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Endoscopic Lumbar Sympathectomy
Written by Katie Crissman
October 01 2020

Hyperhidrosis is known to affect around 3% of the American population, and about half of those people will have plantar hyperhidrosis, or excessive sweating on the soles of their feet.[1][2] When someone is diagnosed with primary focal hyperhidrosis, the type of hyperhidrosis that causes excessive sweating on specific areas of the body, they are first directed to use conservative treatments. For those with plantar hyperhidrosis, the conservative treatment options include topical over-the-counter treatments (antiperspirant), iontophoresis for plantar hyperhidrosis, botox for plantar hyperhidrosis and oral medications for hyperhidrosis. For some people with severe plantar hyperhidrosis these treatments, and even combinations of these treatments, do not seem to be enough. At this point, doctors may begin to talk to patients about surgical treatments for primary focal hyperhidrosis. Most of the time a procedure called an endoscopic thoracic sympathectomy is suggested for people who have palmar hyperhidrosis. There is a similar surgical procedure for people with plantar hyperhidrosis called endoscopic lumbar sympathectomy. However, this surgery comes with some very big risks and many sources advise against its use.

What It Is and How It Works

An endoscopic lumbar sympathectomy is a surgery used to stop excessive sweating from overactive sweat glands on the soles of feet by disrupting nerve signals from the sympathetic nervous system to the feet. This essentially blocks sympathetic nerves from telling the eccrine glands on the feet to produce sweat, thereby preventing excessive sweating. The procedure is similar to how an endoscopic thoracic sympathectomy is performed, only it is performed on a lower level of the spine, usually around L3 and L4.[3]

Before surgery, a patient is administered general anesthesia. A surgeon will mark the areas where they are going to make small incisions. The incisions are made somewhere between the end of the rib cage and the top of the hip bone, and a tiny camera is inserted so the surgeon can see inside the body. Once this has been done the surgeon inserts a balloon into the retroperitoneal cavity and inflate it to make room for the surgeon to visualize and carry out the procedure. Once the sympathetic nerve chain is located the surgeon will clamp it (or use another technique to disrupt it) between the T3 and T4 vertebrae. The procedure can be done unilaterally (on one side only) or bilaterally (both sides) depending on the surgeon and the patient’s needs. The surgeon must be extremely careful not to damage other important nerves, the ureters, lymphatic vessels, the lumbar vein, and other anatomy in that region.[3]

Depending on the surgeon, a patient may be allowed to leave several hours after surgery, or they may have to stay in the hospital for a few days.[3] Most patients do experience significant pain which can last for longer than ten days, in some instances it has been to last for up to three months.[1]

Efficacy

The efficacy of endoscopic lumbar sympathectomy surgery needs to be studied further before any final conclusions about the procedure can be drawn. The studies that have been done on the procedure seems to demonstrate that the surgery is effective at reducing sweating of the feet. One study claimed that ELS could eliminate hyperhidrosis symptoms of the feet over 95% of the time. This shows that the surgery is effective, but the same study also reported that over two-thirds of the patients developed unwanted side effects, specifically neuralgia and compensatory sweating. Overall, the study found that even in patients who suffered from side effects, they still had a statistically significant improvement in their quality of life.[4] Another study, which collected data on a group of women undergoing ELS found that 53% of the patients were unhappy with the aesthetic alterations caused by the surgery. The same study reported that overall the patients in the study had an increased quality of life afterward.[2] Endoscopic lumbar sympathectomy appears to be effective at reducing sweating of the feet, but at a high cost, that many deem unnecessary. Interestingly, 60% of patients who undergo endoscopic thoracic sympathectomy, a type of surgical treatment for palmar hyperhidrosis, also sweat significantly less from their feet.[1]

Complications and Dangers of Surgery

There are several complications that can occur during or after ELS surgery, and it is extremely important for patients to take this into consideration. One of the most dramatic side effects of surgery is ejaculatory impotence in men, and it can be assumed that surgery may also affect women’s genitosexual innervation as well. Some surgeons will only perform the surgery on women, but the practice is questionable because they can suffer nerve damage as well.[5] One study said that out of 92 bilateral ELS surgeries only one man suffered impotence, however, that is a rate of higher than 1%.[4] Another complication is compensatory sweating, which is when sweating becomes worse on other areas of the body once sweating on the original problem area is treated. There is a high incidence of compensatory sweating after ELS, with 87.5% of patients developing it in one study.[6] Postoperative neuralgia, which is considered to be pain of the groin, thigh, or back of varying intensity, is probably the third most significant side effect. One study concluded that two-thirds of patients developed either compensatory sweating or neuralgia.[4] There are other surgical dangers that can occur if a surgeon makes a mistake during a procedure as they are operating near vital organs and nerves.

