Hyperhydrosis is a condition in which the sweat glands are over-active, causing excessiveperspiration. 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 (palmarhyperhydrosis) and feet, but can also affect the axillae (armpits), face, scalp, groins, chest walland abdomen. The condition can cause severe social distress for the individual who has thecondition, preventing the sufferer from performing the most fundamental social functions, such asshaking hands, dining without a jacket, or wearing a sleeveless dress. The condition appears tobe caused by over-activity of the sympathetic nervous system, which controls the amount offormation of sweat, among other functions. Hyperhydrosis is frequently familial, or inherited. It iscommon for parents and children both to have the condition.
The treatment for hyperhydrosis depends upon the area that is primarily affected. For axillae andhands, the mainstay of conservative therapy has included topical treatments such as aluminumchloride (Drysol ™.) Because the sympathetic nervous system controls the amount ofperspiration, medical therapy has included beta blockers such as inderal, or anticholinergic drugssuch as Robinol, Ditropan, and Propanthelin. (These anticholinergic drugs also cause dry mouthand 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 thetherapy is expensive.
Palmar hyperhydrosis is the most common form of hyperhydrosis, and is most effectively treatedwith surgery. The surgery for palmar hyperhydrosis is known as ETS, for Endoscopic ThoracicSympathectomy. ETS is an outpatient procedure during which the surgeon inserts a tiny camerainside the chest. The camera is used to visualize the sympathetic nerves, and to direct a tinyinstrument to cut the nerves at two levels. This procedure stops the sympathetic nervousimpulses to the hands, and almost immediately stops the perspiration. Please see the articleelsewhere in this web site on thoracic sympathectomy.
Axillary hyperhydrosis is also treated effectively by ETS, especially when done in combination forpalmar 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 palmarhyperhydrosis. Many patients with plantar hyperhydrosis will improve with ETS for the palmarvariety.
Facial hyperhydrosis is more difficult to treat. Although facial symptoms can be improved withETS, the body uses the head to get rid of heat. When sweating of the head and face is reducedby ETS, the body’s “thermostat” sends signals to the chest and abdomen to increase the rate ofperspiration. This can result in severe compensatory hyperhydrosis of the abdomen and chest,creating patient dissatisfaction with the procedure. An alternative procedure, which clips the lowerone-third of the Stellate Ganglion, has been described for facial hyperhydrosis. In one report, theauthors claim that this procedure may have less risk of truncal hyperhydrosis. Surgery directly onthe 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 theganglion that has been treated. In one published series of 30 patients, there was no
Please see the ETS article in this web site for more detail.
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, thepalm of the hand immediately stops sweating. (Over time, the hand can actually become so drythat hand lotions are required.) In addition, the palm of the hand becomes flushed, or reddish incolor, because the blood vessels in the hand are now more dilated.
Bilateral sympathectomy can affect peak heart rate in some patients. Professional athletes shouldconsult with their physician carefully before having ETS performed.
The links below give general information on the conditions described above. The physicians ofThoracic Surgery Associates, PC, do not endorse these sites, nor is there any relationshipbetween these sites and Thoracic Surgery Associates, PC.
Books and 1. Lombardi E, Massai C, Orlandini D, Vierucci A. Patologia respiratoria associata Chapters of Books (Dal a dermatite atopica al ’asma/rinite). IN: Vierucci A, ed. “Edit-Symposia Al ergologia - Dal a dermatite al ’asma”. Editeam, Bologna, 2002;31-41. 2. Lombardi E, Orlandini D, Vierucci A. La patologia sibilante nel bambino. IN: Vierucci A, ed. “Al ergologia pediatr
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