Hyperhidrosis

UChicago Medicine performs thoracoscopic sympathotomy, also known as endoscopic thoracic sympathotomy or sympathectomy (ETS), for hyperhidrosis. This is the most common — and most effective — surgery for focal hyperhidrosis, a type of sweating caused by overactive nerves. The goal of the procedure is to cut a carefully selected portion of the sympathetic nerve, which is the system that activates your body's fight or flight response to stress. The overall stress response system is not affected by this procedure.

In ETS, the surgeon makes two small incisions (less than one-quarter of an inch in length) on both sides of the patient’s chest and inserts a camera and a small instrument to cut part of the sympathetic nerve. Our physicians divide, rather than clip, the nerve which provides a permanent and more effective solution to sweating. No stitches are required. The reduction in sweating is immediate. The procedure is performed as an outpatient, results in extremely small post-surgical scars, and requires only a brief period for recovery.

This treatment has been approved by the U.S. Food and Drug Administration to reduce excessive underarm sweating. It uses microwave energy to heat and destroy the sweat glands in the underarm area. Studies have shown that after two in-office treatments, 80 percent of patients have less sweating and underarm odor. At UChicago Medicine, this treatment is performed by specially trained physician assistants with extensive knowledge about treatment of hyperhidrosis. This option is provided at UChicago Medicine through the Thoracic Surgery team.

Our experts are trained in acupuncture and offer this technique for treatment of excessive sweating, including for patients who are bothered by sweating that may not be focal. Acupuncture treatment involves insertion of tiny needles into specific points on the body that are aimed at internally regulating the sweating mechanisms. Each treatment lasts about 40 min, and usually 6 to 8 treatments over a period of 2-4 weeks are necessary for optimal results.

There are a variety of medications that can be prescribed to control excessive sweating. Several topical prescription-strength medications are available and may be the safest first-line options to treat hyperhidrosis. Some work as stronger antiperspirants, while others locally block the signals that stimulate sweating in the applied area.

Available by prescription, these medications work much like over-the-counter antiperspirants, except they are stronger. The patient applies the medicine to the affected area. Although the medication is left on for six to eight hours, the treatment may only be effective for a few hours. Side effects of this treatment may include skin irritation. This option is provided at UChicago Medicine by our expert thoracic surgery or dermatology providers.

Oral medications are also available. These work by blocking neuronal signals that stimulate sweating throughout the body. While oral medications are often effective, they do carry the potential for side effects, which your doctor will discuss with you during your consultation visit. This option is provided at UChicago Medicine by our expert dermatology providers.

A doctor will perform multiple injections of a small amount of botulinum toxin (Botox) in a grid pattern across the affected area, typically the underarm or hand. The treatment is usually effective for four to six months before excessive sweating starts to recur. Treatments will need to be repeated once the effect wears off; after a few treatment cycles the effectiveness of Botox diminishes. Treatments may not be covered by all insurance plans and can be costly and painful. This option is provided at UChicago Medicine by our expert dermatology providers.

This electric unit is used primarily for hyperhidrosis of the hands and feet. The affected area is submerged in a pan of water while a mild electric current is applied. Frequent treatments are necessary to control sweating. Skin irritation may occur. Treatments are done at home, and insurance coverage for home iontophoresis units is variable. People who should not use iontophoresis include those who have a pacemaker, are pregnant, have metal implants such as artificial joints, have a history of irregular heartbeat, or have a rash or other skin condition in the area to be treated. If there are questions about appropriateness of use, individuals should consult their physician. This option is provided at UChicago Medicine by our expert dermatology providers.

The causes of hyperhidrosis are not well understood. The condition occurs daily, often without provocation. It can be worsened by stress, anxiety, a warm environment and physical activity. Excessive sweating is related to the sympathetic nervous system. The sympathetic nervous system prepares the body to cope with stressful situations. Normally, this system helps the body with its "fight or flight" responses. But in people with hyperhidrosis, something goes wrong, and excessive sweating is the result.

Experts aren't sure. But recent information indicates that hyperhidrosis of the palms may be due to genetic factors. Many of our patients have parents or siblings who have hyperhidrosis.

Although this type of profuse sweating is not life-threatening, it can be extremely embarrassing and may interfere with a person's daily activities. Someone with hyperhidrosis may have difficulty grasping objects because of wet hands. They may have to change clothes frequently during the day due to underarm perspiration.  It is not uncommon for a patient’s work, social, or intimate lives to be negatively affected by this problem.

