Palmar Hyperhidrosis


Excessive sweating (hyperhidrosis) can now be treated with a minimally invasive outpatient operation (Thoracoscopic Symphatectomy). At Cedars-Sinai, this procedure is done by thoracic surgeons in partnership with the Hyperhidrosis Program.

Background

Sweating is normal, but palmar hyperhidrosis is a condition that causes excessive sweating of the hands. Excessive sweating of the face, underarms, groin and feet may also occur. This is not a case of being nervous. This is a physiologic condition caused by an overactive sympathetic nervous system. It occurs in about 1% of the population and may be hereditary.

Hyperhidrosis can be very embarrassing and debilitating. It usually begins in childhood. Moist hands cause sufferers to avoid social contacts, such as shaking hands. Teens may be embarrassed to date or participate in social activities. Writing a letter can be an impossible task because so much sweat pours from the hand to the paper. Employees may have trouble gripping equipment. This excessive sweating may be related to heat or stress, but it often occurs for no particular reason.

Medical Treatment

Antiperspirants

Antiperspirants (Drysol) can be applied to the hands and armpits at night and then removed in the morning. These are usually tried first and may be effective in mild cases.

Tapwater Iontophoresis

Several times per week for several weeks, the hands are placed in an electrolyte solution with low level electrical current. Patients can purchase the equipments to do this at home. This may be effective for mild cases. It is time-consuming; some patients often prefer a permanent solution to repeating this treatment over and over again.

Medicines

Anticholinergic drugs (e.g., atropine or Robinol) can reduce the seating, but they cause very annoying side effects (dry mouth, difficulty with vision).

Surgical Treatment

For decades, it has been known that nerves from the sympathetic chain in the chest control the sweating in the hands. Cutting this nerve almost always stop the excessive sweating of the hands and may reduce the sweating of the feet. The operation, however, was not done too often because it was performed through a three-inch incision in the neck, a four-inch incision in the chest with spreading of the ribs or a painful incision in the back.

Thoracoscopic Sympathectomy

Thoracoscopic sympathectomy is the name for the operation in which a nerve in the chest is cut. This procedure may be indicated for the treatment of palmar hyperhidrosis, reflect sympathetic dystrophy, and vascular disease of the hands.

There are a few conditions that are contraindications for the procedure. This includes sweating caused by other diseases, such as hyperthyroidism, menopause or obesity. The operation may not be possible when there is scarring in the chest, such as tuberculosis.

Complications

The most common side effects are the development of increased sweating in other parts of the body (compensatory hyperhidrosis). This may occur on the back or legs. Some patients have increased sweating of the feet.

Horner's syndrome (droopy eyelid) may occur after the procedure. Fortunately, this occurs in less than 1% of patients when the operation is performed for palmar hyperhidrosis. When thoracoscopic sympathectomy is performed for pain in the hands (reflex sympathetic dystrophy) or vascular disease of the hands, more of the sympathetic nerve is removed and there is a slightly higher risk of Horner's syndrome.

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