Cardiovascular and Thoracic Surgery

Hyperhidrosis (Excessive Sweating)

Excessive sweating, also called hyperhidrosis, can affect the entire body, but usually occurs in the palms, soles, armpits, and/or groin area.

Excessive sweating is normal when a person is anxious or has a fever. However, when the condition is chronic, it may be hyperhidrosis or it can signal thyroid problems, low blood sugar, nervous system disorders, or other medical problems. Typically, hyperhidrosis is a benign problem with no clear cause.

What are the symptoms of excessive sweating?

Areas that produce excessive sweat usually appear pink or white, but, in severe cases, may appear cracked, scaly, and soft (especially on the feet). Other symptoms may include a bad odor caused by bacteria and yeast in the wet skin.

Hyperhidrosis can lead to significant distress socially and in the workplace.

The symptoms of excessive sweating may resemble other medical conditions. Always consult your doctor for a diagnosis.

Causes of Hyperhidrosis

The cause of hyperhidrosis is not well understood, but it is known that the sympathetic nervous system (responsible for the fight-or-flight response when under stress) is important in the control of sweating. This system may for some reason be overactive in patients who suffer from hyperhidrosis.

Non-surgical Treatments

There are a number of non-surgical treatments for hyperhidrosis, including, but not limited to:

  • prescription-strength topical antiperspirants
  • orally administered anticholinergic medications, which may partially block the transmission of nerve impulses that have become problematic
  • iontophoresis, which uses water and a very mild electrical current to microscopically thicken the outer layer of the skin

However, these treatments are successful in only a small fraction of patients, and none are without side effects. Botox injections often are successful, but they provide only short-term relief, are very costly, and may become less effective over time.

Surgical Treatments

Surgeons have known for many years that dividing the sympathetic chain in the upper chest can provide a long-term cure for hyperhidrosis. Since this procedure, known as a sympathectomy, can not be accomplished with minimally invasive techniques, the number of patients offered the operation has dramatically risen. Thoracoscopic (VATS) sympathectomy treats hyperhidrosis with an extremely high degree of success and patient satisfaction.

Under general anesthesia, two 2mm incisions are used on each side to pass a tiny video camera and a single dissecting instrument into the chest. The incisions are so small that this is sometimes called “needlescopic surgery.” The sympathetic trunk is visualized and divided at the levels appropriate to the patient’s problem area. Nearly all patients are discharged home the same day and suffer only very minor discomfort for a few days after the operation. Although many patients experience a mild increase in sweating in other parts of their body, this is rarely problematic, and a high majority of patients will be cured of their excessive sweating when the appropriate levels of the sympathetic trunk are divided.

When finished, the surgeon will re-expand the lung, remove the camera and instruments, and sew shut the incision. Then the surgeon will repeat the procedure on your other side. The entire surgery takes about an hour.

Most people can go home the day after the surgery. You may feel pain for a week afterward. Your doctor may suggest that you take over-the-counter or prescription pain medicine. Ask your health care team how to keep the incisions clean. Avoid soaking in the tub or going swimming for two weeks. You can probably do your normal activities after the surgery, but you may need to take it easy at first. Most people can return to work within a week. Be sure to attend any follow-up visits that your doctor schedules.