Hyperhidrosis, or excessive sweating, can range from mild to severe. It can be a slight nuisance, or a condition that interferes with work and is socially embarrassing.
At the University of Chicago Medicine, our highly experienced physicians offer a variety of treatment options to help you alleviate uncomfortable symptoms and regain confidence.
Patients with mild to moderate symptoms are usually the best candidates for the following nonsurgical options:
Available by prescription, these medications work much like over-the-counter antiperspirants, except they are stronger. The patient applies the medicine to the effected 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.
There are a variety of oral medications that can be prescribed to control a patient's reaction to a certain situation. Anti-anxiety medications can help patients who have excessive sweating primarily due to stress-induced anxiety. Antidepressants also have helped patients cope with this condition. These medications often have side effects.
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 and lengthy treatments are necessary to control sweating. Skin irritation may occur.
A doctor will inject a small amount of botulinum toxin (Botox) into the affected area, typically the underarm or hand. The treatment is usually effective for four to six months before excessive sweating starts to reoccur. In some patients, results may last up to a year. Treatments will need to be repeated and can be rather costly and painful. A study published in the New England Journal of Medicine found that Botox injections worked well for severe underarm hyperhidrosis.
Thoracic sympathotomy is the most common — and most effective — surgery for hyperhidrosis. The goal is to destroy a portion of the sympathetic nerve, which activates your body's fight-or-flight response under stress.
Previously, surgeons would have to make a large incision in the chest or neck. Now, a less invasive method, called endoscopic thoracic surgery (ETS), is used. This surgery often is performed in other centers with instruments that measure almost half-an-inch in diameter. But surgeons at UChicago Medicine now use needlescopic techniques to perform ETS with extremely slim instruments, measuring only one-eighth of inch in diameter.
In ETS, the surgeon makes two small incisions in the patient's armpit to insert the instruments that destroy a part of the sympathetic nerve. Our physicians divide, rather than clip, the nerve. That provides a permanent and more effective solution.
This surgery has a quicker recovery time as well as less scarring than other surgeries for hyperhidrosis. In fact, the incisions are so small that they require no sutures for closure.
What causes hyperhidrosis?
The causes of hyperhidrosis are not understood. The condition occurs daily, often without provocation. It can be worsened by stress, anxiety, a warm environment and physical activity. While more research is still needed, experts agree that excessive sweating is controlled by 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.
Is hyperhidrosis a genetic disorder?
Experts aren't sure. But a study in the Journal of Vascular Surgery indicates that palmar hyperhidrosis may be due to genetic factors. Many patients have parents or siblings who have hyperhidrosis.
Is hyperhidrosis life-threatening?
Although this type of profuse sweating is not life-threatening, it can be extremely embarrassing and may interfere with a person's daily life. Someone with hyperhidrosis may have difficulty grasping objects because of wet hands. He or she may have to change clothes frequently during the day due to underarm perspiration.
What if my sweating isn't limited to a certain area of my body?
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 physician.
Is hyperhidrosis treatable?
Yes. UChicago Medicine offers surgical treatment of hyperhidrosis. Depending on the severity of the patient's condition, a physician may recommend non-surgical methods of treatment as a first step.
Are non-surgical options effective for hyperhidrosis?
Although non-surgical options provide incomplete relief for most patients, these measures should be explored before surgery is considered.
When is surgery the right treatment option?
For patients who have moderate to severe hyperhidrosis, surgery may be the best option.
How successful is surgery?
Success depends on the type of surgery you have and the location of your sweating. Surgery is effective for 98 percent of hand hyperhidrosis and 80 percent effective for underarm hyperhidrosis.
What are the side effects of surgery?
Although it is considered minimally invasive, there are some side effects that may occur as a result of surgery. Your surgeon will discuss your specific risk factors with you. 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.
A few of the more 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 fraction of one percent of patients and, at times, corrects on its own.
Risk factors vary from surgery to surgery. Also, a patient's underlying conditions may increase their risk for certain side effects. For example, patients suffering from emphysema may be at greater risk for lung problems after surgery.
What happens after surgery?
Surgery is performed on an outpatient basis, but the operation does require general anesthesia. Most patients experience discomfort or pain in the chest wall area for less than a week following the surgery. Doctors recommend that patients restrict themselves to light activity, such as climbing stairs or walking a few days after the surgery.
UChicago Medicine is one of the few medical centers in the country to perform needlescopic hyperhidrosis surgery. Because the needlescopic instruments are so slim, surgeons only need to make two incisions less than one-eighth of an inch in length. This results in extremely small post-surgical scars — less than half the size of other ETS procedures. Most patients do not even need stitches after surgery.
Our thoracic surgery team includes nationally recognized experts who have had extensive experience in thoracoscopic techniques. They have performed hundreds of thoracoscopic sympathotomy procedures for hyperhidrosis with excellent results.