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Surgical Treatments for Primary Focal Hyperhidrosis
Written by Katie Crissman
October 01 2020

Who Does This Surgery Work For?

There are two types of hyperhidrosis and endoscopic thoracic sympathectomy is indicated for those who have primary focal hyperhidrosis. In other words, people who have hyperhidrosis that is not caused by another underlying condition. This type of surgery has been found to be most effective as a treatment for sweaty hands (palmar hyperhidrosis) but can also help with axillary hyperhidrosis and craniofacial hyperhidrosis. The ideal candidate for this type of surgery had an early onset of their disease, usually during adolescence, and is a young adult without other complicating health issues. Most doctors prefer to perform it on patients who are under the age of 25 and who have a body mass index within the normal or slightly overweight range. While hyperhidrosis itself is not bad for a person's health, the difficulties it can cause can be extremely detrimental which is why, in some cases, surgery is the right option.[1]

How Does This Surgery Work?

During an endoscopic thoracic sympathectomy a surgeon makes a small incision between a patient’s ribs and then uses a tiny camera to search for the nerves that control sweat production in the upper extremities. They then attempt to sever or destroy these nerves so that the nervous system can no longer use the neural pathways associated with creating extra sweat. This prevents the body from producing extra sweat because the communication network from the brain to the body has been permanently disrupted. Due to the fact that nerves are being destroyed in this surgery it cannot be reversed.[1]

To disconnect the nerves surgeons either use endoscopic resection, ablation or clipping of the nerves. The surgeon chooses which nerves to deaden depending on where the hyperhidrosis is impacting the patient most.

For example, a cut will be made higher up under the 3rd rib to treat palmar hyperhidrosis, or sweaty hands, while a lower cut under the 4th or 5th rib would be made to treat axillary hyperhidrosis. This procedure is always done under general anesthesia but most patients can go home the same day the surgery is performed.[1]

The reason a surgical procedure that disrupts nerve signals can stop excessive sweating is because hyperhidrosis is caused by an overactive sympathetic nervous system. The sympathetic nervous system is connected to sweat glands, and when the nervous system is overactive it signals sweat glands to become overactive as well. By severing that connection, surgeons prevent sweat glands from being activated and this prevents them from producing too much sweat.

Complications and Considerations of Surgery

This type of surgery is generally reserved as a last resort for people who are severely impacted by hyperhidrosis and who have not responded to over-the-counter treatments or other treatments doctors use to manage hyperhidrosis. Once done, the results are permanent. Certain complications can occur such as:

Some of the possible complications listed above have a fairly high incidence of occurring, so care must be taken when making the decision to have this type of surgery.[1]

Compensatory Sweating

Compensatory sweating is considered to be one of the most likely complications of ETS and it has also been reported to be one of the most dissatisfying. The occurrence rate is anywhere from 3% to 98% of patients. Compensatory sweating is when the body overcompensates by producing too much sweat in another area of the body once the original problem area has been corrected by ETS surgery. So, for example, if palmar sweating was completely corrected by surgery a patient who suffers from compensatory sweating may then have an overabundance of sweat production on their abdomen. This can greatly affect quality of life for some, and it has the potential to make the anxiety associated with hyperhidrosis worse.

If it is going to show up, compensatory sweating usually occurs on the stomach, back, legs, groin, upper legs or gluteal area[1]. Excessive sweating of the groin and other areas can be very irritating for some. Even though many patients suffer from this complication most are still satisfied with the results of the procedure. It is an important factor for each individual to consider before undergoing such a dramatic treatment.[1] There are other options for treatment when managing hyperhidrosis with a doctor.

