Excessive Sweating also known in medical literature as (hyperhidrosis) is an ailment affecting about 1 ½% of the population. In contrast to overall total body sweating we are dealing mainly with focal hyperhidrosis. This term denotes clinical situations where patients having specific sites of excessive sweating. The most common combination of focal excessive sweating are the hands, armpits and feet. This by far exceeds all other forms of excessive sweating. Other sites of excessive sweating are facial hyperhidrosis and nasal hyperhidrosis. Those individuals afflicted with these problems are having both social and functional problems. The level of excessive sweating can range from mild to severe. In the moderate and severe cases the daily problems are numerous. Handling computers, writing papers, driving, interviews; all are situations where those suffering are expressing severe difficulties. According to the International Classification of the hyperhidrosis society those patients belong to group 4 which translates into patients who are having those problems on a daily basis.
Numerous attempts were and are made in order to help those individuals. There are a number of conservative methods totreat hyperhidrosis and obviously every person should first try those conservative measures. There are lotions containing aluminum chloride in different concentrations that can help. Those are prescribed lotions. The main drawback is that they can cause skin irritation and in severe cases the success rate is extremely low. There are different brands to these lotions and in different countries there are different products. Second in line are electrical devices known as iontophoresis devices. These can be purchased online or with a prescription. There is a need to use them quite often and the success rate so far is described as minimal. Oral medications are also available with prescription. Those anticholinergic medications (Robinul) are acting against the chemical transmitter that produces sweat. There are some mild side effects associated with them but again here the success rate is reported as minimal. Never the less attempts should be made by anyone before any decision about further surgical treatment is made.
Treatment modalities such as acupuncture, hypnosis, biofeedback, anti anxiety medications were all described but again here the success rate is minimal. Botox injections for hyperhidrosis became quite popular over the last few years but they are costly, painful, and very temporarily helpful if at all.
When all conservative measures fail and the individuals are continuing to suffer from their daily problems, then consideration should be given to the surgical procedure known as endoscopic thoracic sympathectomy (ETS). This particular procedure was developed over the last two decades and it involves interruption of the sympathetic nerve flow within the chest cavity. It is being done in an endoscopic way enabling the operation to be carried out on an outpatient basis with a very short recovery time. It should be stressed that ETS helps mainly with severe hand sweating. Excessive foot sweating enjoys less than 50% improvement after endoscopic thoracic sympathectomy. For those patients that did not enjoy any improvement with their excessive feet sweating then the new modality of lumbar sympathectomy is offered now.
For those patients with excessive armpit sweating only ETS should not be done. For this group of patients, after trying conservative measures such as aluminum chloride methods (Drysol) then the new modality of axillary suction currettage should be offered. This procedure has a local effect on the armpit sweat glands and basically does not have the effects of compensatory sweating which is a constant side effect after ETS. Patients should know that the compensatory sweating is a constant side effect and can range from to mild moderate to severe. The majority of patients have mild to moderate compensatory sweating which enables them to continue with their normal way of life. Between 3 - 5% of the patients can have severe compensatory sweating which can be a difficult problem. For that reason the method of clamping the nerve instead of cutting the nerve offers a possibility of reversal if needed.