Hyperhidrosis

Signs and Symptoms

Hyperhidrosis is characterized by abnormal, profuse sweating that can affect one or a combination of the following:

• Hands, called palmar hyperhidrosis
• Armpits, called axillary hyperhidrosis
• Feet, called plantar hyperhidrosis

The excessive sweating often interferes with daily activities. For example, patients with palmar hyperhidrosis have wet, moist hands that sometimes interfere with grasping objects. Those with axillary hyperhidrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress. Plantar hyperhidrosis, excessive sweating of the feet, makes ones socks and shoes wet, which leads to increased foot odor.

Symptoms of hyperhidrosis often become noticeable during childhood and adolescence. In many cases sweating can be quite severe, affecting everyday life and causing social embarrassment. It is thought that the excessive sweating may be brought on by stress, emotions or exercise. However, it also can occur spontaneously.

The sympathetic nervous system controls the sweating throughout the body. Often there is no identifiable cause, but excessive activity of the sympathetic nervous system is believed to be responsible in the majority of those affected. The sympathetic nervous system normally responds strongly in situations of fear or stress. It is not understood why patients with hyperhidrosis appear to have constant increased activity of this system. The involved nerves branch from the sympathetic chain within the chest cavity.

Diagnosis

Hyperhidrosis is diagnosed by physical examination. In addition, your doctor will ask how long you have been experiencing excessive sweating, what areas are affected, how often it happens and other questions to get a sense of the extent of your condition.

Treatment

Many patients with hyperhidrosis try topical medications or herbal remedies to ease their condition, but these efforts have only temporary or no benefit.

The only treatment with proven long-term results involves surgical interruption of the sympathetic chain. These nerves primarily affect blood flow to the skin and the function of the sweat glands. Interrupting the sympathetic nerves in the chest results in dilation of the veins and arteries in the arm and hand as well as the complete blockage of sweating.

Recently, a minimally invasive procedure called endoscopic thoracic sympathectomy (ETS) was developed to treat hyperhidrosis. Using very small incisions, the sympathetic chain is cut or clamped to eliminate the excessive sympathetic nerve activity. Using this approach, the procedure may be done on an outpatient basis with quicker recovery and less scarring than open surgery. The procedure is highly effective in eliminating excessive sweating of the hands in over 98 percent of patients. In addition, the risk of complication is very low. ETS also can be applied in selected patients with axillary hyperhidrosis, or excessiving sweating of the armpits.

Vascular surgeons at UCSF Medical Center have significant experience in the treatment of hyperhidrosis using ETS. We can perform ETS on both sides of the body during a single operation if needed. The operation requires general anesthesia, and two 5 millimeter incisions on each side. Most patients leave the hospital in under 24 hours and their recovery is generally complete within two weeks.