Sweating is a normal, physiological bodily function. Sweating occurs and the heat balance is maintained as the sweat glands are stimulated as a result of increased body temperature or exercise. However, hyperhidrosis-seen as a disease-is an abnormally excessive sweating without increased body temperature which emerges after the sympathetic system is stimulated too much.
What are the underlying causes of hyperhidrosis?
Hyperhidrosis may be secondary to specific conditions such as infectious diseases, cancer, diabetes, hyperthyroidism, heart diseases, menopause, obesity or use of certain medications. It is necessary to seek medical attention in case of an unusual, abnormally excessive sweating.
In addition to this, “primary hyperhydrosis” refers to overactivity of the sweat glands without the presence of any underlying disease. The exact cause is not known. The condition may be worsened by stress, but the underlying cause is not a psychiatric disorder. Recently, scientific studies report a genetic origin. The incidence rate of this condition is same in both men and women.
How is hyperhidrosis noticed? What are the symptoms?
Although hyperhidrosis may be observed in any part of the body, it affects certain regions. The face, armpits and hands are the parts that are affected most commonly. Excessive sweating of the hands and face may be observed starting from birth, while sweaty armpits generally occur during adolescence.
Questionnaire studies indicate that excessive sweating limits daily life activities, leads to poor communication with other people, puts people to shame when shaking hands, causes difficulty in writing and using keyboard, affects the education life, results in lack of self-confidence, unsociability and reduces quality of life.
When a person is involved in social interaction, he/she is affected physiologically with the worry of sweating, which causes excessive sweating of the hands, face and armpits. Skin infections are more common in the areas of sweating. Another unwanted condition is unpleasant smell caused by bacteria in the area of sweating. Smell of sweat may cause a person to stay away from social interaction or to be excluded from the society.
Excessive sweating is ignored by many persons, but it should be known that the condition may affect professional-social and educational life negatively when left untreated. Thus, it is important to start treatment of excessive sweating as soon as possible.
How is hyperhidrosis diagnosed?
Primary hyperhidrosis is diagnosed by obtaining a detailed clinical history and ruling out secondary causes. To diagnose regional primary hyperhidrosis, investigation is done in accordance with the criteria determined by international study groups that have conducted researches regarding this condition. These criteria include that regional, visible excessive sweating should have been persisting for minimum of six months, should be seen bilaterally, limit daily life activities, occur minimum once a week, family history should be notable for excessive sweating, excessive sweating should have started before the age of 25 years and should not occur during sleep. Final diagnosis is established by physician considering these criteria.
What are non-surgical methods in treatment of hyperhidrosis?
Antiperspirants, iontophoresis and botox are among the non-surgical methods applied in treatment. Also, it is possible to alleviate or eliminate excessive sweating through certain medications recommended only by physician and doses of which should be carefully monitored. Unfortunately, positive outcomes obtained with these methods are temporary.
How is surgical treatment of hyperhidrosis performed?
The sympathetic nervous system controls the activity of the sweat glands in the body and is a part of the autonomic nervous system which cannot be controlled intentionally. Sympathectomy is a procedure performed to reduce the activity of the nerves related to the sweat glands. As a permanent solution, “thoracoscopic sympathectomy” can successfully be performed for patients for whom local therapies do not help the complaint.
Scientific studies regarding hyperhidrosis have proven the safety and success of “thoracoscopic sympathectomy”, which is performed using a cutting-edge fine telescope and cameras and eliminates the activity of sympathetic nerves surgically.
The decision regarding whether the operation is indicated is made by physician after relevant tests and exams are done. The patient is informed about the possible side effects and then the operation is performed.
The operation is performed through a tiny incision made on the skin of the armpit. During the operation, a substantial part (99%) of the patients is not intubated (placement of a tube into the trachea) and no drain is placed. No cosmetic problem, like scar, occurs. The risks of general anesthesia are minimized since the patients are not intubated during the operation.
What are postoperative considerations?
Generally, 1-day hospital stay is sufficient after the operation. If possible, the patient can also be discharged on the same day.
When to resume normal activities after the procedure?
After hyperhidrosis surgery, patients can immediately return to daily life activities including light physical activities.
Does hyperhidrosis recur after the surgical treatment?
Scientific studies demonstrate that hyperhidrosis may recur after the operation, albeit rare, and the operation has been repeated in some cases. Compensatory sweating, also known as reflex sweating, is a side effect that may occur in the back and lumbar region after thoracic sympathectomy and regress in time; no consensus has been reached yet on the underlying cause of this condition. Before the operation, patients are informed in detail about reflex sweating.
Excessive sweating of the face, hands and armpits may cause the feeling of being ashamed and affect professional, social and educational life negatively. Actually, sweating-a normal, physiological bodily function- is considered hyperhydrosis when doctors make a detailed examination and identify relevant signs. Surgical treatments yield promising outcomes. Professor Berkant Özpolat, from the Department of Thoracic Surgery of Güven Hospital, has given information about hyperhidrosis and surgical treatment of hyperhidrosis.
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