Hyperhidrosis
Encyclopedia
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.
s, feet
, armpits, and the groin
area are among the most active regions of perspiration due to the relatively high concentration of sweat gland
s; however, any part of the body may be affected.
Hyperhidrosis can also be classified depending by onset, congenital or acquired. Primary hyperhidrosis is found to start during adolescence or even before and seems to be inherited as an autosomal dominant genetic trait. Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The latter form may be due to a disorder of the thyroid
or pituitary gland, diabetes mellitus
, tumors, gout
, menopause
, certain drugs, or mercury poisoning
.
Hyperhidrosis may be also divided into palmoplantar
(symptomatic sweating of primarily the hands or feet), gustatory
and generalized hyperhidrosis
.
Alternatively, hyperhidrosis may be classified according to the amount of skin that is affected and its possible causes. In this approach, excessive sweating in an area that is greater than 100 cm2 (up to generalized sweating of the entire body) is differentiated from sweating that affects only a small area.
or excitement
can exacerbate the situation for many sufferers. Other factors can play a role; certain food
s and drink
s, nicotine
, caffeine
, and smells
can trigger a response.
A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous
.
Hyperhidrosis of a relatively large area (>100 square cm or generalized)
Hyperhidrosis of relatively small area (<100 square cm)
is used in regular antiperspirants. However, hyperhidrosis sufferers need solutions with a much higher concentration to effectively treat the symptoms of the condition. These antiperspirant solutions are especially effective for treatment of axillary hyperhidrosis. Normally it takes around three to five days to see the results. The main secondary effect is irritation of the skin. For severe cases of plantar and palmar hyperhidrosis there is some success using conservative measures such as aluminium chloride antiperspirants.
Injections of botulinum toxin
type A, going by the brand name of Botox or Dysport, are used to disable the sweat glands.. The effects can last from 4–9 months depending on the site of injections. This procedure used for underarm sweating has been approved by the U.S.
Food and Drug Administration
(FDA).
Several anticholinergic
drugs reduce hyperhidrosis. Oxybutynin
(brand name Ditropan) is one that has shown promise. although it has important side effect
s, which include drowsiness, visual symptoms and dryness in the mouth and other mucous membranes. A time release version of the drug is also available (Ditropan XL), with purportedly reduced effectiveness. Glycopyrrolate
(Robinul) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin and has similar side-effects. Other anticholinergic agents that have been tried include propantheline bromide
(Probanthine) and benztropine
(Cogentin).
Antidepressant
s and anxiolytic
s were formerly used on the belief that primary hyperhidrosis was related to an anxious personality style
.
The other main surgical option is endoscopic thoracic sympathectomy
(ETS), which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that runs alongside the spine. Clamping is intended to permit the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery". Satisfaction rates above 80% have been reported, and are higher for children. The procedure causes relief of excessive hand sweating in about 85-95% of patients. ETS may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating; however, patients with facial blushing and/or excessive facial sweating experience higher failure rates, and patients may be more likely to experience unwanted side effects, although this has not been established in a controlled trial or independent study.
ETS side effects have been described as ranging from trivial to devastating. The most common secondary effect of ETS is compensatory sweating, sweating in different areas than prior to the surgery. Major drawbacks related to compensatory sweating are seen in 20-80%. Most people find the compensatory sweating to be tolerable while 1-51% claim that their quality of life decreased as a result of compensatory sweating
." Total body perspiration in response to heat has been reported to increase after sympathectomy.
Additionally, the original sweating problem may recur due to nerve regeneration, sometimes within 6 months of the procedure.
Other side effects include Horner's Syndrome
(about 1%), gustatory sweating (less than 25%) and on occasion very dry hands (sandpaper hands). Some patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise; leading to an impairment of the heart rate to workload relationship.
Lumbar sympathectomy
is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. With this procedure the sympathetic chain in the lumbar region is clipped or divided in order to relieve the severe or excessive foot sweating. The success rate is about 90% and the operation should be carried out only if patients first have tried other conservative measures.
This type of sympathectomy is no longer considered controversial in regards to hypotension and retrograde ejaculation.
The issues of retrograde ejaculation, inability to maintain erection and hypertension are not validated. In separate 2007 and 2010 papers none of the patients experienced sexual dysfunction.
