What is Hyperhidrosis?
Hyperhidrosis is a disorder characterized by excessive sweating. It occurs in up to 1% of the population. It can involve the hands (palmar), armpits (axillary) and/or feet (plantar) The exact cause is unknown. We do know that sweating is controlled by the sympathetic nervous system.

Symptoms
The main symptom is excessive sweating of the hands, armpits and/or feet. This sweating is severe, often so severe that sweat drips from the hands onto clothing or computer keyboards and causing patients to have a cold wet handshake. It is sometimes caused by emotion, stress or exercise, but can occur spontaneously.

Treatment

Medical Treatment
Anticholinergic drugs or topical creams are inconvenient, unpleasant and the relief is temporary.

Iontophoresis (placing the hands in a bath through which an electrical current is passed) provides only short term relief (6 hours to 1 week).

Botox (botulinim toxin) treatment requires several injections in the palms or underarms to provide relief for 1 to 6 months.

Surgical Treatment
The surgical treatment of Hyperhidrosis involves cutting the sympathetic trunk. This is accomplished by a procedure called endoscopic thoracic sympathectomy (ETS) or thoracoscopic sympathectomy. General anesthesia is required for this procedure. Once asleep, 3 small incisions are made below the armpit. A telescope attached to a miniature video camera is passed through one incision. The sympathetic chain is identified. The other incisions are utilized to accommodate the surgical instruments. The lung is collapsed to allow the surgeon to maneuver. When the procedure is completed the lung is re-expanded and the incisions are closed. A small tube may be kept in place to allow evacuation of air from the chest, but this is usually removed within a few hours of surgery. After one side is completed the second side is approached in the same manner.
Patients are usually hospitalized for 12-24 hours and may require oral pain medication for 7-10 days.

Risks
There are certain risks to all surgical procedures. These include allergic reaction to anesthetic agents or infection at the site of operation. Damage to the artery, vein or nerves that run beneath each rib can occur. This can lead to bleeding or inflamation of the nerve and chronic irritation or pain. Older patients may be subject to additional risk of cardiac problems (heart attack, abnormal rhythm), stroke, pneumonia, blood clots, and urinary tract infections. The incidence of any of the above complications is very low (1% or less) but such problems can arise from any surgery and patients must be aware of all risks no matter how small.

Potential Side Effects
There are some potential side effects. Most common is "compensatory sweating" (50-60% of patients). This occurs when the body attempts to compensate for the decreased sweating in the upper chest, back and arms by increasing sweating on the face, abdomen, back, buttocks, thighs or feet.
A second potential side effect is gustatory sweating. This is an increase sweating with eating. This occurs in 5-10% of patients, but is rarely severe.
The third potential side effect is Horner’s syndrome (1%). This includes a slight droop of the eyelid, a small or narrow pupil and a lack of sweating on the side of the face. This syndrome is sometimes reversible, but can be permanent.

Chances of Success
ETS will cure approximately 95-98% of excessive hand hyperhidrosis and 75-80% of armpit hyperhidrosis.

Referrals to be evaluated for this treatment can be made to

Toll-free Information Line:
1-877-284-2000 Patient to Physician Access
1-800-538-7300 Physician to Physician Access

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This page was developed by Robin Macherey, RN
(rmachere@wpahs.org)