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Watch Video - Hyperhidrosis Explained by Dr. Nielson
 
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Hyperhidrosis - Treatment Options, Excessive Sweating Symptoms



Overview of hyperhidrosis symptoms and treatment (misspelled hyperhydrosis) options.   Sweating is necessary to control body temperature during times of exercise and in 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.

Classification
Causes of hyperhidrosis can be primary or secondary

Regions of the body affected
Scalp, facial (face), neck, 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, neck 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 impairing to almost everything one does during the day.  It is embarrassing and makes it hard to  focus on the "task at hand"  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, diabetes, endocrine treatment for malignant disease, menopause, obesity, psychiatric disorders, systemic malignant disease, to list a few.

Manifestations of Primary Hyperhidrosis

Click to Enlarge
RESULTS MAY VARY FROM PERSON TO PERSON.
Severe Hand Sweating. Patient from Texas.
Before
Severe Hand Sweating.
After
Hand Sweat Reduced.
sweat diagram body regions

Scalp or Head/Face/Neck Hyperhidrosis and Blushing
Excessive sweating of the scalp, face, neck. Commonly associated with moderate to severe blushing and burning of the face as well. This condition often causes the individual to become self-conscious and to develop a low self esteem.  The person tries to cope by avoiding these difficult situations and circumstances.

Palmar or Hand Sweating Hyperhidrosis
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, but also feel cold too.  Some individuals have a bluish-purple discoloration of their hands and fingers as well.

Axillary or Armpit Hyperhidrosis
Minimally Invasive!  An option for underarm sweating treatment called Micro ETS   Learn More
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.

hand skin peeling

Click Image to Enlarge
Peeling skin, or sweat blisters, are an example of how excessively sweaty hands can affect the skin and a person's confidence.

Truncal/Thigh or Torso/Leg Hyperhidrosis
Less frequent. May be associated with sweating of other areas of the body.

Plantar or Foot Hyperhidrosis
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).

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 thoracic sympathectomy (ETS), is the treatment of choice for severe hyperhidrosis.  Interruption of nerve impulses to sweat glands of the palms, face, neck, 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, face, neck are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back right behind the lungs. Dr David Nielson developed Micro ETS, a much less invasvie and more precise procedure.  Dr David Nielson performs Micro ETS through a single 1/12th inch axillary incision per side, without collapse of the lungs nor digging (dissecting) the sympathetic nerve out from the inner chest wall tissue to find the nerve, but rather, using the tips of the micro endoshears which are 2 mm (1/12th inch) in diameter, the sympathetic nerve is precisely divided where it crosses the 2nd rib head without injury to the sympathetic nervous system above so that Horner's Syndrome (drooping of the upper eyelid) doesn't occur. Tissue is hardly disturbed so recovery is fast and risk is minimal.

Many surgeons perform ETS through two to three incisions per side, and each incision is much larger, collapse the lungs and disset out the nerve from the inner chest wall tissue which can cause bleeding, more pain, Horner's Syndrome, etc.

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 much less invasive endoscopic technique and he only makes a single 1/12th inch incision per side.

Click to Enlarge
RESULTS MAY VARY FROM PERSON TO PERSON.
Severe Facial Sweating. Patient from New Jersey.
Before
Severe Facial Sweating.
After
Symptoms Resolved.

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 using the tips of the micro endo scissors is much less painful
    • Nerve & ganglia are not removed
    • Surrounding tissue is not disturbed in order to find the nerve, so Horner's Syndrome (drooping of the upper lid) doesn't occur.
    • Sweating of the face/scalp/neck and Blushing/burning of the face can be improved by stopping all nerve signal precisely at the 2nd rib level.
    • Sweating of the hands completely ceases and the fingers become warm immediately after the nerve signal transmission is stopped at the 2nd rib level.
  • T2 level cut only (T2/T3/T4 for severe axillary sweating)
  • Kuntz nerve Videos Dr David H Nielson Micro ETS cut if present
  • Out-patient surgery (discharged a few hours after)
  • No sutures required
  • Rapid recovery
Contact Dr David H Nielson  

Operating time is short, postoperative pain and discomfort are minimal for patients who undergo this micro-incision technique "Micro ETS".  Improvement is seen immediately for Hyperhidrosis of the scalp, face, neck, hands, axillae and Blushing/burning of the face/neck.  Hands/fingers become warm as well. Patients leave the operating room with a dry scalp, face, neck, hands, and axillae.    Excessive sweating of the whole body and/or trunk cannot be treated surgically.

Please contact us for more information on hyperhidrosis: Call 210-490-7464   Email info@dhnmd.com  or Submit a questionnaire.


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