Percutaneous sympathectomy is a related minimally invasive procedure in which the nerve is blocked by an injection of phenol
. The procedure allows for temporary relief in most cases. Some medical professionals advocate the use of this more conservative procedure before the permanent surgical sympathectomy.
is a new procedure of non-invasive delivery of controlled electromagnetic energy to the region where the sweat glands reside. The energy generates heat which results in thermolysis of the sweat glands. At the same time, a continuous hydro-ceramic cooling system protects the superficial dermis and keeps heat at the level of the sweat glands. Because sweat glands do not regenerate after treatment, the results are lasting.
Iontophoresis
was originally described in the 1950s, and its exact mode of action remains elusive to date. The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. Some people have seen great results while others see no effect. The device can be painful (pain is usually limited to small wounds and over time the body adjusts to the procedure) and the process is time-consuming. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.
Hypnosis
has been used with some success in improving the process of administering injections for the treatment of hyperhidrosis . Absorbent shoe insoles decrease the sweat in shoes. Relaxation and meditation
and weight loss have also been proposed to be of help.
Affected people are constantly aware of their condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks become impossible chores, which can psychologically drain these individuals.
Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating. Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.
Some careers present challenges for hyperhidrosis sufferers. For example, careers that require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Those in careers that require federal background checks (such as education), may encounter difficulty with some methods of fingerprint scanning used by law enforcement agencies. Employees, such as sales staff, who interact with many new people can be negatively affected by social rejection. It is extremely frustrating whenever a sufferer touches or holds something on the sales display, it has to be wiped clean each and every time they come in contact with it as it leaves a lot of sweat marks. The risk of dehydration
can limit the ability of some sufferers to function in extremely hot (especially if also humid) conditions. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands.
predisposition.
In 2006, researchers of Saga University in Japan reported that primary palmar hyperhidrosis locus maps to 14q11.2-q13.
Classification
Hyperhidrosis can either be generalized or localized to specific parts of the body. HandHand
A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs...
s, feet
Foot
The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws...
, armpits, and the groin
Groin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
area are among the most active regions of perspiration due to the relatively high concentration of sweat gland
Sweat gland
Sweat glands, or sudoriferous glands, are small tubular structures of the skin that produce sweat. There are two kinds of sweat glands:...
s; however, any part of the body may be affected.
Hyperhidrosis can also be classified depending by onset, congenital or acquired. Primary hyperhidrosis is found to start during adolescence or even before and seems to be inherited as an autosomal dominant genetic trait. Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The latter form may be due to a disorder of the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
or pituitary gland, diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, tumors, gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
, menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
, certain drugs, or mercury poisoning
Mercury poisoning
Mercury poisoning is a disease caused by exposure to mercury or its compounds. Mercury is a heavy metal occurring in several forms, all of which can produce toxic effects in high enough doses...
.
Hyperhidrosis may be also divided into palmoplantar
Palmoplantar hyperhidrosis
Palmoplantar hyperhidrosis is excessive sweating usually localized to the palms, soles, and/or axillae, and may be worse during warm temperatures....
(symptomatic sweating of primarily the hands or feet), gustatory
Gustatory hyperhidrosis
Gustatory hyperhidrosis is excessive sweating that certain individuals regularly experience on the forehead, upper lip, perioral region, or sternum a few moments after eating spicy foods, tomato sauce, chocolate, coffee, tea, or hot soups....
and generalized hyperhidrosis
Generalized hyperhidrosis
Generalized hyperhidrosis is excessive sweating that may be induced by febrile diseases, vigorous exercise, or a hot, humid environment, such as a tropical milieu....
.
Alternatively, hyperhidrosis may be classified according to the amount of skin that is affected and its possible causes. In this approach, excessive sweating in an area that is greater than 100 cm2 (up to generalized sweating of the entire body) is differentiated from sweating that affects only a small area.
Cause
The cause of primary hyperhidrosis is unknown, although some surgeons claim that it is caused by sympathetic overactivity. NervousnessAnxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
or excitement
Pleasure
Pleasure describes the broad class of mental states that humans and other animals experience as positive, enjoyable, or worth seeking. It includes more specific mental states such as happiness, entertainment, enjoyment, ecstasy, and euphoria...
can exacerbate the situation for many sufferers. Other factors can play a role; certain food
Food
Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals...
s and drink
Drink
A drink, or beverage, is a liquid which is specifically prepared for human consumption. In addition to fulfilling a basic human need, beverages form part of the culture of human society.-Water:...
s, nicotine
Nicotine
Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
, caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, and smells
Odor
An odor or odour is caused by one or more volatilized chemical compounds, generally at a very low concentration, that humans or other animals perceive by the sense of olfaction. Odors are also commonly called scents, which can refer to both pleasant and unpleasant odors...
can trigger a response.
