What is hyperhidrosis?


Hyperhidrosis is excessive sweating. We all sweat and hot weather, embarrassment and anxiety cause it to increase. This is normal and it is only when the sweating is excessive, ruins clothing or causes extreme social embarrassment that it is called Hyperhidrosis. Generalised Hyperhidrosis may be the result of systemic disease such as chronic infection or an over-active thyroid gland. Localised sweating confined to the armpits or hands is not usually associated with any generalised disease.


2. Where does sweat come from?


There are thousands of little glands in the skin that produce sweat. Sweating is one of the ways the body uses to cool itself. The amount of sweat depends how hot it is and on stimulation of the sweat glands by the nerves which supply them. Excessive sweating is not harmful in itself. Therefore treatment is only required if the sweating is so severe that it is causing embarrassment or difficulties at work.


3. What treatment is available?


You may initially be prescribed a strong antiperspirant called aluminium chloride. This is applied at night and washed off in the morning. Antiperspirants work better in the armpits than on the hands. If medical treatment is unsuccessful in controlling the sweating, then an operation to divide the nerves that supply the sweat glands may be needed – a thorascopic sympathectomy.


4. What is a thorascopic sympathectomy?


The nerves that supply the sweat glands in the armpit and palms can be cut to reduce the amount of sweating. These nerves lie deep in the neck, close to the spine. Using ‘keyhole’ surgery the nerves are destroyed through two or three tiny holes in the chest, using special instruments. This procedure is called a thorascopic sympathectomy.


5. How is a thorascopic sympathectomy carried out?


You will have a general anaesthetic for the operation. When you are asleep, a small hole is made in the upper chest. The lung on the side of the operation is allowed to collapse a little to make some room; meanwhile your other lung is capable of doing all the breathing. A camera on a thin telescope is inserted into the chest to find the nerves, which are to be divided. One or two other small holes are made to put in the instruments, which divide the nerves. The instruments to divide the nerves are removed, the lung is re-expanded and the telescope is removed. Sometimes a small plastic drain tube is left in your chest for a few hours to make sure all the air is removed from the chest cavity, and your lung is fully expanded again.


6. How long will I be in hospital?


You will be kept in hospital overnight after the operation. Occasionally, if the lung is slow to expand, you may have to stay a little longer. Rarely, a small drain tube is needed to help the lung expand, called a chest drain.


7. How successful is thorascopic sympathectomy?


The operation usually gives a satisfactory reduction in sweating in over 90% of patients and in nearly all cases the results are permanent. It is usually more successful for sweating of the palms, than the armpits. Sometimes the palms are so dry afterwards that moisturising cream is needed to prevent the skin cracking. Stopping the sweating in the palms and armpits may result in extra sweating elsewhere. This ‘compensatory’ sweating commonly occurs on the back, below the shoulder blade.


8. Are there any special complications of thorascopic sympathectomy?


The only particular complication is a drooping of the eyelid on the operated side due to damage of the nerves in the root of the neck. This is rare (less than one in fifty) and usually recovers. Sometimes the ribs where the telescope was inserted into the chest are sore for a few weeks and hurt when breathing deeply or coughing. This is due to bruising of the ribs and gradually improves.