in chest cavity), hyperthermia, and bradycardia (slow heartbeat).

無創微波: 美國Miradry原廠僅授權於腋下除汗使用,曾有患者術後起嚴重水泡及影響手部感知功能,恢復期長達數月。

MiraDry destroys axillary apocrine glands. This procedure is not appropriate to treat excessive palmar sweating.

75% patients have tried several treatments before coming to see Dr. Chuang.

Percutaneous Stereotaxic Thermocoagulation (PST) for Palmar Hyperhidrosis (excessive sweating of the hands)


No risk of developing severe type of compensatory sweating
Compared to endoscopic thoracic sympathectomy (ETS), Percutaneous Stereotaxic Thermocoagulation has much lower rate of developing compensatory sweating.

ETS is at T2 and T3 ganglia levels, which has higher rates of developing compensatory sweating due to T2 interruption. Percutaneous Stereotaxic Thermocoagulation involves T3 or T4 ganglion level, which has low rates of developing compensatory sweating.

永久性、安全性、高成功率 -三大特色PST 根治手汗
Long term effectiveness, Safety, and High cure rate -
Three benefits of Percutaneous Stereotaxic Thermocoagulation:


No residual scar
Just two needle puncture points on upper back after treatment there is no residual scar after two weeks.


Short procedure time and speedy recovery
The entire procedure takes approximately 1 hour. Patients return home on the same day with minimal restrictions on daily activity.


Cost effective and time efficient treatment
This is a one-time procedure that does not require maintenance treatment or additional treatment cost.

根據過去100位患者(平均追蹤5.8個月)經過立體定位燒灼法治療T3後,88%患者保持乾爽效果,10%與一般人手部的濕潤程度相同,減少術前汗量約70%), 2%減少術前汗量約50%

High cure rate
One hundred patients were followed up for an average of 6 months: 88% of the patient reported dry palms, 10% of the patient reported normal palm sweat equal to a normal person and show the hand sweating to decrease 70%, and 2% patients show the hand sweating to decrease 50%.


The procedure has the potential to treat excessive sweating in other body parts

After the procedure, 67% of the patient had improvement in excessive sole sweating, 91% of the patient had improvement in axillary sweating, and 81% of the patient had improvement in facial sweating.


Extensive clinical expertise and experience
Dr. Chuang is a neurosurgeon who has been treating excessive palmar sweating for over 30 years. He has treated over 2000 patients with a success rate of 99%.

Patients pay after they have a successful treatment. In the event of recurrence, Dr. Chuang will repeat the procedure free of charge.

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Appointment hours:
Wednesdays to Saturday at 9:00 am, please make an appointment by app or by e-mail.

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