Excessive Sweating

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Hyperhidrosis

What is hyperhidrosis?
Where does hyperhidrosis occur?
What are the symptoms of hyperhidrosis?
What are the alternative treatments for hyperhidrosis?
Is there a surgical treatment for hyperhidrosis?

What is hyperhidrosis?

Every day, the human body perspires to maintain constant internal body temperature. Perspiration is regulated by the Sympathetic Nervous System, which controls about five million sweat glands in the body. Sweating is controlled by branches of the sympathetic chain that is located within the chest cavity. Hyperhidrosis is a medical condition that causes perspiration far greater than the physiological needs of the body. Although no one knows why some individuals sweat excessively, it is known that the sweating is controlled by the sympathetic nervous system. Excessive sweating may be episodic or continuous.

You are about to go on a job interview, to church, or to meet someone new and you notice that your hands and underarms are sweating. Or, you’ve just completed an aerobic workout and your whole body is soaked in sweat. Your body (Sympathetic Nervous System) naturally secretes sweat to cool down the body. But, in some cases, up to 1% of the population has excessive sweating where the body (Sympathetic Nervous System) overworks to cool down the internal body temperature. The condition is known as hyperhidrosis.

Locations of hyperhidrosis

Hyperhidrosis can occur suddenly or continuously, in the four major areas: hands (palmar hyperhidrosis), armpits (axillary hyperhidrosis), feet (plantar hyperhidrosis), and face (facial hyperhidrosis).
palmar hyperhidrosis | axillary hyperhidrosis | plantar hyperhidrosis | facial hyperhidrosis

Symptoms of hyperhidrosis

Having palmar hyperhidrosis, axillary hyperhidrosis, plantar hyperhidrosis, and/or facial hyperhidosis is a profound and dramatic experience. It affects all aspects of life, including work and related professional activities, the activities of daily living and normal, interpersonal social actions.

Sweaty hands can occur while meeting someone for the first time, through nervousness or emotional distress. Even rubbing on a small amount of lotion can trigger palmar hyperhidrosis.

In severe palmar hyperhidrosis cases, sweat is seen to drip literally down from the hands. This is a condition which can be detected in early childhood. Patients with palmar hyperhidrosis disorder are constantly aware of their condition and think they have to live with it. Usually, the sweating of the hands is the most distressing manifestation of primary hyperhidrosis. The amount of sweating varies from moisture to actual dripping. Many patients report, also, that their hands feel cold and clammy.

Because hands are exposed in social and professional settings, many patients with Hyperhidrosis are self-conscious and may avoid social contact. They may be reluctant to shake hands or handle paperwork. Patients have even been embarrassed to hold the hands of those they love.

Axillary Hyperhidrosis, excessive sweating in the armpits, can cause embarrassing wet marks on shirts. People with this condition avoid many colors and fabrics which could show the sweat marks.

Plantar Hyperhidrosis refers to excessive sweating of the feet. It is a known cause of foot odor and athlete’s feet. The combination of palmar and plantar hyperhidrosis can create a problem for a driver because the moisture of the hands and feet can build up to make the steering wheel and foot pedals slippery; this, in turn, can cause a lack of control of the vehicle.

Facial Hyperhidrosis, sweating of the face, may be so profuse that it causes the person to be insecure, appearing overly-anxious, when this is not really the case. Along with facial sweating, someone could experience facial blushing, another embarrassing manifestation of the activity of the sympathetic nervous system.

Alternative Treatments of hyperhidrosis

Ointments or antiperspirants

This is the initial treatment for moderate or light hyperhidrosis. A product such as Drysol® is recommended. Doctors generally recommend applying it to problem areas after drying the skin completely. Wearing it only at bedtime and then washing it off in the morning with plain water reduces the chance of skin irritation. It is somewhat irritating and will stain clothing. Do not use a regular deodorant afterwards. Repeat the treatment, nightly, until the sweating is under control. After it begins to work, use once or twice, weekly, to maintain the effect, and use a regular deodorant on the other days. The medication is less effective on the thick skin of the palms and soles.Oral Anticholinergic Medication

Certain prescription oral medications can prevent the release of Acetylcholine, the neurotransmitter responsible for causing the eccrine sweat gland to go into overdrive. Robinul® is frequently recommended and easy to take, once per day. The negative side to this medicine is the list of potential side effects including dry mouth, blurred vision, constipation, urinary retention and palpitations.Iontopheresis

