Chronically Sweaty Hands? Surgery May Help

Sweating is a natural involuntary process controlled by the sympathetic nervous system designed to regulate human body temperature and remove toxins from the body. About 3 percent of Americans have what is known as hyperhidrosis, a condition characterized by excessive sweating primarily affecting sweat glands on the palms, underarms and soles of the feet.

“Everyone sweats, but there are some people at the extreme end of the spectrum that sweat so much it seriously impairs their lifestyle,” explains Michael Reed, MD, a thoracic surgeon with UC Physicians and University Hospital. “Sweating is more important to people when they become more socially active and enter the workforce. For someone with hyperhidrosis, even shaking hands can become an awkward situation.”

Left untreated, severe cases of hyperhidrosis can impact a person’s ability to do their job—for example, manual laborers required to use hand tools or nurses who must frequently make contact with patients when measuring vital signs. It can also affect practical tasks such as holding a pencil to write or a steering wheel to drive.

Most cases can be treated with over-the-counter dry rubs and antiperspirants or prescription medications. But for the most severe cases involving palm sweating, Reed says surgery is the only permanent solution.

The procedure—known as endoscopic transthoracic sympathectomy (ETS)—is only appropriate for a select group of hyperhidrosis patients and should be a last option. It involves making small incisions under each arm and inserting specialized tools to clip the nerve that controls hand sweating. Reed says there are numerous factors for determining if a patient is good candidate for surgery, including:

Motivation to have surgery: A certain level of risk is involved in any surgery, so it’s important to determine if the patient is truly bothered by the excessive sweating or being pressed by others to seek treatment. “Patients need to do this for themselves, not a spouse, girlfriend or boyfriend,” says Reed.

Exhaustion of other treatment options: Although the ETS procedure is done with minimally invasive techniques, it is still the most extreme treatment option for hyperhidrosis. Reed counsels all his patients to consult a dermatologist before choosing to have surgery. In some cases, excessive palm sweating can be treated effectively with oral medications, prescription-strength antiperspirants or electric-water stimulation treatments, known as lontophoresis.

Understanding and accepting the side effects: It is very common for patients who have the ETS procedure to experience more sweating in other areas of the body, primarily the trunk or groin. “The patient needs to recognize and be OK with sweating more somewhere else after surgery. Most patients say they don’t care as long as their hand sweat is decreased,” says Reed.

Reed and his colleague Sandra Starnes, MD, perform the ETS procedure at University Hospital. After the nerve is clipped, excessive sweating is almost immediately eliminated and the patient typically goes home the same day.

For more information on hyperhidrosis, visit http://www.netwellness.org, a collaborative health-information Web site staffed by Ohio physicians, nurses and allied health professionals.

Provided by University of Cincinnati (news : web)