A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous
Positive feedback
Positive feedback is a process in which the effects of a small disturbance on a system include an increase in the magnitude of the perturbation. That is, A produces more of B which in turn produces more of A. In contrast, a system that responds to a perturbation in a way that reduces its effect is...
.
Hyperhidrosis of a relatively large area (>100 square cm or generalized)
- In people with a past history of spinal cord injuries
- Autonomic dysreflexiaAutonomic dysreflexiaAutonomic dysreflexia, "AD" also known as "autonomic hyperreflexia or Hyperreflexia, is a potentially life threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal...
- Orthostatic hypotensionOrthostatic hypotensionOrthostatic hypotension, also known as postural hypotension, orthostasis, and colloquially as head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg, and may be...
- Posttraumatic syringomyelia
- Autonomic dysreflexia
- Associated with peripheral neuropathies
- Familial dysautonomiaFamilial dysautonomiaFamilial dysautonomia is a disorder of the autonomic nervous system which affects the development and survival of sensory, sympathetic and some parasympathetic neurons in the autonomic and sensory nervous system resulting in variable symptoms including: insensitivity to pain, inability to produce...
(Riley-Day syndrome) - Congenital autonomic dysfunction with universal pain loss
- Exposure to cold, notably associated with cold-induced sweating syndrome
- Familial dysautonomia
- Associated with probable brain lesions
- Episodic with hypothermiaHypothermiaHypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
(Hines and Bannick syndrome) - Episodic without hypothermia
- Olfactory
- Episodic with hypothermia
- Associated with intrathoracic neoplasms or lesions
- Associated with systemic medical problems
- PheochromocytomaPheochromocytomaA pheochromocytoma or phaeochromocytoma is a neuroendocrine tumor of the medulla of the adrenal glands , or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually noradrenaline , and adrenaline to a lesser extent...
- Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
- Thyrotoxicosis
- Diabetes mellitusDiabetes mellitusDiabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
- Congestive heart failureCongestive heart failureHeart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...
- AnxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
- Menopausal state
- Due to drugsDRUGSDestroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
or poisoning - Night sweats
- Compensatory
- Associated with toxins
- Infantile acrodynia induced by chronic low-dose mercury exposure, leading to elevated catecholamine accumulation and resulting in a clinical picture resembling pheochromocytomaPheochromocytomaA pheochromocytoma or phaeochromocytoma is a neuroendocrine tumor of the medulla of the adrenal glands , or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually noradrenaline , and adrenaline to a lesser extent...
.
- Infantile acrodynia induced by chronic low-dose mercury exposure, leading to elevated catecholamine accumulation and resulting in a clinical picture resembling pheochromocytoma
Hyperhidrosis of relatively small area (<100 square cm)
- Idiopathic unilateral circumscribed hyperhydrosis
- Reported association with:
- Blue rubber bleb nevus
- Glomus tumorGlomus tumorA glomus tumor is a rare benign neoplasm arising from the glomus body...
- POEMS syndromePOEMS syndromePOEMS syndrome is a rare medical syndrome. It is defined as the combination of a plasma-cell proliferative disorder , polyneuropathy, and effects on many other organ systems. It begins in middle age – the average age at onset is 50 – and affects up to twice as many men as women...
- Burning feet syndromeBurning Feet SyndromeBurning feet syndrome, also known as Grierson-Gopalan syndrome, is a medical condition that causes severe burning and aching of the feet, hyperesthesia, and vasomotor changes of the feet that leads to excessive sweating. It can even affect the eyes, causing scotoma and amblyopia...
(Goplan's) - Trench footTrench footTrench foot is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. It is one of many immersion foot syndromes...
- Causalgia
- PachydermoperiostosisPachydermoperiostosisPachydermoperiostosis or Primary hypertrophic osteoathropathy is a rare genetic disorder that affects both bones and skin. Other names are idiopathic hypertrophic osteoarthropathy or Touraine-Solente-Gole syndrome...
- Pretibial myxedemaPretibial myxedemaPretibial myxedema is an infiltrative dermopathy, resulting as a rare complication of Graves' disease, with an incidence rate of about 1-4% in patients.-Presentation:...
- Gustatory sweating associated with:
- EncephalitisEncephalitisEncephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...
- SyringomyeliaSyringomyeliaSyringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in pain, paralysis, weakness, and stiffness in the back, shoulders, and...
- Diabetic neuropathies
- Herpes zoster (shingles)
- ParotitisParotitisParotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.-Infectious parotitis:...
