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Hyperhidrosis or excessive sweating

What is hyperhidrosis?

Hyperhidrosis can be described as heavy sweating disproportionate to the body’s needs regulate temperature. It is important to note that hyperhidrosis is an inadequate amount of sweating but does not affect the quality or properties of the sweat itself at all, for instance, the smell of the sweat is not altered. This excessive production of sweat is perceived by the sufferer as unpleasant and can become a limiting factor in their daily activities.

Sweat is produced by two types of glands, the eccrine and apocrine glands. The glands affected in hyperhidrosis are the eccrine glands, which are responsible for regulating body temperature and are mainly located in the armpits, the palms of the hands and the soles of the feet.

As in almost all diseases, hyperhidrosis may be primary or secondary. Secondary hyperhidrosis may be due to a disease (hyperthyroidism, diabetes...) or a pre-existing condition like degeneration phenomena of the autonomic nervous system, cerebral infarction or other lesions of the nervous system (central and peripheral), malignant diseases, infection, metabolic syndromes... Secondary hyperhidrosis is usually generalized and can, occasionally, be due to a particular drug or medication.

Primary hyperhidrosis is not associated with any other disease or medication and is usually located, as mentioned above, in the armpits, hands, feet or on the head or scalp and can affect several areas simultaneously. A hereditary component has been described, although no specific mutation has been identified. It is estimated that incidence of the condition may be between 0.6% or 2.8%, it affects men and women equally, symptoms usually appear under the age of 25 and may appear constantly or in phases or episodes. Excessive sweating, in these cases, may be triggered by heat, physical activity or stress, regardless of the environmental temperature.


What are the symptoms?

The main symptom of hyperhidrosis is the excessive production of localized sweat in one or more parts of the body (typically the armpits, palms of the hands or soles of the feet) which is uncomfortable and may affect our simple activities (for example, handling small items like screws or nuts, writing or drawing in the case of the hands), everyday actions at work (shaking hands with clients if the affected region is the hands) or the way we interact with other people (like avoiding wearing certain items of clothing for fear of showing sweat lines in the armpits). Heavy sweating can be triggered by situations that could be considered "normal", like the heat or doing sport (although it must be emphasized that the amount of sweat referred to in hyperhidrosis is excessive) or other situations like stress or emotional stimuli.

To diagnosis hyperhidrosis, a physical examination is carried out in the consultation room and the extent to which the problem affects the patient's quality of life is assessed.

What treatments are available at Hospiten?

1.- Botulinum toxin 

2.- Surgical treatment

Each of the different treatments is indicated to a greater or lesser degree, depending on the area and extent of involvement.

1.- Botulinum toxin

It is used above all in axillary (armpit) hyperhidrosis, although it can also be used to treat other regions such as the face, the groin, the palms of the hands (treatment can be quite painful in this area) or the soles of the feet.

The most widespread method the applying the product is with small subdermal injections. This is a temporary block, effective for approximately six months.

This treatment would be carried out on an outpatient basis in the consultation room.

2- Surgical treatment

The surgical treatment of hyperhidrosis consists of interrupting the transmission of stimuli in the chain connecting the different levels of thoracic sympathetic ganglia with each other. This interruption can be performed using a variety of techniques that range from section (sympathotomy) and/or removal (sympathectomy) of a part of the sympathetic chain and selected sympathetic ganglia, to the insertion of a clip that interrupts the transmission of stimuli through the sympathetic chain without sectioning. The most widely used method today is sectioning the chain, as it is an effective method with fewer side effects than the removal of part of the chain.

a) What does the procedure consist of?

The intervention is performed, after completely anesthetizing the patient and performing selective intubation, sequentially accessing each of the hemithorax using a minimally invasive technique (thoracoscopy) through small incisions in the skin at the level of the armpit. After locating the sympathetic chain, this is sectioned at one or more levels depending on the area or areas to be treated.


 b) What happens after surgery?

After surgery, the most common thing is that the patient wakes up without any type of chest drain in a post-surgical resuscitation unit. However, a control chest x-ray should be performed to ensure that there is no air remaining inside the chest cavity since, if that were the case, and depending on the amount of air, it may be necessary to insert a drain to remove that air.

If no complications are identified on the chest X-ray, the patient may be discharged from hospital within a few hours with prescribed painkillers to continue follow-up in outpatient consultation. This is a not very painful procedure that can be treated with first level analgesics like paracetamol.

As a general rule, the effects of the procedure are evident within the first hours although, in some cases, the patient may take a little more than 24 hours to feel the full effects.

d) Which patients benefit from the intervention?

Hyperhidrosis on the palms of the hands is the type of hyperhidrosis that benefits most from surgical treatment. At the same time, surgical interruption of the sympathetic chain is also very effective in the treatment of combined palm and armpit sweating.

In the case of isolated axillary (armpit) sweating, sympathetic chain section may be less effective and botulinum toxin may be considered as the initial treatment of choice (this treatment would be performed on an outpatient basis in the clinic), considering surgical treatment if the toxin was not effective or according to patient preferences.

Plantar (soles of the feet) hyperhidrosis is the type that benefits the least from surgical treatment and, if it occurs in combination with excessive sweating of the hands, it may actually increase after surgical treatment through compensatory excessive sweating.

Sympathecotomy is not indicated for the treatment of sweating disorders related to the apocrine glands (bromhidrosis or excessive body odor) and patients with secondary hyperhidrosis do not benefit from it.



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