Overall, endoscopic lumbar sympathectomy seems to be an effective procedure that is rife with complications and serious side effects. Patients should be cautious when thinking about this operation, as many doctors who manage hyperhidrosis cases strictly advise against it.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
  2. De Paula Loureiro, M., De Campos, J., Kauffman, P., Jatene, F. B., Weigmann, S., & Fontanac, A. (2008). Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat. Clinics,63(2), 189-196. Retrieved October 1, 2018.
  3. Reisfeld, R. (2010). Endoscopic Lumbar Sympathectomy for Focal Plantar Hyperhidrosis Using the Clamping Method. Surg Laparosc Endosc Percutan Tech, 20(4), 321-236. Retrieved October 2, 2018.
  4. Rieger, R., Pedevilla, S., & Lausecker, J. (2015). Quality of Life After Endoscopic Lumbar Sympathectomy for Primary Plantar Hyperhidrosis. World Journal of Surgery, 39, 905-911. doi:10.1007/s00268-014-2885-4
  5. Collin, J., & Whatling, P. (2000). Treating hyperhidrosis Surgery and botulinum toxin are treatments of choice in severe cases. BMJ, 320(7244), 1221-1222. Retrieved October 2, 2018.
  6. Wolosker, N., Ishy, A., Yazbeck, G., Milanez de Campos, J. R., Kauffman, P., Puech-Leão, P., & JateneII, F. B. (2013). Objective evaluation of plantar hyperhidrosis after sympathectomy. Clinics,68(3), 311-315. doi:10.6061/clinics/2013(03)OA05
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Antiperspirant

What You Need to Know About Carpe Clinical Regimen

By Katie Crissman /

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen - it combines several high performing products with a specific care routine to provide long term sweat reduction for even the heaviest sweaters. Read on to see if Carpe Clinical Regimen is right for you!

Antiperspirant is great - for most people. You apply it once a day and it stops your sweat! It’s easy. But, what if that’s not what happened? You bought it, read the label, and used it exactly as directed and, unfortunately, you’re still sweating - excessively. If this is you, then you’ve come to the right place. There are products specifically made for heavy sweaters who haven’t had luck with traditional antiperspirants. These products typically include the words “extra strength”, “clinical strength” or “prescription strength” and they are, thankfully, available over the counter without a doctor’s prescription. 


The difference between clinical strength products and their weaker counterparts are the active ingredients they use. Clinical strength lines typically use one of several newer types of metallic salt ingredients that are known to be both stronger and less irritating than aluminum chloride (which is the standard active ingredient in antiperspirants) [1]. While there are many clinical strength products on the market, we are going to focus on a new clinical strength regimen that combines a strong active ingredient with a specific care routine to get excessive sweating under control. 


Carpe Clinical Regimen -  What It Is and How It’s Different

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen. It’s different from other prescription grade products because it combines several strong products with a specific care routine to ensure maximum product performance. It’s also different from Carpe’s other products because it uses a stronger active ingredient and delivery system. The system is geared toward people who experience intractable armpit sweating, but Carpe also makes products for people who struggle with other types of sweat. The Carpe Clinical Grade Underarm includes three specific products that, when used together, have been found to be highly effective at reducing sweat production. These products include:

  • Carpe Clinical Grade Underarm Antiperspirant 
  • Carpe Clinical Grade Exfoliating Wash
  • Carpe Clinical Grade Underarm Wipes[2]

Carpe Clinical Grade Regimen uses an active ingredient called Aluminum Zirconium Tetrachlorohydrex GLY (20%) combined with other soothing inactive ingredients to effectively stop sweat in its tracks while reducing skin irritation.[3] Aluminum Zirconium Tetrachlorohydrex is a newer generation metallic salt that stops sweat production and is known to be more effective than other types of active ingredients antiperspirants typically use. One study mentioned in the journal Dermatologic Clinics found that antiperspirants using Aluminum Zirconium Tetrachlorohydrex were, on average, 34% more effective than antiperspirants that used aluminum chloride as an active ingredient.[1] Carpe’s traditional products use an active ingredient called Aluminum Sesquichlorohydrate at 15% which is effective, but less potent than Aluminum Zirconium Tetrachlorohydrex.[4]


It’s important to note that Carpe’s Clinical Grade Regimen provides a long term impact on sweat reduction from making short term lifestyle changes. This is because the results build up over time and peak at about 4 weeks. It takes 4 weeks of using the Carpe clinical grade products once each morning and every other night to see the full effect of what they can do. This is typical of all antiperspirants as their effects tend to build up with consistent use. Consistently using antiperspirant products is especially important for those with hard to treat sweat problems because it can be the difference between treatment success or failure.[1][2] 


If you’re frustrated with the way your current antiperspirant is working or how it isn’t working, then consider giving Carpe’s Clinical Grade Regimen a try! It’s active ingredient is comparable to other prescription strength products on the market but it’s multistep system with easy to use wipes is completely unique! Remember, an easy to use, consistent antiperspirant routine is going to give you long term sweat reduction so it’s important to find a system that works for your lifestyle. 


Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0>https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
  2. How It Works (Clinical). Carpe. https://mycarpe.com/pages/how-it-works-clinical. 
  3. Clinical Underarm  PM Wipes. Carpe. https://mycarpe.com/products/clinical-grade-underarm-antiperspirant-wipes?variant=34814174724229
  4. Underarm Antiperspirant for Excessive Underarm Sweating. Carpe. https://mycarpe.com/products/underarm-antiperspirant-tube?variant=39247505358981
Body Areas Affected by Hyperhidrosis

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating

By Daniel McCarthy /

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating


On my first day of work a few years ago, I got dressed to impress and walked the 20 minutes to my new office to meet my new colleagues for the first time. Having just moved to the southern US, I’d been getting used to the unbearable humidity and its effects on my excessive armpit sweating. Luckily (I thought), the sun wasn’t out and the temps dropped below 80, so maybe my sweat glands wouldn’t take center stage! Well...I arrived to meet my colleagues looking like a wet bass in business clothes. Thank goodness I arrived 15 minutes early, which brings me to the first outrageous thing people try to avoid armpit sweating. 

  1. The Hand Dryer 

I anxiously scurried to the nearest bathroom, declothed, and put the hand dryer to good use on my shirt stains and sweat stains. More outrageously, I awkwardly hovered my sweaty extremities (including my sweaty underarms) over the hand dryer. Thankfully, I reapplied my antiperspirant and headed out to meet my colleagues a decently dry man. That was the day I knew I really needed clinical strength antiperspirant for my excessive armpit sweating (and a car). 


  1. Pantyliners


Many with excessive underarm sweating already know that underarm pads are one way to help with sweating armpits. But if you find yourself sans pad and worried about your excessive armpit sweating, you would not be the first person to try pantyliners. That’s right, pantyliners have been used in a pinch to help keep sweat stains at bay. 

  1. Give a shirt

In 2019, a reddit user posted that to combat his excessive armpit sweating, he skipped the typical clothing and made his own shirt. He posted asking others to try out his creation and received over 250 replies! By creating and giving others shirts, this innovative reddit user designed his way into the hearts of many with smelly armpits. 

  1. Get inked

If you’ve been debating whether to get a tasteful tattoo and you have hyperhidrosis, this finding may just help you make your decision. A 2017 study found that getting inked helped reduce sweat [1]! Now, I don’t recommend choosing a tattoo as a means of treatment for excessive armpit sweating (and maybe don’t tattoo your armpit), but the connection is a fun little fact nonetheless. 

  1. Become a naked mole rat

If you can’t pull the trigger on an armpit tattoo, another method some people have tried is hair removal. Yes, like Steve Carrell (who actually has hyperhidrosis himself) in the hit movie 40-year Old Virgin, removing hair can help reduce sweat buildup for you too. Many likely already “naturally” lose hair thanks to some sweat prevention products, but more natural hair removal may just be the trick to solving excessive sweating. 

  1. Armpit art

Even though we know most sweaty armpit causes, like too much caffeine or spicy foods, it’s no fun to cut these out completely. A more outrageous approach to excessive underarm sweating is actually turning sweating armpits into art. Multiple users of the Reddit community r/Hyperhidrosis have created shirts, sweatshirts, and other clothing that includes beautiful tie-dye in the armpits. Creative, fun, and beautiful, and even better when combined with sweat prevention like antiperspirant or carpe underarm. 

  1. Vinegar your armpit

You may already know how to get rid of pit stains with vinegar, but there are other interesting ways it can help with excessive armpit sweating. Splashing vinegar on your sweaty underarms  is one method many recommend. Those that swear by this method also recommend using deodorant or antiperspirant, too. 

While we don’t know how this was discovered, I like to think someone accidentally splashed vinegar on their pits hundreds of years ago and voila! Too bad the first person to splash his pits with vinegar didn’t also have access to the best antiperspirant for his excessive armpit sweating. 

