Hyperhidrosis

Hyperhidrosis is described as excessive sweating from the glands of the upper extremities, most pronounced in the hands and the armpit. This sweating may, in some cases, cause extreme embarrassment or discomfort and can result in significant social disability.

There are several options available to treat hyperhidrosis, but non-operative management has very limited success and is of short duration, if effective at all. Hyperhidrosis can be eliminated by undergoing a thoracic sympathectomy, which is division of the sympathetic nerves in the chest.

CLASSIFICATION AND CAUSES

There are two types of Hyperhidrosis:

A. Hyperhidrosis as part of an underlying condition (SECONDARY HYPERHIDROSIS)-This occurs when there is an existing condition that promotes excessive sweating involving the whole body such as:

• Hyperthyroidism or similar endocrine diseases
• Endocrine treatment for prostatic cancer or other types of malignant disease
• Severe psychiatric disorders
• Menopause

B. Hyperhidrosis without known cause (PRIMARY OR ESSENTIAL). This is a far more frequent condition than secondary and appears in one or several locations of the body (most often hands, feet, armpits or a combination of them). It usually starts during childhood or adolescence and persists throughout life. Nervousness and anxiety can elicit or aggravate sweating, but psychological/psychiatric disturbances are only rarely the cause of the disorder.

• Facial Hyperhidrosis - sweat pouring down from the forehead in conditions of stress
• Palmer Hyperhidrosis - excessive sweating of the hands is, generally, the most distressing condition. The hands are more exposed in social and professional activities than any other part of our body. Many individuals with this condition are limited in their choice of profession, unable to manipulate materials sensitive to humidity (paper) or are reluctant to shake hands; some patients may begin avoiding social contact. The degree of sweating varies and may range from moderate moisture to dripping. Most patients notice their hands feel not only moist, but also cold.
• Axillary Hyperhidrosis - Excessive sweating under arms.
• Plantar Hyperhidrosis - Excessive sweating on feet.
• Other Locations - Less frequently, it is located on the trunk, thighs and face.

TREATMENT FOR SECONDARY HYPERHIDROSIS

In Secondary Hyperhidrosis, the underlying condition should be treated first. Patients on hormonal therapy for prostatic cancer (castration, LHRH-analoges) with disturbing sweat attacks can get relief by the administration of antiestrogens (ciproterone acetate).

TREATMENT FOR PRIMARY HYPERHIDROSIS

These include:

Antiperspirants - usually recommended as the first therapeutic measure. The most effective agents appear to be the aluminum chloride (20-25%) in 70-90% alcohol, applied in the evenings 2-3 times/week.

Iontrophoresis - this method consists of applying low intensity electric current, supplied by a D/C generator, to the palms and/or soles immersed in an electrolyte solution. This procedure may not be applied to the face, trunk or thigh area.

Drugs - there are no specific drugs available to treat profuse sweating. Psychotrophic (mostly sedative) and/or anticholinergic drugs are often tested but show too many side-effects before any noticeable results can be achieved. Drugs are not usually recommended.

Psychotherapy - has little effect in the majority of patients. Psychological problems are in most cases a consequence of Hyperhidrosis, not the cause. This treatment cannot cure the disorder, only help the patient accept living with the problem.

Surgery - Patients with axillary Hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands. If sweating extends beyond the hairy portion of the axilla, several skin incisions may be needed, sometimes resulting in formation of hypertrophic and/or constrictive scars.

Sympathectomy - This treatment interrupts the nerve tracks and nodes (ganglia) which transmit the signals to sweat glands. Basically, this can be achieved for all locations in the body, but only the nerve nodes responsible for the sweat glands of the palms and the face are accessible without the need for major surgical procedure.

Endoscopic Thoracic Sympathectomy - Today, this is the treatment of choice for moderate to severe palmar and facial Hyperhidrosis (but also axillary, especially if combined with palmar sweating). This minimally invasive endoscopic technique has been developed in recent years on a few hospitals in Europe, superceding Conventional Thoracic Sympathectomy, a very invasive procedure performed in the past. The endoscopic procedure is very safe and leads to definitive cure in nearly 100% of patients, leaving only a minimal scar in the armpit.

The patient considering ETS should be aware that:

• Compensatory sweating may appear after ETS
• It is usually mild to moderate and well tolerable
• It cannot be predicted by any diagnostic means whether it will show up and how intense it will manifest itself
• If often has a tendency to decrease within the first 6-12 months
• There seems to be a relationship between the number of ganglia treated and the incidence and intensity of compensatory sweating
• Heavy compensatory sweating is relatively rare
• There is no reliable treatment for heavy compensatory sweating on the trunk
• It is almost irreversible if it persists for more than 1 year

Individuals with combined Hyperhidrosis of the palms and soles have a good chance to improve the sweating of their feet after an operation aiming to suppress sweating of the hands. Isolated plantar Hyperhidrosis can, however, only be cured by Lumbar Sympathectomy, an open abdominal procedure. Diffuse Hyperhidrosis of the trunk or general sweating of the whole body cannot be treated by surgery.

BAPTIST HEALTH Medical Center-Little Rock and Hugh Burnett, M.D., thoracic surgeon, are proud to offer Endoscopic Thoracic Sympathectomy treatment.

This procedure is performed on both sides during the same operation through two 5 millimeter incisions placed on the back and utilizing a 5 millimeter thoracoscope. This is usually done as an out-patient procedure and the relief of sweating is immediately apparent in the recovery room. It is long lasting in more than 95 percent of patients.

"Thoracic sympathectomy is a specialized treatment option not widely offered and because of this, we see patients from around the country. Their symptoms are alleviated completely in most cases after having this procedure," said Burnett.

Burnett is an experienced surgeon who has performed thoracic sympathectomy by open and thoracoscopic methods for 30 years. He is certified by the American Board of Surgery and the American Board of Thoracic Surgery.

OTHER TREATMENTS

Alternative Medicine - Includes homeopathy, massage, acupuncture and phytotherapeutic drugs-in almost all cases this showed no noticeable improvement in reducing symptoms.

Botulinum Toxin - This toxin has the ability to interfere with the effect of the transmitter substance acethylcholine at the synapses (contact point of a nerve ending with another nerve cell or a muscle) and leading to progressive paralysis of all muscles in the body, including the respiratory muscles. In extremely low doses, botulinus toxin has been adopted in cases with localized muscle hyperactivity, resulting in a reduction in transmitting impulses to the muscle. This treatments seems to work adequately in axillary Hyperhidrosis, lasting for 6-12 months depending on the dosage.