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EXCESSIVE SWEATING

Do you avoid shaking hands when you meet people?

Patients with hyperhidrosis have excessive sweating that hampers their daily activities. It is sometimes brought on by stress, emotion, or exercise, but can also occur spontaneously. Patients with palmar hyperhidrosis have wet, moist hands that interfere with grasping objects. Most patients with palmar hyperhidrosis also consider it a difficult social problem since every time they shake hands, they leave the other person's palm very moist, a sensation most people find unpleasant. Those who suffer from axillary hyperhidrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress. Once again, this proves to be very unsightly and a social disadvantage. Plantar hyperhidrosis is the excessive sweating of the feet and leads to moist socks and shoes as well as increased foot odor.

Although nobody understands the exact cause of excessive sweating in specific individuals, it is known that the sweating is controlled by the sympathetic nervous system. This sympathetic nervous system (along with the parasympathetic nervous system) are both parts of the autonomic nervous system. This system works behind the scenes involuntary or automatically. It regulates many of our bodily functions which occur without conscious control such as the rate at which we breathe, the beating of our heart, and the production of sweat, which is important for regulating body temperature. (The other nervous system in our bodies is the somatic nervous system and is the system of voluntary nerves that give us sensation (pain, heat, and touch) as well as the control of our muscles that allow us to move the different portions of our body at will.) Although there is ongoing research investigating hyperhidrosis, it is not known what specific defect occurs that results in excessive sweating. Whether it is due to over activity of the sympathetic nervous chain or it is the sweat glands themselves is uncertain.

The initial treatment for hyperhidrosis is usually medical and does not involve surgery. There are ointments and salves available (i.e., Drysol) that are astringents that tend to dry up the sweat glands. Another treatment is iontopheresis. This consists of a treatment of electrical stimulation, usually in the hands. Patients place their hands in a bath through which an electrical current is passed. This treatment tends to "stun" the sweat glands and can decrease the secretion of sweat for 6 hours.

One of the most recent treatments is the injection of Botox® into the area of excessive sweating. This affects nerve endings, decreasing the transmission of the nerve impulses to the sweat glands, resulting in decreased sweating. It generally requires several injections in the palms or underarms and may remain effective up to ten months. Many medicines have been utilized with varying success. These include both sedatives (in those patients with stress-induced hyperhidrosis) and medications that affect the nervous system.

Surgical treatment of hyperhidrosis involves destroying or removing a specific portion of the main sympathetic nerve which enervates the armpits or hands. This can now be performed with surgical endoscopes which only leave a small one-half inch scar. This is referred to as endoscopic thoracic sympathectomy (ETS), or thoracoscopic sympathectomy. ETS has the potential to cure approximately 95-98% of excessive hand (palmar) hyperhidrosis and approximately 75-80% of armpit (axillary) hyperhidrosis.

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