Hyperhydrosis
What is it?
Hyperhydrosis is a condition in which the sweat
glands are over-active, causing excessive perspiration. The degree
of perspiration can be so severe that the palms of the hands weep
fluid, or the axillae are constantly wet. The condition most frequently
affects the hands (palmar hyperhydrosis) and feet, but can also
affect the axillae (armpits), face, scalp, groins, chest wall
and abdomen. The condition can cause severe social distress for
the individual who has the condition, preventing the sufferer
from performing the most fundamental social functions, such as
shaking hands, dining without a jacket, or wearing a sleeveless
dress. The condition appears to be caused by over-activity of
the sympathetic nervous system, which controls the amount of formation
of sweat, among other functions. Hyperhydrosis is frequently familial,
or inherited. It is common for parents and children both to have
the condition.
Non-surgical therapy
The treatment for hyperhydrosis depends upon the area that is
primarily affected. For axillae and hands, the mainstay of conservative
therapy has included topical treatments such as aluminum chloride
(Drysol ™.) Because the sympathetic nervous system controls
the amount of perspiration, medical therapy has included beta
blockers such as inderal, or anticholinergic drugs such as Robinol,
Ditropan, and Propanthelin. (These anticholinergic drugs also
cause dry mouth and altered heart rate.) There is a topical form
of Robinol that is available for facial hyperhydrosis.
Botox injections have come into vogue for many conditions, including
axillary hyperhydrosis. Although Botox is somewhat effective in
the axillae, the duration of success is short, and the therapy
is expensive.
Surgical therapy
Palmar hyperhydrosis is the most common form of hyperhydrosis,
and is most effectively treated with surgery. The surgery for
palmar hyperhydrosis is known as ETS, for Endoscopic Thoracic
Sympathectomy. ETS is an outpatient procedure during which the
surgeon inserts a tiny camera inside the chest. The camera is
used to visualize the sympathetic nerves, and to direct a tiny
instrument to cut the nerves at two levels. This procedure stops
the sympathetic nervous impulses to the hands, and almost immediately
stops the perspiration. Please see the article elsewhere in this
web site on thoracic sympathectomy.
Axillary hyperhydrosis is also treated effectively by ETS, especially
when done in combination for palmar hyperhydrosis. Alternative
surgical procedures are available for axillary hyperhydrosis,
including a liposuction technique that removes the axillary sweat
glands (Dr. Pnini, www.sweaty-armpit.com).
Plantar hyperhydrosis (excessive sweating of the feet) is most
commonly associated with palmar hyperhydrosis. Many patients with
plantar hyperhydrosis will improve with ETS for the palmar variety.
Facial hyperhydrosis is more difficult to treat. Although facial
symptoms can be improved with ETS, the body uses the head to get
rid of heat. When sweating of the head and face is reduced by
ETS, the body’s “thermostat” sends signals to
the chest and abdomen to increase the rate of perspiration. This
can result in severe compensatory hyperhydrosis of the abdomen
and chest, creating patient dissatisfaction with the procedure.
An alternative procedure, which clips the lower one-third of the
Stellate Ganglion, has been described for facial hyperhydrosis.
In one report, the authors claim that this procedure may have
less risk of truncal hyperhydrosis. Surgery directly on the Stellate
Ganglion carries a significant risk of Horner’s Syndrome.
Horner’s Syndrome is a neurological syndrome consisting
of ptosis of the eyelid and dilation of the pupil on the side
of the ganglion that has been treated. In one published series
of 30 patients, there was no case of Horner’s.
Technique of ETS
Please see the ETS article
in this web site for more detail. Side effects of ETS
The sympathetic nervous system affects many of the body’s
functions, including blood pressure, blood vessel tone, heart
rate, and pain sensation. When ETS is performed for hyperhydrosis,
the palm of the hand immediately stops sweating. (Over time, the
hand can actually become so dry that hand lotions are required.)
In addition, the palm of the hand becomes flushed, or reddish
in color, because the blood vessels in the hand are now more dilated.
Bilateral sympathectomy can affect peak heart rate in some patients.
Professional athletes should consult with their physician carefully
before having ETS performed. Educational resources
The links below give general information on the conditions described
above.
The physicians of Thoracic Surgery Associates, PC, do not endorse
these sites, nor is there any relationship between these sites
and Thoracic Surgery Associates, PC.
www.sweaty-palms.com
www.sweaty-armpit.com
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