- Parotid abscesses
- Thoracic sympathectomy
- Auriculotemporal or Frey's syndromeFrey's syndromeFrey's syndrome is a food related syndrome which can be congenital or acquired specially after parotid surgery and can persist for life.The symptoms of Frey's syndrome are redness and sweating on the cheek area adjacent to the ear...
- Encephalitis
- Miscellaneous
- Lacrimal sweating (due to postganglionic sympathetic deficit, often seen in Raeder's syndrome)
- Harlequin syndromeHarlequin syndromeHarlequin syndrome is a condition characterized by asymmetric sweating and flushing on the upper thoracic region of the chest, the neck, and the face. It is caused by sustaining an injury to the sympathetic nervous system,the part of the nervous system that reacts to stress and flight-or-fight...
- Emotional hyperhydrosis
Medications
Aluminium chlorideAluminium chloride
Aluminium chloride is the main compound of aluminium and chlorine. It is white, but samples are often contaminated with iron trichloride, giving it a yellow colour. The solid has a low melting and boiling point. It is mainly produced and consumed in the production of aluminium metal, but large...
is used in regular antiperspirants. However, hyperhidrosis sufferers need solutions with a much higher concentration to effectively treat the symptoms of the condition. These antiperspirant solutions are especially effective for treatment of axillary hyperhidrosis. Normally it takes around three to five days to see the results. The main secondary effect is irritation of the skin. For severe cases of plantar and palmar hyperhidrosis there is some success using conservative measures such as aluminium chloride antiperspirants.
Injections of botulinum toxin
Botulinum toxin
Botulinum toxin is a protein produced by the bacterium Clostridium botulinum, and is considered the most powerful neurotoxin ever discovered. Botulinum toxin causes Botulism poisoning, a serious and life-threatening illness in humans and animals...
type A, going by the brand name of Botox or Dysport, are used to disable the sweat glands.. The effects can last from 4–9 months depending on the site of injections. This procedure used for underarm sweating has been approved by the U.S.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA).
Several anticholinergic
Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
drugs reduce hyperhidrosis. Oxybutynin
Oxybutynin
Oxybutynin is an anticholinergic medication used to relieve urinary and bladder difficulties, including frequent urination and inability to control urination , by decreasing muscle spasms of the bladder. It competitively antagonizes the M1, M2, and M3 subtypes of the muscarinic acetylcholine...
(brand name Ditropan) is one that has shown promise. although it has important side effect
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s, which include drowsiness, visual symptoms and dryness in the mouth and other mucous membranes. A time release version of the drug is also available (Ditropan XL), with purportedly reduced effectiveness. Glycopyrrolate
Glycopyrrolate
Glycopyrrolate is a medication of the muscarinic anticholinergic group. It does not cross the blood brain barrier and consequently has no to few central effects. It is a synthetic quaternary amine...
(Robinul) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin and has similar side-effects. Other anticholinergic agents that have been tried include propantheline bromide
Propantheline bromide
Propantheline bromide is an antimuscarinic agent used for the treatment of excessive sweating , cramps or spasms of the stomach, intestines or bladder, and involuntary urination . It can also be used to control the symptoms of irritable bowel syndrome and similar conditions...
(Probanthine) and benztropine
Benztropine
Benzatropine , also known as benztropine , is an anticholinergic marketed under the trade name Cogentin which is used in the treatment of Parkinson's disease, parkinsonism, akathisia, and dystonia.- Indications :...
(Cogentin).
Antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s and anxiolytic
Anxiolytic
An anxiolytic is a drug used for the treatment of anxiety, and its related psychological and physical symptoms...
s were formerly used on the belief that primary hyperhidrosis was related to an anxious personality style
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...
.
Surgical procedures
Sweat gland removal or destruction is one surgical option available for axillary hyperhidrosis. There are multiple methods for sweat gland removal or destruction such as sweat gland suction, retrodermal currettage, and axillary liposuction, Vaser, or Laser Sweat Ablation. Sweat gland suction is a technique adapted from liposuction, in which approximately 30% of the sweat glands are removed, with a proportionate reduction in sweat.The other main surgical option is endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy is a surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. ETS is used to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar...
(ETS), which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that runs alongside the spine. Clamping is intended to permit the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery". Satisfaction rates above 80% have been reported, and are higher for children. The procedure causes relief of excessive hand sweating in about 85-95% of patients. ETS may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating; however, patients with facial blushing and/or excessive facial sweating experience higher failure rates, and patients may be more likely to experience unwanted side effects, although this has not been established in a controlled trial or independent study.
