Hyperhidrosis
| Excessive Sweating Symptoms and Treatment
Overview
of hyperhidrosis
symptoms and treatment (misspelled hyperhydrosis)
options. Sweating
is necessary to control body temperature during times of exercise and
warm/hot surroundings. Sweating is regulated by the sympathetic nervous
system. In 0.6 to 1.0% of the population, this system is revved-up and
works at a very high level causing sweating to occur at inappropriate
times in specific areas of the body. This condition is known as hyperhidrosis.
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Classification
- Causes of hyperhidrosis can be primary or secondary
Regions of the body - scalp, facial
(face), palmar (hands), axillary
(armpits), truncal (trunk), plantar
(feet)
Primary or idiopathic hyperhidrosis
- Hyperhidrosis without a known
cause. A more frequent condition than secondary hyperhidrosis.
Localized commonly in the hands, armpits, scalp, face, and/or
feet. Starts during childhood or early adolesence, worsens during
puberty, and then persists for the rest of one's life. Nervousness
and psychiatric disorders are rarely the cause. The excessive sweating
is very embarrassing and social, professional, and intimate relationships
are often seriously affected. |
Secondary hyperhidrosis - Caused by
an underlying condition. Usually causes excess sweating of the entire
body, however. Some of these conditions are; endocrine disorders
such as hyperthyroidism, endocrine treatment for malignant disease, menopause,
obesity, psychiatric disorders, systemic malignant disease.
Manifestations of Primary Hyperhidrosis (Move
mouse over titles to see body regions)
Excessive sweating of the scalp and face. Commonly associated with moderate to
severe facial blushing as well. This condition often causes the individual
to become self-conscious and to develop a low self esteem.
Far and above the area of the body causing the most distressing condition.
The hands are used socially and professionally more than any other
part of the body. Excessively wet hands may even limit the
choice of one's profession. Avoiding social contact is common for
individuals with severe hyperhidrosis palmaris. Patients notice not
only that their hands feel very wet all the time, but also
feel cold. Some individuals have a bluish-purple discoloration
of their hands as well.
Sweating of the armpits causes large wet marks and staining on the
clothes. A strong body odor develops quickly which can cause very
negative emotional/psychological repercussions. Slightly more common
in females than males. The highest incidence occurs with people
of Asian and Jewish ancestry, but can affect all races.
Less frequent. May be associated with sweating of other areas of the body.
Excessive sweating of the feet. Can be associated with hyperhidrosis
of other areas of the body.
Symptoms
(Characteristics) Either
sudden onset or continuous sweating. Sweating
usually brought on by no apparent reason. Usually not aggravated by exercise.
Emotional stress, high ambient temperatures, and/or gustatory stimuli
are the most important aggravating factors. Hyperhidrosis usually improves
during the cold/cool months and worsens during hot/warm months. Sweating
usually stops during sleep. Hereditary (25% of individuals with hyperhidrosis
tend to have a family member with symptoms as well).
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Hyperhidrosis
Treatment - Secondary hyperhidrosis is treated by first
addressing the underlying disorder. If a patient is on hormonal therapy
then administration of an anti estrogen (ciproterone acetate) can give
relief to sweat attacks. Primary hyperhidrosis patients and secondary
hyperhidrosis patients experiencing moderate to severe sweating not relieved
otherwise may benefit from the following alternative
treatment modalities; Antiperspirants
(Drysol), Iontophoresis. Medications
(anti-cholinergics), Surgery.
Hyperhidrosis Surgery
- Known as endoscopic
sympathectomy (ETS), is the treatment of choice for severe hyperhidrosis. Interruption
of nerve impulses to sweat glands of the palms, face, axillae (armpits)
by cutting or electrocautery is called "Thoracic Sympathectomy".
The ganglia (nerve junctions) which lead to the sweat glands of the
palms, axillae, scalp and face are accessible through the chest (thoracic
cavity) because they travel along the side of the spine of the back. Using
a Micro Single Incision endoscopic technique, easy access to this area
requires only a single 1/12th inch incision per side. In the past,
a rib was removed or a large painful incision was required between
two ribs to provide access to this area. Some surgeons today make three
to four small incisions when performing endoscopic thoracic sympathectomy. Dr.
Nielson has applied state-of-the-art
technology to his endoscopic technique and he only makes a single 1/12th
inch incision per side.
ADVANTAGES of Micro
ETS™ are:
- Single 1/12th inch axillary incision per side
- Less intercostal nerve & chest muscle
trauma
- Less post-op pain
- Lungs are NOT collapsed
- Precise cut of sympathetic nerve that is much
less painful
- Nerve & ganglia are not removed
- Surrounding tissue is not disturbed
- T2 level cut only (T2/T3 for severe axillary
sweating)
- Kuntz nerve
 cut
if present
- Out-patient surgery (discharged the same day)
- No sutures required
- Rapid recovery
Operating time is short and postop pain and discomfort
minimal for patients who undergo this micro-incision technique. Improvement
is immediate for scalp, facial, palmar, and axillary hyperhidrosis.
Patients leave the operating room with dry scalp, face, hands, axillae. Excessive
sweating of the whole body and/or trunk cannot be treated surgically.
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