Long Term Outlook

The long term satisfaction associated with endoscopic thoracic sympathectomy is varied, but predominantly positive. One concurrent finding across several studies was that patients who underwent surgery as a treatment for sweaty hands were much more satisfied than those who were treated for axillary or other types of hyperhidrosis. [3]

Although patients are at a high risk of developing certain complications, such as compensatory sweating or Horner’s syndrome, ETS is still considered to be a highly effective treatment for hyperhidrosis. In many cases the benefits appear to outweigh the risks. Most patients who undergo endoscopic thoracic sympathectomy suffer from severe hyperhidrosis that greatly impacts their quality of life, and so the benefits of the surgery appear to be worth the risks.[1,3]

The decision to get endoscopic thoracic sympathectomy should not be made lightly, but it is an effective treatment for those who have tried other methods and who have not seen improvement. Some of the other treatment options that can be tried prior to surgery inlcude:

  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
  2. Endoscopic thoracic sympathectomy (ETS). (n.d.). Retrieved July 24, 2018, from https://www.sweathelp.org/hyperhidrosis-treatments/ets-surgery
  3. Herbst, F., MD, Plas, E. G., MD, Fugger, R., MD, & Fritsch, A., MD. (1994). Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis of the Upper Limbs. Annals of Surgery, 220(1), 86-90. Retrieved July 24, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234291/pdf/annsurg00053-0102.pdf.
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Causes of Hyperhidrosis

How to Tell if I Have Hyperhidrosis

By Katie Crissman /

Are you dealing with excessive sweating? If you’re a super sweater, here's how you can tell whether your symptoms may be related to a condition called hyperhidrosis.

What is Hyperhidrosis?

Hyperhidrosis is a medical condition categorized by excessive sweating that isn’t related to temperature regulation. It affects roughly 3% of people and it’s very treatable.[1]

If you have hyperhidrosis then you may experience symptoms like: 

  • Sweating that specifically affects your hands, feet, underarms, face or groin.
  • You can’t find an environmental trigger for your sweat like heat.
  • Your sweat so much that it impacts your self confidence and interferes in your personal or work life.
  • You have to change clothes often due to sweat problems.[1]

You get the idea - hyperhidrosis causes sweating that’s disruptive and more or less constant. It’s important to know that there are two types of hyperhidrosis. They are called primary focal hyperhidrosis, and secondary generalized hyperhidrosis. In this article we are going to focus on the symptoms of primary focal hyperhidrosis.[1] 

However, if you have excessive sweating that doesn’t seem related to primary hyperhidrosis read our article on secondary generalized hyperhidrosis as it’s caused by underlying health conditions and it’s important to get them looked at. 

Back to primary hyperhidrosis! Here are some quick facts to know about the condition:

  • It’s categorized by profuse sweating in one or more specific areas of the body, the main areas affected are:
    • Hands
    • Feet 
    • Underarms 
    • Face
    • Groin
    • Breast
  • It typically starts in adolescence or during early adulthood. Sometimes kids can experience excessive hyperhidrosis as well.
  • It’s not a result of any other disease or disorder - the excessive sweating itself is the disorder.
  • Men are more likely to have it.
  • It tends to run in some families.
  • The sweating tends to be symmetrical on the body. For example, if your right hand sweats your left hand will too.
  • It’s treatable![1]

Factors to Consider When Self-Diagnosing Hyperhidrosis

If you can relate to our description of hyperhidrosis consider these factors when self diagnosing. The first thing to know is that you should consult a doctor! Specifically, a dermatologist who’s trained in dealing with hyperhidrosis. If you’re still interested in more information consider the following: 

1. Temperature and Weather

 

First and foremost, you should be cognizant of whether or not you sweat in response to high temperatures in your surrounding environment. Since sweat is produced primarily as a means to cool the body via thermoregulation, all people should sweat when the temperature is high. Typically, the higher the temperature, the more sweat produced to keep the body cool. However, the first sign of both primary and secondary hyperhidrosis is whether or not your body sweats even when the temperature is at a comfortable, or even cool, level. 

For those with hyperhidrosis, they have sweat glands that are overactive because they are receiving and reacting to too many signals from the spinal cord and brain. Due to the fact that these synaptic signals are sent regardless of temperature, gauging the temperature of the environment when sweating occurs is a strong indicator of potential hyperhidrosis.

2. Environmental Triggers

In addition to temperature, you should be aware of whether or not other environmental triggers are causing excessive sweating on a repeated basis. For example, situations that are anxiety producing like meeting new people, anticipating handshakes, preparing for major assignments or tests, and public speaking may prompt an individual’s hyperhidrosis to worsen. This is because hyperhidrosis and anxiety are closely related. 