Occasionally, people will have profuse sweating throughout their body. This is called secondary hyperhidrosis because it usually occurs as a sign of a serious underlying condition, such as thyroid disease or tuberculosis. If you have this type of sweating, you should contact your primary care physician. For patients in whom a cause for the sweating is not identified, acupuncture may help reduce the symptom.

Yes. UChicago Medicine offers surgical and nonsurgical treatments of hyperhidrosis. Depending on your symptoms, a provider may recommend nonsurgical methods of treatment as the first step.

Yes. Surgery is not necessary for the majority of patients who are bothered occasionally by excessive sweating, particularly when they are in stressful situations. Nonsurgical treatments include heat destruction of the underarm sweat glands, oral medications, topical medications, acupuncture, electrical stimulation, and Botox injections.

miraDry®, a treatment that uses thermal (heat) energy in the underarms is especially effective for underarm hyperhidrosis. In our experience, two treatments can help reduce underarm sweating and odor in about 80 percent of patients. Iontophoresis is another option, which reduces sweating through electrical stimulation treatments.

This treatment uses heat to destroy sweat glands in the underarms. Most patients will need two, one-hour treatments scheduled about 12 weeks apart before they will notice less underarm sweating and odor. Most people also notice that hair growth under their arms decreases by about 50 percent after two treatments.

Adults who have excessive sweating in the armpits are candidates.

However, this treatment is not for pregnant or breastfeeding patients as well as those with rashes, infections or scarring from previous surgeries in the underarms. It is also not for patients with electronic implants such as pacemakers, cochlear implants or insulin pumps. People taking Accutane may need to postpone treatment for a few months after they have completed their medication.

A local anesthetic is used to minimize pain during the procedure. After treatment, you will have swelling, bruising, redness and pain in your underarms for about a week. You can go back to work the same day, but you will need to avoid exercising for a few days.

Most people have less underarm sweat and odor after two treatments, scheduled about 12 weeks apart. Many people also notice less underarm hair. These reductions in sweating, odor and underarm hair growth are permanent.

No.

Acupuncture involves temporary insertion of tiny needles into carefully identified treatment points throughout the body. The activation of these points stimulates the body’s natural systems to help reduce the sweating.

Insertion of tiny needles is sometimes accompanied by a temporary tiny pricking sensation. Most patients find that the treatment process is very relaxing.

The risks of acupuncture include bleeding and infection, but these occur only rarely. Some people feel a little light-headed for a few minutes after their initial treatments.

For patients who have moderate to severe focal hyperhidrosis, which is caused by overactive nerves, surgery may be the best option Particularly for patients with hyperhidrosis of the palms of their hands. The success of surgery for foot sweating is unpredictable, and surgery is not recommended for targeting this area of the body. Surgery can also be used for face/scalp sweating and blushing when oral medications have failed to provide relief. It is useful for underarm sweating when other remedies have been unsuccessful.

Success depends on the location and characteristics of your sweating. In our experience, surgery is effective for 98 percent of hand hyperhidrosis and 80 percent effective for underarm or scalp/facial hyperhidrosis.

Although it is considered minimally invasive, there are some side effects that may occur from surgery. One common side effect is compensatory sweating: excessive sweating shifts from the hands, armpits or face to another area of the body, such as the chest, abdomen or groin area. It is the most common side effect and occurs to some extent in virtually every patient undergoing this operation. Most patients find that compensatory sweating is an acceptable trade-off.Your surgeon will discuss your specific risk factors with you.

Potential complications of surgery include:

• Incisional pain, bleeding, infection and lung injury. The risk of these complications is less than one percent.
• Horner’s Syndrome: A complication that affects one side of the face including droopy eyelid, constricted pupil and loss of sweating. Horner’s Syndrome occurs in only a small fraction of one percent of patients and, at times, corrects on its own.

A patient’s underlying conditions may increase their risk for certain side effects. For example, patients suffering from prior lung infection causing scarring of the lung to the chest wall may be at greater risk for lung problems after surgery.

Surgery is performed on an outpatient basis under general anesthesia. Most patients experience discomfort or pain in the chest wall area for only a few days following the surgery. We recommend that patients restrict themselves to light activity, such as climbing stairs or walking, for a few days after the surgery.