Treatment for Hyperhidrosis

Jan 11, 2018

Hyperhidrosis is pathological sweating which can occur anywhere in the body but typically affects the palms and axillae. It is caused by a dysregulation in the sympathetic nervous system and may be idiopathic or have a secondary cause such as hyperthyroidism. It can be an extremely debilitating medical condition and can severely impact upon a person’s work and lifestyle.

Hyperhidrosis may present with excess sweating for more than 6 months when 2 or more of the following is applied:

• Bilateral symmetrical sweating
• Impairment of daily activities
• At least one episode per week
• Onset before 25 years of age
• Positive family history
• Focal sweating that ceases during sleep

Treatment options

There are non-surgical treatments including:

• Antiperspirants
• Iontophoresis
• Botox
• Sweat gland ablation
• Medications (e.g. Anticholinergics)

When the treatments listed above are not working, there is the option of surgery.

Thorascopic sympathectomy is a definitive procedure to treat essential palmar and axillary hyperhidrosis. It is safe and effective, involving ablation of the thoracic ganglia responsible for palmar or axillary hyperhidrosis. It has a very high success rate.

The procedure is minimally invasive and involves the insertion of two small ports within the chest cavity. A camera is used to enable the visualisation of the bundle of nerves known as the sympathetic chain. These nerves control the sweating reflex. Division of the nerves is achieved using cautery.

For palmar hyperhidrosis ablation is at the level of T2-T3. For axillary hyperhidrosis, ablation is at T3-T4. If the patient suffers from both palmar and axillary hyperhidrosis then levels T2 to T4 are ablated.

While most patients can undergo thorascopic sympathectomy, there are a number of contraindications that should be considered.

These include:

• Previous chest surgery
• Conditions that cause pleural adhesions or scarring

Recovery

The procedure is usually performed as a day procedure or with an overnight stay in hospital. The most common complication is compensatory sweating; this usually resolves spontaneously, although the time frame is variable and may take several months. Rare complications include pneumothorax and Horner’s syndrome.

Results

Best results and levels of satisfaction for thorascopic sympathectomy are obtained in patients with palmar hyperhidrosis. However, good results can also be obtained in patients with axillary hyperhidrosis.

References

Solish N, Bertucci V, Dansereua A, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007;33:908–23

Haider A, Solish N. Focal hyperhidrosis: diagnosis and management. Can Med Assoc J 2005;172:69–75.

Dr Tam Nguyen
Vascular Surgeon

Vascular Care Centre
Suites 1 & 2, 310 Crown Street
Wollongong NSW 2500
P: 02 4226 9333
F: 02 42294006