When thinking of your own sweatiest moments, are they tied to a specific set of conditions? If so, you may have primary focal hyperhidrosis that is triggered by those specific conditions. 

However, an important distinction between hyperhidrosis and stress sweating related to anxiety must be made; just because someone sweats in a specific situation doesn’t mean they have hyperhidrosis. Most people will sweat a little before a business meeting, and many people find the idea of a public speech to be intimidating. 

The important distinction is to determine whether or not your body is producing sweat to aid with thermoregulation (i.e. keeping you cool and calm when you become a little worried before an event) or producing sweat at an excessive and uncontrollable rate. 

3. Timing of Your Sweat

The third factor to evaluate in order to tell if a person’s sweating is indicative of hyperhidrosis is the length of time a person has been experiencing excessive sweating. If you’ve been sweating excessively since adolescence or young adulthood it’s a sign you may have primary hyperhidrosis. If it just started suddenly later in life it’s less likely to be secondary hyperhidrosis. 

If you think you might have hyperhidrosis there are many ways to manage your sweat and there are several treatments you can try. A great starting place is finding a good antiperspirant - we recommend Carpe antiperspirant lotion. They have products tailored to each specific part of your body and their special formula is gentle on skin.

Are you still curious about whether you have hyperhidrosis? Take this quiz.

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 
  2. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. (2017, June 8). The impact of hyperhidrosis on patients' daily life and quality of life: A qualitative investigation. Retrieved May 21, 2018, from https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0693-x
  3. MiraMar Labs, O'Shaughnessy, K., & Melkerson, M. (2011). 510(k) Summary. Division of Surgical, Orthopedic And Restorative Devices. Retrieved May 23, 2018, from https://www.accessdata.fda.gov/cdrh_docs/pdf10/K103014.pdf.
    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
    Causes of Hyperhidrosis

    Everything you need to to know about Hyperhidrosis (or Excessive Sweat)

    By Chris Reid /

    WHAT IS HYPERHIDROSIS?

    Hyperhidrosis, or excessive sweating, is basically when you sweat beyond comfort. People with hyperhidrosis just have overactive sweat glands. 

    The medical definition is sweat that is produced in excess of what is necessary for thermoregulation (the ability to maintain a healthy temperature.

    Sweating is a perfectly natural and necessary function the body uses to cool itself down. We need to sweat to live, however, with hyperhidrosis, you’ll sweat even when your body isn’t overheating.[1] 

    SIGNS YOU MAY HAVE HYPERHIDROSIS: 

    • When dressing, you take into account how your clothes will be affected by sweat and whether they will show sweat stains. 
    • You are always aware of your environment and whether or not you can influence the temperature. 
    • You've hesitated to shake someone's hand. 
    • You tailor your routine to take in account a need for reapplying your deodorant. 
    • You worry about taking off you shoes in front of others. 
    • You leave a sweat trail. 
    • Noticeable sweat even when you aren't working out or overheated. 

    WE DON'T JUST SWEAT UNDER THE ARMS: 

    All can be affected: 

    • Feet
    • Hands
    • Groin
    • Chest/Breasts
    • Thighs
    • Buttocks
    • Face
    • Scalp

    You could have sweat in just one of these areas, or like the lucky few experience full body excessive sweating. 

    Hands, feet, and underarms are the parts of the body that are most likely to be affected by hyperhidrosis.[3]

    People who suffer from hyperhidrosis have the same number and size of sweat glands as people who don’t have the condition. Their sweat glands are just overactive.[1]

    THERE ARE SOLUTIONS: 

    Good news, you don't have to live with uncomfortable sweat.

    SOME OPTIONS: 

    If you are interested in medical solutions, you can book an appointment with your dermatologist and learn how to manage hyperhidrosis with a dermatologist.[3]

    THERE ARE TWO MAIN FORMS OF HYPERHIDROSIS

    The vast majority of people will either have primary focal hyperhidrosis or secondary generalized hyperhidrosis. 

    Primary Focal Hyperhidrosis

    Primary Focal Hyperhidrosis (PFH) is by far the most common type, affecting up to 90 percent of people who have hyperhidrosis. 

