http://home.houston.rr.com/hhsws/thc/treatment.htm

Treatment

Hyperhidrosis can be treated surgically or non-surgically depending on the severity of your condition.

 

Non-Surgical Treatment 

Mild cases of hyperhidrosis can be managed with topical anti-perspirants such as Certain Dri or Drysol that block the pore of sweat glands to decrease the total amount of perspiration. Medicines such as Robinul can decrease the reactivity of the sympathetic nervous system but with the side effects of dryness of mouth, eyes and skin. Iontophoresis (low intensity electric current in a salt water) can be more effective than anti-perspirants with similar mechanism to block the openings of sweat glands of hands and feet that immersed in it with regular applications.

 

Recently, Botox can be effective if injected repeatedly in 2 to 8 months especially for armpits. However, 28 injections in one hand for palmar hyperhidrosis is quite an unpleasant ordeal for patient and doctor. Weeks of weakness of thumb and finger function can be quite unwelcome for some jobs and activities. Furthermore, repeated necessity of injections with antibodies formation is a concern.


Surgical Treatment 

In the modern era, the most effective treatment for severe cases is Endocscopic Thoracic Sympathectomy (EST). Thoracic Sympathectomy was first tried to treat epilepsy in 1889. Later on, besides Hyperhidrosis, it was the main operation for Raynaulds disease that causes vessels of hands and feet to spasm with tissue ischemia and /or necrosis, and many medical illnesses including essential hypertension in the past. These operations need large incisions by chest surgeons or back incisions by neurosurgeons to remove part of the nerves inside the ribs. They are quite a serious undertaking with significant morbidity and even mortality. They are painful and disfiguring. Patients always lost their abilities to sweat in hands, face, head and different parts of body. At the time without CT scan or MRI, the zone of Anhidrosis (a condition when no sweating can happen) was one of the best ways to locate the levels of spinal cord and sympathetic ganglions involvement.


Dr. E. Kux championed the EST in his 1951 report. In recent years, it emerged as an effective, bilateral simultaneously and simple enough as an outpatient surgery.

 

EST can be performed with inserting scope and instruments through tiny skin incisions to divide, clip or excise an appropriate segment of sympathetic nerves in the chest cavities. 

 

Possible Side Effects

Inevitably there will be tiny scars. Mild wounds and back pain are expected in every patient for a short period of time. Wound infection is extremely unlikely to happen, and rare incidents of air leakage can be managed easily and temporarily with Heimlich valve apparatus. Intra-operative bleeding is unlikely to be an issue. Recurrence is also unlikely. Horners syndrome should be a rarity or completely prevented. Gustatory sweating can occasionally happen after eating certain food.

 

The main problem is Compensatory Sweating (CS) elsewhere. CS can unpredictably occur at anywhere except the targeted areas, but usually presents at lower back, upper abdomen, inner thighs, behind knees, groins or even at feet. Though this problem is usually mild to moderate and well accepted by patients, its severe form is the main source of bad result in the long term. Current concept is leaning to replace it more appropriately as Reflex Sweating as advocated by Dr. C.C. Lin, because the amount of CS can be many times more than expected and its etiology of pathogenesis. It is the main effort here at Texas Hyperhidrosis Center to minimize its extent and severity.

 

The other complication is Anhidrosis (no sweating and too dry) occurs at hands and other unintended areas. A head that cannot sweat is not a pleasant free gift of postoperative dry hands. Furthermore, hands need appropriate moisture for their texture and gripping. Extreme dry hands lead to hyperkeratosis, scaling and fissuring of the skin. Dry hands lose hands grasping power. This is another evolving progress that this center tries to improve with the cooperation of other worldwide leaders. Ideally just right moisture of hands is the goal of ETS.
