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Patient
Advice and Information
Hyperidrosis
by Dr Panayiotopoulos, Consultant Vascular and General Surgeon
Essex.
1.
What is hyperidrosis?
Hyperhidrosisis excessive sweating as a result of the
overactivity of the eccrine sweat glands of the affected
area. This overactivity is triggered by the sympathetic nervous
system. It is a chronic condition that can be localized
[focal] or generalized. It can also be idiopathic [spontaneous,
the commonest form] or pathological [related to other
conditions,like diabetes, chronic infection, malignancies or a
reaction to drugs].
2. What are the symptoms and signs?
-
The main symptom is excessive sweating
that has a significant impact on the patient’s quality of life, with
social and even professional consequences. The sweating occurs for
no apparent reason and often leads to
social phobias
due to the embarrassment it causes.
-
Focal hyperhidrosismost commonly affects the
palms and/or feet, followed by the axilla.
In some cases the face may be affected, which may be accompanied by
blushing.
-
In generalized hyperhidrosisthe excessive sweating occurs all over
the body, including the torso and the limbs.
-
If untreated, hyperhidrosiscan lead to dehydration, depletion of
minerals and maceration of the skin, resulting in infections.
3. What causes it?
Although the exact cause is unknown, the excessive
sympathetic stimuli are thought to be caused by a physiological
rather than psychological derangement, as there is a family history
present in 30-50% of cases.
4. How can it be treated?
.
Conservatively.
.
Topical antiperspirants, like aluminium chloride based treatments,
may be effective in mild cases.
.
Oral
anticholinergics to block the neural stimuli may inhibit the
sweating but have severe side effects and the success is poor.
.
Injection treatment
.
Topical introduction of salt ions into the skin by electric current
[lontophoresis], can be effective, but
is time consuming and quite uncomfortable.
. Botulism toxin injected in the area
blocks the neurotransmitters that cause the sweating. It is more
effective in hyperhidrosisof the axilla, but not the palms.
.
.
Surgery is a potentially permanent
solution that is particularly successful for hyperhidrosisof the
palms.
.
Endoscopic thoracoscopic sympathectomy
with the small cameras [minimally invasive
keyhole surgery] is the treatment of choice as it cuts a section of
the sympathetic nerves [running at the side of the spine in the
thorax] that provide the stimulus for hyperidrosis. However, it can
result in compensatory sweating, which can be severe, in another
part of the body.
.
More limited thoracic sympathectomy procedure,
involving only the T2
and T3 sympathetic ganglia has been shown to be equally effective,
reducing at the same time the risk of compensatory hyperidrosis.
Your Thoracic Sympathectomy Procedure
1. Before your
operation
Thoracoscopic sympathectomy is
usually performed as a day case. Day case surgery means that
you come to the hospital the day you are to be operated and after
surgery, when you recover from anaesthesia [3-4 hours] your escort
will take you home, with all instructions given to you before [by
the surgeon] and after surgery [by the nursing staff].
2. Coming into hospital
You will be asked to come in or
the morning of your operation without drinking anything after
midnight. Please bring with you all the medicines you are taking to
show to the doctor.
You will be received in the ward
by a nurse who will note your personal details and ask about
any other conditions you suffer from. You will be also visited by
the surgeon who is to perform your operation, and the doctor
who will give you anaesthesia. Many people are concerned
about anaesthetics, so please ask the anaesthetist if you have any
specific worries so that he may reassure you. All of these people
are ready to answer any questions that you may have, so please ask.
You will be asked to sign a
consent form that the procedure has been explained to you and
you agree to go ahead.
3. The operation
This is performed under general anaesthesia.
Surgery involves two small halls
in the chest wall near the axilla, one to insert the camera and one
to insert the instrument to cut or burn the sympathetic trunk. The
anaesthetist has introduced a double lumen tube in the lungs, in
order to be able to stop inflating the lung of the operated side, in
order to allow the surgeon to see the sympathetic nerves, which are
located at the back of the chest. The procedure usually takes only
15min, the lung is re-inflated and the patient wakes up in recovery.
An X-ray of the chest follows
within 3-4 hours to check for pneumothorax or bleeding. However,
complications of this type are extremely rare.
4. After the operation
.
In
almost all cases there is no pain and the patient is able to go home
the same day, taking over his/her normal activities.
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Please note:
A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist. |