ETS side effects have been described as ranging from trivial to devastating. The most common secondary effect of ETS is compensatory sweating, sweating in different areas than prior to the surgery. Major drawbacks related to compensatory sweating are seen in 20-80%. Most people find the compensatory sweating to be tolerable while 1-51% claim that their quality of life decreased as a result of compensatory sweating
Compensatory hyperhidrosis
Compensatory hyperhidrosis is a form of neuropathy. It is encountered in patients with myelopathy, thoracic disease, cerebrovascular disease, nerve trauma or after surgeries. The exact mechanism of the phenomenon is poorly understood. It is attributed to the perception in the hypothalamus that the...
." Total body perspiration in response to heat has been reported to increase after sympathectomy.
Additionally, the original sweating problem may recur due to nerve regeneration, sometimes within 6 months of the procedure.
Other side effects include Horner's Syndrome
Horner's syndrome
Horner's syndrome is the combination of drooping of the eyelid and constriction of the pupil , sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present...
(about 1%), gustatory sweating (less than 25%) and on occasion very dry hands (sandpaper hands). Some patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise; leading to an impairment of the heart rate to workload relationship.
Lumbar sympathectomy
Sympathectomy
A Sympathectomy is a procedure during which at least one sympathetic ganglion is removed.An example is endoscopic thoracic sympathectomy....
is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. With this procedure the sympathetic chain in the lumbar region is clipped or divided in order to relieve the severe or excessive foot sweating. The success rate is about 90% and the operation should be carried out only if patients first have tried other conservative measures.
This type of sympathectomy is no longer considered controversial in regards to hypotension and retrograde ejaculation.
The issues of retrograde ejaculation, inability to maintain erection and hypertension are not validated. In separate 2007 and 2010 papers none of the patients experienced sexual dysfunction.
Percutaneous sympathectomy is a related minimally invasive procedure in which the nerve is blocked by an injection of phenol
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...
. The procedure allows for temporary relief in most cases. Some medical professionals advocate the use of this more conservative procedure before the permanent surgical sympathectomy.
Other
miraDryMiraDry
miraDry, is the trademark name of a non-invasive microwave-based technology for the treatment of axillary hyperhidrosis created by Miramar Labs in 2003 and FDA Cleared in 2011....
is a new procedure of non-invasive delivery of controlled electromagnetic energy to the region where the sweat glands reside. The energy generates heat which results in thermolysis of the sweat glands. At the same time, a continuous hydro-ceramic cooling system protects the superficial dermis and keeps heat at the level of the sweat glands. Because sweat glands do not regenerate after treatment, the results are lasting.
Iontophoresis
Iontophoresis
Iontophoresis is a technique using a small electric charge to deliver a medicine or other chemical through the skin. It is basically an injection without the needle...
was originally described in the 1950s, and its exact mode of action remains elusive to date. The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. Some people have seen great results while others see no effect. The device can be painful (pain is usually limited to small wounds and over time the body adjusts to the procedure) and the process is time-consuming. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.
Hypnosis
Hypnosis
Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...
has been used with some success in improving the process of administering injections for the treatment of hyperhidrosis . Absorbent shoe insoles decrease the sweat in shoes. Relaxation and meditation
Meditation
Meditation is any form of a family of practices in which practitioners train their minds or self-induce a mode of consciousness to realize some benefit....
and weight loss have also been proposed to be of help.
Prognosis and impact
Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. Hyperhidrosis can also have devastating emotional effects on one’s individual life.Affected people are constantly aware of their condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks become impossible chores, which can psychologically drain these individuals.
Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating. Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.
Some careers present challenges for hyperhidrosis sufferers. For example, careers that require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Those in careers that require federal background checks (such as education), may encounter difficulty with some methods of fingerprint scanning used by law enforcement agencies. Employees, such as sales staff, who interact with many new people can be negatively affected by social rejection. It is extremely frustrating whenever a sufferer touches or holds something on the sales display, it has to be wiped clean each and every time they come in contact with it as it leaves a lot of sweat marks. The risk of dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
can limit the ability of some sufferers to function in extremely hot (especially if also humid) conditions. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands.
Epidemiology
Primary hyperhidrosis is estimated at 2.8% of the population of the United States. It affects men and women equally, and most commonly occurs among people aged 25–64 years. Some may have been affected since early childhood. About 30–50% have another family member afflicted, implying a geneticGenetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
predisposition.
In 2006, researchers of Saga University in Japan reported that primary palmar hyperhidrosis locus maps to 14q11.2-q13.