    People with primary focal hyperhidrosis only sweat in particular areas like the hands, feet, armpits, face, and groin.

    Sweat will occur on both sides of the body in the same place and often in more than one area — like both hands and feet. [3]

    Symptoms usually begin in childhood or adolescence and tend to last for a person’s entire lifetime. There is evidence that primary focal hyperhidrosis is hereditary, meaning it often runs in families.[3]

    Secondary Generalized Hyperhidrosis

    While primary focal hyperhidrosis appears to be something you’re born with, secondary generalized hyperhidrosis (SGH) is a condition that shows up during adulthood. Think of SGH as an uninvited guest who arrives on your doorstep with no warning. [3]

    When someone has secondary hyperhidrosis the biggest problem isn’t the hyperhidrosis – it’s the disease or condition that might be causing it. [3]

    The source of this type of hyperhidrosis can also be a medication. Many common medications can cause hyperhidrosis as a side effect.[3]

    Unlike primary focal hyperhidrosis, the sweating from secondary hyperhidrosis tends to occur all over the body. This is a telltale sign of the condition.[3]

    Unlike primary hyperhidrosis, this condition doesn’t have to be permanent. If the instigating condition is found and treated, it can fix the hyperhidrosis. It may take a little work.[3]

    If you are concerned that your hyperhidrosis might have an underlying cause, schedule an appointment to talk to your doctor and find out.[3]

    THE IMPACTS OF HYPERHIDROSIS

    While hyperhidrosis isn’t particularly dangerous physically, it can be embarrassing.[3]

    Unfortunately, hyperhidrosis is more serious than just uncomfortable sweating.

    Up to a third of people who deal with excessive sweating from hyperhidrosis say that they are constantly bothered by their sweating.

    • 75% of respondents reported that hyperhidrosis negatively impacted their social, emotional, and mental health.[4] 
    •  Hyperhidrosis and anxiety often go hand in hand.[3] 

    HOW COMMON IS HYPERHIDROSIS?

    • 3% of the US population struggles with hyperhidrosis. In other countries the percentage of the population that has it is even higher.[3] 

    Because hyperhidrosis is such an embarrassing and overlooked condition, many individuals avoid reporting the issue to their doctor. This means that the number of people who have hyperhidrosis might even be higher than we currently think.[3]

    What Causes Hyperhidrosis?

    Doctors don’t truly understand what causes primary focal hyperhidrosis yet. One theory is that particular nerves that control the amount of sweat overreact or malfunction. That malfunction can cause the excessive sweating that can be life-changing for those who suffer from it.[7]

    Since hyperhidrosis affects so many people, researchers are now shifting into full gear to discover the causes of excessive sweating so they can develop better treatments. Future treatments and research for hyperhidrosis are being developed more rapidly than ever before.[3]

    What Conditions Can Cause Secondary Generalized Hyperhidrosis?

    Many diseases and medical conditions can cause hyperhidrosis. However, just because you have one of the conditions listed below this paragraph doesn’t mean you’ll develop hyperhidrosis.

    Here are some of the more common conditions that may be causing the hyperhidrosis you have developed as an adult.

    • A febrile illness
    • Menopause
    • Hyperthyroidism
    • Heart failure
    • Diabetes
    • Frostbite
    • Alcoholism - Alcohol can cause excessive sweating when someone is intoxicated, withdrawing, or in someone with an intolerance.
    • Gout
    • Lymphoma and some other cancers and tumors.
    • Obesity
    • Pregnancy
    • Parkinson’s disease
    • Rheumatoid arthritis
    • Stroke[3]

    There are also several types of common medications that cause hyperhidrosis as a side effect. So, if you are on medication and you begin experiencing new or increased amounts of sweating mention it to your doctor. Some of these medications include antidepressants, painkillers, blood pressure medications and many others.a [3]

    If you think you might have secondary generalized hyperhidrosis it is very important that you speak to a doctor. Many of the things that cause it can be resolved, and it could be a sign of a more serious problem. Don’t panic, but it is wise to look into the reason you are sweating more.

    What Are the Treatments for Primary Focal Hyperhidrosis?