  1. Baking soda your sweaty underarms

If you find deodorant or antiperspirant irritating, one creative way to help alleviate your excessive underarm sweating is baking soda. Many crafty people with hyperhidrosis swear that not only can baking soda help reduce sweat, but it can also help alleviate pesky underarm smell with some of the best sweat prevention. 

  1. Restart the plaid fad

Black t-shirt, black sweatshirt, black button down, black tank top. If this sounds like your closet, you’re clearly an expert on the hyperhidrosis wardrobe. But if you want some variety as you fight excessive armpit sweating, add some plaid, a trick many with hyperhidrosis use that you may not know. Hey, you just may be starting the resurgence of the plaid fad, and at worst, you’ll add some fun, lumberjack variety to your dark closet. 


Sources: 

[1] Luetkemeier, M. J., Hanisko, J. M., & Aho, K. M. (2017). Skin Tattoos Alter Sweat Rate and Na+ Concentration. Medicine and science in sports and exercise, 49(7), 1432–1436. https://doi.org/10.1249/MSS.0000000000001244
Body Areas Affected by Hyperhidrosis

How to Cure Sweaty Hands Permanently at Home

By Daniel McCarthy /

How to Cure Sweaty Hands Permanently at Home 

Scenario 1: You’re invited into the office, confident you will land the job. You’ve prepared, you’re highly qualified, you have absolutely nothing to worry about. You walk in and confidently reach out to shake the CEOs hand. But then, your confidence turns to dread as the CEO pulls her hand back, wet with your sweat. 

Scenario 2: You’re at home, playing video games with your friends and absolutely dominating. They get so upset, they tell you to take a break to let another friend play. But there’s another problem... nobody wants to use your controller after you finish. Despite your domination, your palmar hyperhidrosis (excessively sweaty hands) has taken center stage. 

Do these scenarios sound familiar? Wondering how to cure sweaty hands permanently? Although you may not have had these exact things happen to you, your sweaty hands likely have caused something similar and you’re looking for a home remedy. To stop sweating these situations, let’s talk about how to cure sweaty hands permanently at home. 

One of the best ways to cure sweaty hands at home is actually not related to the hands at all. Instead, working on reducing anxiety can have immensely positive results on how to cure sweaty hands permanently naturally. There are many root causes of anxiety, and some or many may be related to your hyperhidrosis. Likewise, it is easier said than done to reduce anxiety. But there are also many ways to work on reducing anxiety that are worth a try. One interesting way to reduce anxiety, and in turn, sweaty hands, is to be grateful. Specifically, Petrocchi and Couyoumdjian found that “grateful people experience less anxiety mostly because they are able to encourage and be compassionate and reassuring toward themselves when things go wrong in life” [1]. Other ways include stepping outside for a walk, drinking tea, or even distracting yourself. In general, starting with anxiety reduction not only can help with how to cure sweaty hands, but also your wellbeing in general. 

Another great way to cure sweaty hands at home permanently is to reduce consumption of coffee and alcohol. Now you may be reading this and thinking “Hey, those are all my favorite things! I’m done with this article!”. And while I wholeheartedly agree and enjoy coffee and alcohol myself, consumption in moderation is key, especially with hyperhidrosis. Caffeine, for example, activates part of the brain that is already a main part in causing hyperhidrosis symptoms. Instead of giving it up, try to reduce consumption to under 200 mg or add in decaf to your routine. Alcohol can affect hyperhidrosis in a similar manner, but like coffee, 1-2 glasses of alcohol may be okay. When figuring out how to cure sweaty hands permanently naturally, it is important to find a balance of coffee, alcohol, and managing your hyperhidrosis. And remember to always drink responsibly, in moderation. 

Tackling how to cure sweaty hands permanently, naturally, and at home may require more than behavioral changes we’ve talked about so far. Luckily, there are other great remedies you can try at home! First, finding the right antiperspirant is of paramount importance, especially appropriate antiperspirant for hands. Another possible over the counter option is anti-sweat wipes. If neither of these work for you, another option to cure your sweaty hands permanently is to buy your very own iontophoresis machine for at-home use. This machine delivers mild electrical currents to your hands (or other affected body part) while submerged in water. A combination of these treatments may have your hands feeling less clammy in no time! 

Ultimately, your palmar hyperhidrosis may not be treatable at home and permanently, but these recommendations may help alleviate some of your symptoms. If symptoms persist, consult a medical professional for further assistance with how to cure sweaty hands. 



Sources

Sources

1. Nicola Petrocchi & Alessandro Couyoumdjian (2016) The impact of gratitude on depression and anxiety: the mediating role of criticizing, attacking, and reassuring the self, Self and Identity, 15:2, 191-205, DOI: 10.1080/15298868.2015.1095794

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