This treatment consists of electrical stimulation of the affected areas. The site of choice is submerged in water and electricity is emitted by the device. The intensity is gradually increased until the patient notices a tingling feeling, which some people find unpleasant. After several uses, the person will sweat less for four to six weeks. To really get it to work, it needs to be used one half hour every night, per site. Treatment is repeated until sweating is under control. Drionic® is the product recommended. The results may vary: in cases of light hyperhidrosis, some patients are happy, but others may consider the treatment too time-consuming and expensive.Injection

Another treatment is the injection of BOTOX® into the area of excessive sweating. People who find no relief from conventional drug treatment for the persistent problem of sweaty palms or underarms may get short-term improvement from injections of a potent bacterial toxin. Botulinum toxin type A is a powerful chemical that, in its diluted prescription form, BOTOX®, has been used safely in treating eye muscle disorders, wrinkles and other conditions. BOTOX® is nothing more than a protein that acts on the junction of the nerve and the muscle, making the muscle less active. It reduces sweating by blocking release of the chemical acetylcholine, which stimulates secretion of the sweat glands. When a small amount of BOTOX® is injected into the armpits or palms, it stops those areas from getting clammy and sweaty. BOTOX® injections, however, are only temporary and have to be repeated two to three times a year. In addition, they are painful and expensive. Some BOTOX® patients say the treatment has given them renewed self-confidence, while others think the whole process is not worth the trouble. Generally, BOTOX® injections are ineffective in cases of severe palmar or facial hyperhidrosis.

Surgical Treatment for Hyperhidrosis

Although alternative treatments such as oral medication, BOTOX®, Drysol® and Drionic® are available, the only long-lasting, effective treatment is to surgically stop the signal transmissions of the sympathetic nerve impulse to sweat glands. Basically, this can be achieved for all locations in the body such as palms, face, armpits, and feet. This procedure is known as Endoscopic Thoracoscopic Sympathectomy (ETS).The surgrical procedure and technique

The best person to perform Endoscopic Thoracic Sympathectomy (ETS) is a highly trained, experienced, thoracic surgeon.

The operation is performed on an outpatient basis while patient is under general anesthesia administered by a board-certified or board-eligible anesthesiologist. The sympathetic nerves are located along the back, just behind the ribs. The surgeon uses a scope with magnification and illumination provided by the camera to view the sympathetic nerves. The vascular surgeon cuts or clamps the sympathetic nerves of the  ganglion through two small incisions (5 to 10 mm) below the armpit area on each side of the chest. In the cutting method, the nerve is simply cut. These nerves are cut to stop or reduce the body’s ability to produce sweat in those identified problem areas. Our surgeons prefer this method over the clamping method. In the clamping method, metal clamps are applied on the nerve to stop the sweating from a particular section of the nerve; the success rate for this method is low. The procedure is performed bilaterally in the same session. After patients wake up from the anesthesia, they are moved to a recovery room, where they are carefully monitored, before being discharged to go home. Patients can return to work or school within several days. The procedure is extremely effective for palmar and axillary hyperhidrosis. The endoscopic technique is very safe and is curative in 98% of patients.Results

The primary indication for surgery was palmar hyperhidrosis (PH) in 302 of 309 patients (97.7%), although in 7 patients (2.3%) axillary hyperhidrosis (AH) was the primary indication.A family history was elicited in 74 of 132 (56.01%) and a provocative response to hand lotion was present in 101 of 132 (76.5%). Thoracoscopic sympathectomy afforded almost instantaneous cures for PH, with marked improvement in 100% for whom the sympathectomy was done. Of 180 patients prospectively questioned in detail, 173 (96.1%) had some degree of plantar hyperhidrosis. Of these, 148 (84.4%) had some improvement, with 70 (40.5%) achieving complete relief of the plantar hyperhidrosis. In 98 patients who had some complaints of AH, 68 (69.4%) were completely relieved with the AH, while 25 (25.5%) were relieved but not completely cured. In 7 patients, the primary indication for sympathectomy was AH and of these, 3 (42.9%) had complete relief, 2 (28.6%) had partial relief, and 2 (28.6%) had no relief. Of the entire series of 309 patients, 4 (1.3%) developed severe compensatory hyperhidrosis (CH). In 180 prospectively questioned patients, CH was present in 81 (45%).

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