    If you are diagnosed with primary focal hyperhidrosis, there are many things you can do.These are the existing treatments for hyperhidrosis, but new treatments are currently being explored by scientists:

    • Antiperspirants:There are many over-the-counter antiperspirants that can be very useful when trying to curb sweat. If a regular antiperspirant isn’t cutting it for you, ask your doctor to write a prescription for a stronger one. You can apply antiperspirant to places other than just your underarms. Use it on your hands, hairline, or feet as well. There are even antiperspirants for the face and groin that are made specifically for sensitive areas.
    • An Iontophoresis machine:This medical device sends low-voltage currents into a pan of water where your hands or feet are sitting. The electricity can lessen the activity of your sweat glands, at least for a while. However, it can take up to 10 sessions with the iontophoresis machine to deactivate your sweat glands. You may need to use this machine up to three times a week in the beginning and one treatment can take up to 40 minutes. Although iontophoresis as a treatment for palmar and plantar hyperhidrosis may give your hands and feet a much needed break, the iontophoresis machine is anything but convenient. Iontophoresis really does work, but patients have to be willing to keep up with a regular treatment regimen for it to work successfully.
    • Botox:If other treatments aren’t enough in your, you might need Botox injections. Botox can be particularly useful for axillary hyperhidrosis, but botox can also be a treatment for palmar and plantar hyperhidrosis. Botox can provide up to 6 months of reduced sweating. If you’re going to pursue this route, you should look for someone who is experienced at doing Botox injections in the underarms to ensure the right area is targeted.
    • Anticholinergics:A few oral medications can for hyperhidrosis can reduce the amount of sweat you produce by stopping your sweat glands from working. Most commonly patients are prescribed anticholinergics like glycopyrrolate or oxybutynin as a treatment for hyperhidrosis. These medications also have several side effects, including heart palpitations, blurry vision, and dry mouth.
    • ETS Surgery:An endoscopic thoracic sympathectomy (ETS) is a surgical treatment for primary focal hyperhidrosis. It is an operation where an individual actually has the nerve endings that transfer sensory information to the sweat glands destroyed. Since no known successful reversal of an ETS surgery has ever been recorded, this option isn’t usually on the table unless the other treatments have failed. As with any surgery, it can be risky. There is also a type of surgery called an endoscopic lumbar sympathectomy which is used to treat plantar hyperhidrosis, but this surgery can be very dangerous and is almost never recommended.[3]

    Defeating Hyperhidrosis

    Undoubtedly, hyperhidrosis can be a hard condition to cope with. Until recently, the lack of research into hyperhidrosis had made hyperhidrosis difficult to manage. Thankfully, however, new treatments and awareness has made hyperhidrosis much easier to handle. Keep trying treatments until you find what works for you and remember that you are not alone in suffering with this condition. It’s just a matter of figuring out what you can do to control your sweat instead of your sweat controlling you!

    Sources
      1. MedicineNet Medical Journal. (2016, May 13). Definition of Hyperhidrosis. Retrieved May 14, 2018, from https://www.medicinenet.com/script/main/art.asp?articlekey=16272
      2. Diaphoresis: What causes excessive sweating? (n.d.). Retrieved May 20, 2020, from https://www.medicalnewstoday.com/articles/321663#overview
      3. 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
      4. Lenefsky, M., & Rice, Z. P. (2018). Hyperhidrosis and Its Impact on Those Living With It. AJMC. Retrieved from https://www.ajmc.com/journals/supplement/2018/hyperhidrosis-managed-markets-update-treatments/hyperhidrosis-and-its-impact--on-those-living-with-it

    Nordqvist, C. (2017, December 21). Hyperhidrosis: Symptoms, causes, diagnosis, and treatment. Retrieved May 14, 2018, from https://www.medicalnewstoday.com/articles/182130.php

    Doolittle, James, et al. “Hyperhidrosis: an Update on Prevalence and Severity in the United States.” Archives of Dermatological Research, vol. 308, no. 10, 2016, pp. 743–749., doi:10.1007/s00403-016-1697-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27744497/

    Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science. Retrieved from https://www.bookdepository.com/Hyperhidrosis-Janine-R-Huddle/9781633215160

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