Primary hyperhidrosis is a condition of excessive and inappropriate sweating due to overactivity of certain portions of the sympathetic nervous system, which controls sweating and other involuntary functions. This most often affects the palms of the hands but may also affect the axillae (underarms) and face, where it is sometimes accompanied by severe flushing or reddening. Other areas including the soles of the feet and the trunk may also be involved. Hyperhidrosis may be more common in Asian populations but can occur in any ethnic group. Although the cause of the disorder is unknown, it appears to have a tendency to run in families.
Usually the excessive sweating begins around the time of puberty, when maturation of the sweat gland under the arms and in the groin region occurs; how this maturation is related to the onset of palm (and sometimes foot) sweating is not known. Sweating may be quite severe and may occur spontaneously or be brought on by anxiety, or even by wearing covering on the feet. The problem can sometimes be severe enough that sweat actually drips from the fingers. This can be not only a very difficult social problem, but in occupations requiring frequent contact with people (receptionists, physicians, food handlers, etc.), it actually can be quite disabling. Common treatments have included the use of drying powders and even galvanic stimulators, which actually run electrical current through the palms to temporarily render the sweat glands inactive. This procedure, while moderately effective, is uncomfortable and requires daily use, sometimes several times a day. More recently, the use of botulinum toxin injection into affected areas has been introduced. When performed by an experienced physician, this can also be effective. Like galvanic stimulation, it is temporary and acts only on the locally treated skin surface. For many years, it has been recognized that control of the sweat glands in the palms and face comes mainly from a portion of the nervous system called the sympathetic ganglia, primarily those located in the upper chest region, and that removal of certain of these ganglia could cure hyperhidrosis and related problems. Traditionally this surgery was performed as an open procedure, done by various approaches according to the experience of the surgeon. These open approaches were large operations and involved considerable discomfort and some risk. Modern technology has made it possible to accomplish the same goal using endoscopic techniques. This "band-aid surgery" involves a tiny fiberoptic device inserted via a small incision under the arm, usually with a second small incision nearby used to insert other surgical instruments. Removal of the T2 and T3 ganglia results in immediate relief of palmar sweating in more than 90 percent of patients, and most are discharged home the following day. The cure is permanent in most people. Improvement in sweating and blushing of the face also occurs, and some decrease in sweating of the underarms can generally be expected as well. Risks of surgery can include increased sweating in the trunk, legs, and feet, called "compensatory sweating," and there is a small risk—less than 1 percent in the most recent medical literature—of a side effect called Horner's syndrome, involving a slightly droopy eyelid on the side of the surgery. Other risks include "gustatory sweating," in which certain tastes or smells trigger sweating. This rare side effect may be due to the surgery, or may represent a symptom previously masked by more generalized sweating. The risks, expected side effects, and benefits of surgery must be carefully discussed between the patient and the surgeon before a decision to proceed with surgery is made. There is no substitute for an in-person examination and interview by a knowledgeable physician when making a decision about hyperhidrosis or any other medical condition. For people with hyperhidrosis, this surgery can make an enormous difference in lifestyle and self-image. For more information or to make an appointment, contact the Neurosurgery Clinic at 312/695-8143. Send e-mail to John C. Liu, MD at jliu@nmff.org with any questions.
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