Hyperhidrosis – excess sweating

By DR. PAULO VIEIRA DE SOUSA [email protected]

Dr. Paulo Vieira de Sousa is a general surgeon and clinical director at the Hospital Particular do Algarve in Faro, specialising in local and keyhole surgery. He was a former assistant surgeon at the Hospital Egas Moniz in Lisbon and assistant of the surgery department at the Medical University of Lisbon.

Sweating is our body’s natural response to the increase in body temperature, but when sweating is in excess, it is considered a disease called hyperhidrosis.

Hyperhidrosis can be a primary disease without a precise known cause or it can be secondary to other diseases, namely hyperthyroidism, obesity, infectious diseases, tumours, menopause and some medical treatments.

It’s very uncomfortable not to be able to greet someone with a handshake or not to be able to send a letter or sign a document without leaving a wet print on everything touched.  

This kind of sweating occurs mainly in the hands and armpits, but it can also affect other parts of the body such as the head, feet or the back.

Hyperhidrosis affects one to two per cent of the general population and normally starts at a young age or at puberty and lasts throughout adult life. It affects both men and women and it follows a hereditary pattern, affecting several members of the family.

Hyperhidrosis is caused by excess activity in certain parts of our sympathetic system, which is responsible for the automatic  control of the response of our body to stress and sudden unexpected occurrences, increasing the activity of the heart, lungs, muscle strength and sweating of our organism.

The sympathetic system is principally controlled by the parasympathetic system, also in an automatic way, and because of this we are not aware of all these changes that take place in our system. The parasympathetic system is responsible for bringing all levels back to normal, decreasing the heart rate, respiratory rate and the sweating.

In some people, there is an increase in the sympathetic activity in certain parts of the body that are not controlled by the parasympathetic system, and this causes excessive sweating in those specific areas.  

There are at present various treatments available to patients suffering from this ailment. The main idea is to block or reduce the amount of sympathetic activity in the affected area without interfering with the rest of the body.

Dermatological solutions (antiperspirants) are mainly used in the armpits, with some efficiency in patients suffering from sweaty armpits , but are ineffective in other locations. Some doctors are reported as saying that excess use of antiperspirants in the armpits can be associated with breast cancer due to the excess of aluminium.

Intoforesis (low level electicity current administered along with special drugs) and botox are effective but not a long lasting solution, making patients constantly dependent on the treatments as they must be repeated every three to four months in order to control the symptoms and the excessive sweating.

Removing the sweat glands from the armpits is an aggressive procedure that only controls the excessive sweating in this particular area and has been associated with some surgical complications.

The most recent and effective treatment for this disease is local sympathectomy with video assisted thoracic surgery.

This is a minimally invasive procedure that consists of entering the thoracic cavity with a millimetric video camera, which identifies the overactive sympathetic chain responsible for the sweating of the hands or the armpits and blocks it in a permanent way.

This procedure normally requires a general anesthesia, but it can be done in a one night stay at the hospital with minimal pain or discomfort for the patient.

Only two to three incisions of approximately five millimetres, which easily become undetected after a few weeks, are necessary in the armpits area.

From our experience, patient satisfaction with the results of this procedure is approximately 98 per cent in hand sweating and 95 per cent in armpit sweating.

There is no great experience in the use of video assisted lumbar sympathetic blockage for the control of sweaty feet, even though this type of surgery has been performed by us with good results in some cases.

The main post-operative complaint is compensatory sweating. This occurs when the patient stops sweating from the hands or armpits but has compensatory sweating from the feet, the back or the abdomen. This may  occur in 20 to 30 per cent of cases, but in all circumstances it is  temporary and every patient says that this compensatory sweating, when it appears, is less distressing than the original pathology.