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.

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.

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.