Hyperhidrosis

Hyperhidrosis is a medical condition characterized by excessive sweating that is not necessarily related to heat or exercise.

This condition, which can significantly impact daily life and emotional well-being, affects about 2-3% of people.

Hyperhidrosis can affect different parts of the body, including the palms, feet, face and scalp. Sweating from hyperhidrosis is more than the usual amount of sweat someone would experience from heat or movement. This extra sweating can create discomfort and social and emotional difficulties.

Hyperhidrosis is a manageable condition with a variety of treatment options available.

Symptoms

Symptoms of hyperhidrosis include visible sweating, which can affect various parts of the body such as hands, feet, underarms, and face.

Many patients experience social anxiety and skin irritation due to persistent wetness.

Risk factors and genetic factors

While the exact cause of primary hyperhidrosis is not well understood, it often runs in families, suggesting a genetic component.

Secondary hyperhidrosis can be attributed to underlying conditions like thyroid problems, diabetes or infections.

Screening

Diagnosis typically involves a physical examination and a review of your medical history. Tests like the starch-iodine test or thermoregulatory sweat test may be employed to confirm hyperhidrosis.

Treatment options

A variety of treatment options are available, tailored to the patient’s needs, ranging from medications to surgical interventions.

At-home treatment

For some people, managing hyperhidrosis at home is enough. You can manage symptoms by:

• Using antiperspirants and deodorants
• Showering or bathing more often
• Wearing breathable, absorbent clothing

Medications

Commonly prescribed medications include:

• Antiperspirants
• Anticholinergics
• Beta-blockers

These aim to reduce sweat production and manage symptoms effectively.

Treatment therapies

For those who do not respond to medication, treatments and procedures such as botulinum toxin injections, iontophoresis, or thoracic sympathectomy may be options.

• Botulinum toxin: Injections to overactive nerves can stop sweat production for months. Repeat injections are necessary.
• Iontophoresis: During this therapy, you put your hands or feet in water. A low electrical current is emitted through the water, blocking sweat glands. Repeat treatments may be necessary.

Surgical care

Sympathectomy

During this minimally invasive procedure, a surgeon cuts a nerve that controls the sweat glands.

Video-assisted thoracic surgery (VATS) sympathectomy is an operation to remove a specific portion of the main sympathetic (sweating) nerve.

The operation, which removes about three to four inches of nerves that control the sweat glands, doesn’t affect the patient’s muscle function or sensation but greatly reduces sweating in the hands and/or the armpits.

Day of surgery

On the day of surgery, patients can expect a pre-operative consultation, followed by the procedure itself, which is typically minimally invasive. Our surgeons at WashU Medicine are renowned for their skill and experience, ensuring the highest standard of care.

Recovery

After surgery, patients may experience mild discomfort, which can be managed with prescribed pain relievers.

Our team provides detailed instructions to ensure a smooth recovery. Follow-up appointments will be scheduled to monitor progress and address any concerns.

Potential complications

The most common potential side effect of the VATS sympathectomy is compensatory sweating, which occurs in up to 60 percent of patients.

Although the operation prevents sweating in the hands and/or the armpits, it is possible that patients will notice more sweating on their backs, legs and other regions of their bodies.

This compensates for lack of sweating in the upper extremities.

Most patients, even those who have compensatory sweating, report satisfaction with the results of this surgery.

Preventative measures and long-term management

Preventative measures such as maintaining good hygiene, using moisture-wicking clothing, and stress management can help manage hyperhidrosis.

Although recurrence is rare after surgery, ongoing medication might be necessary for some patients. Our team is committed to providing long-term support for all our patients.