Excessive Sweating (Hyperhidrosis)

Excessive sweating can be a real nuisance – in severe cases it can ruin people’s lives by causing social embarrassment. There are treatments available for this distressing condition – these range from psychotherapy counselling to Botox injections through to an operation called a ‘sympathectomy’.

Information about some of these treatments as well as the commonly asked questions are found below:  

Who gets excessive sweating?

Most patients are young adults and the problem is three times more common in women than in men.

What causes excessive sweating?

We don’t know for sure. It is known that there is a wide range of "normal" sweating which helps to control the body's temperature. Excessive sweating (Hyperhidrosis) is well outside the accepted range. We also know that some medical problems can alter the body's metabolism with resulting changes in the normal sweat production. Hyperhidrosis is different in that there is no abnormality in the metabolism and only one part of the body may be affected (ie just the hands or armpits).

Which parts of the body are affected?

The most common areas are the armpits, hands, feet, face and scalp. Sometimes sweating can be a nuisance in the groin, on the back, or between the buttocks.  

What are the effects of excessive sweating?

Excessive sweating in the hands can cause social problems in holding hands or other physical contact. For patients who have manual type jobs this can be a serious disability.

Patients may have had trouble holding pens and have had difficulty writing at school and this may extend into adult life with problems using keyboards.

Many people are profoundly embarrassed by excessive sweating especially those with uncontrolled facial sweating. Many of patients have sought medical help without success, which may lead sometimes to feelings of rejection or inadequacy.

What can be done about excessive sweating?

There are several ways of treating excessive sweating, depending on how bad it is and what part of the body is affected. Treatments range from simple measures like anti-perspirants and avoiding activities that cause sweating through to operations to cut the nerves that make the sweat glands produce perspiration. There are some drugs that can be of use, but many have side effects.

 Non – operative treatments

Antiperspirants - Talcum powders and anti-perspirants are usually unhelpful in serious excessive sweating. There are very strong anti-perspirants available containing Aluminium Hydroxide which can be helpful although these can make the skin very dry and irritate it.

Drug treatments – A Beta blocker drug can be of benefit. This drug slows the heart rate and reduces the effect of the normal mechanisms that start the sweating process. There are other drugs available called ‘anti-cholinergics’ but these medications can have bad side effects such as blurred vision and a dry mouth, so a lot of patients do not like to take them.

Counselling - If certain stressful situations provoke an attack of excessive sweating this can cause a "vicious cycle" of anxiety about the condition. Some patients find that counselling (also known as psychotherapy) can be very helpful in overcoming the anxiety and reducing the sweating. Some patients find that hypnosis is also helpful.

Iontophoresis: This is a treatment for the hands and feet where the affected part is placed in a water bath and a mild electric current is passed through the water. It is not known why this works to reduce excessive sweating. It is not ideal for hand sweating as there are other very effective options for this such as Thoracoscopic sympathectomy (see below) but it can be a useful option for sweaty feet. The treatment does need to be repeated frequently.

Botox injections:
Botox is an abbreviation of ‘Botulinum Toxin’. This is a natural poison, which in large doses can cause a severe illness.

However, purified Botox in small doses administered in appropriate patients can be used to interrupt the messages that are sent down nerves to sweat glands that caused them to produce sweat. The Botox is injected into the skin, most usually in the armpit and can be very effective in reducing the sweating to a manageable level. Botox can also be used to eliminate wrinkles in the skin, although we do not offer this type of treatment.

The injections are made with a very fine needle and the whole procedure takes about 15 – 20 minutes.

The advantage of Botox is that it avoids an operation. The drawback is that the treatment does not last very long and needs to be repeated at 4 – 6 monthly intervals.

Operations for Excessive Sweating:

 Thoracoscopic Sympathectomy:  

For patients suffering from sweaty hands, the best option is probably an operation.

This operation is sometimes called ETS (which stands forEndoscopic Transthoracic Symathectomy)

It is a key-hole surgery operation that is 99% effective at curing hand sweating and, with a slight modification, can also cure armpit sweating in 70 - 80% of people. The same operation can also be used for facial flushing, blushing or sweating – although it is less successful for this problem.

The operation is done to divide the nerves which run in the back of the chest wall.

To do the operation, the patient is given a general anaesthetic, then a surgical telescope is inserted into the chest through a tiny (1cm) incision. The scars are tiny and can barely be seen after only a few weeks.

The sympathetic chain can be seen and cut. By doing this, the hand instantly becomes bone dry as the nerve signals to the sweat glands are switched off. If the armpit is being treated as well, removal of another part of the chain can stop the sweating in 4 out of 5 cases.

As with all surgical procedures there are side effects and potential complications that patients and their relatives must be aware of before having this operation.

1 - Compensatory Sweating

Sometimes after the operation, the sweat that should have come from these areas is re-distributed elsewhere in the body. This is called Compensatory Sweating. It can be especially bad in the lower back. Most patients find this easier to live with than having sweaty hands.

2 - Damage to the Lung needing a chest drain

In rare cases (approximately 1 in 100 patients) the lung can be difficult to re-inflate after surgery. It is then necessary to insert a small tube into the chest (called a chest drain) for a couple of days to get the lung expanded again.

3 - Horner's Syndrome

If higher parts of the sympathetic chain are injured during surgery the face can become dry on the same side as the operation and the eye lid may droop a little. This is called Horner's syndrome. This problem is rare and usually temporary.

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