EXCESSIVE SWEATING (HYPERHIDROSIS) - a patient's guide
What is hyperhidrosis?
Hyperhidrosis is a condition in which the body sweats excessively and inappropriately. Usually this sweating happens for little or no reason and can be so profuse as to dominate the sufferer's life because of the amount of wetness produced.
It is not the same as the excessive sweating which occurs in association with medical conditions such thyrotoxicosis or carcinoid syndrome, and it is not the same as the hot flushes which occur during a woman's menopause.
Classically the person with hyperhidrosis will tell of lifelong difficulty handling paper at work or school, problems using keyboards, difficulties holding on to sports equipment, and terrible embarrassment in social contacts. Where the feet are affected there is inability to wear loose sandals like thongs and slipping on tiled or polished floors is a daily hazard. Other sufferers have huge problems with wetting their clothes and bedding due to nocturnal sweating.
Who gets hyperhidrosis?
The problem is usually most noticeable in young adults although most sufferers report that they were first affected during their childhood. Young women are affected almost three times more commonly than young men. Once established it can last for the rest of people's lives.
Although it does occasionally seem to affect several members of one family, it is not recognised as a hereditary condition and it is even possible for only one of identical twins to be affected. There seems to be no racial difference in incidence.
Why have I got hyperhidrosis?
This is not known for certain. It is well recognised that there is a wide range of what is considered "normal" sweating and this is an important part of the body's temperature regulating mechanism. Hyperhidrosis is well outside the accepted range of so-called normal. It is also known that some disorders mentioned above can alter the body's metabolism with resulting alterations in the normal sweat production. Hyperhidrosis is however different in that there is no detectable abnormality in the victims' metabolism and furthermore only a segment of the body may be affected.
Where does hyperhidrosis usually affect a person?
The most common sites for hyperhidrosis are the armpits, hands, feet, face and scalp. It can affect any other part of the body and is sometimes troublesome in the groin, on the back, or the natal cleft between the buttocks.
How does hyperhidrosis affect people?
This is a most distressing condition which is capable of totally dominating the life of the sufferer. Those whose hands are affected report social problems in holding hands or other physical contact and this is a serious disability in those whose occupation relies on this such as nurses, therapists, doctors, and so on.
Childhood experiences include problems with learning to handle paper and writing, and this continues into adult life with problems using keyboards and musical instruments.
Driving cars can even be a problem for some, and others have difficulty with sporting equipment.
Many are profoundly embarrassed by their affliction especially those with uncontrolled facial sweating. To compound their distress many of these people have sought medical help only to have their problem go untreated or even sometimes undiagnosed, which in turn leads sometimes to feelings of rejection or inadequacy.
Often sufferers wear dark clothing to conceal their embarrassment and many carry a scarf, tissues, or even a towel to constantly dab and dry their dripping skin. It is a true affliction.
Is hyperhidrosis permanent?
True hyperhidrosis is not self limiting and does not resolve spontaneously without treatment. For some reason hyperhidrosis seems not to be such a problem in older people but occasionally surgery is required in the over fifties.
Is hyperhidrosis harmful?
Apart from the emotional effects and the associated embarrassment there is nothing physically harmful in this condition.
Will my children inherit hyperhidrosis from me?
It is possible that children of a parent with hyperhidrosis will develop the condition but it is not very likely and there is no known hereditary tendency.
What can be done about hyperhidrosis?
Most people with true hyperhidrosis have tried all sorts of remedies with little or no relief. For profuse armpit sweating standard antiperspirant cosmetic preparations are often ineffective and need to be applied so frequently and in such amounts that skin burning can result without the sweating being controlled.
For problems in the feet there are applications available but in true hyperhidrosis these are not usually adequate.
In cases where there is more widespread sweating drug treatments have been tried and again these either do not seem to be effective or the side effects (such as dry mouth) are intolerable.
Other non-surgical methods such as iontophoresis are occasionally tried but have not been found to be either particularly successful or practical.
Where sweating occurs only in the armpits operations have been performed in the past to excise (cut out) the sweat glands. This may be the preferred option in some cases but it can leave unacceptable scarring and infection rates are significant. Post-operative arm movement can also be limited if there are any problems with wound healing in the armpit.
An old operation which has been available for many years is "Sympathectomy". This is now very much in vogue again because of the modern concept of "minimally invasive" or "keyhole" surgery which has made this procedure safe, accurate, and very well tolerated by patients. This is Thoracoscopic or Endothoracic Sympathectomy.
What is a Sympathectomy?
The principle of the operation is that we know that sweating is controlled via a pair of nerve trunks called the Sympathetic Nerves that run down each side of the body deep inside the chest and abdomen against the side of the spine. If these nerves are cut in certain places then sweating will be abolished in well defined areas of the body.
Unfortunately not all sufferers are suitable for this procedure but those who are often have their lives transformed by this remarkable technique. The areas which can be reliably dried out by endothoracic sympathectomy are the scalp, face, hands, and armpits. A similar procedure (Lumbar Sympathectomy) can be used to dry out the feet but has not been in the same popular demand in most published series.
What are the side effects of sympathectomy treatment?
The most common side effect is compensatory sweating in another part of the body. It is most common in the middle of the back or under the breasts and is noticeable in over half of people who have the operation. It is only rarely a serious problem and most people find it quite acceptable as a trade off in order to be rid of the original hand and armpit sweating. There are no reported major effects in terms of the way the body's heat or fluid regulation functions after sympathectomy.
What possible complications are there from treatment?
Like all surgical operations there can be complications. Fortunately these are hardly ever seen when the operation is done by an experienced surgeon. Bleeding and infection are almost unheard of.
Because the lung has to be pushed out of the way during surgery in the chest it is possible to get a condition known as "pneumothorax" in which the lung partially collapses. This means that a small drain tube is needed in the chest for a few hours to re-expand the lung. There is no long term or permanent damage from this.
The only other recognised special complication of thoracoscopic sympathectomy is "Horners Syndrome" which occurs in less than 5% of operations and is often only temporary lasting several days. In Horners Syndrome the eyelid droops by a tiny amount. It does not droop over the pupil and does not affect vision in any way, so is usually barely noticeable.
Where can I get help for my hyperhidrosis?
The procedure of Thoracoscopic Sympathectomy is available in several centres in New Zealand, most often in private clinics. Some public hospitals can offer the operation also. As with all surgery it pays to ascertain the experience of the surgical team before deciding to go ahead. A referral for consultation with a specialist can be obtained from your local doctor who will be able to check for any other underlying medical conditions and who will be able to advise on choice of surgeon.
Will my medical insurance cover Sympathectomy?
Most insurance companies accept claims for this type of surgery but as always it is important to check on your particular cover before going ahead.