Those that seek treatment, enter into a wondrously dry lifestyle of comfort, confidence, and enjoyment in their everyday activities and work and personal relationships.

PALMAR HYPERHIDROSIS: sweaty palms and sweaty hands

Palmar Hyperhidrosis or excessive sweating of the palms and hands is one of the most common manifestations of the condition. Caused by over-stimulation of the sweat glands in the palms, hand sweating can be severe and emotionally devastating. Some patients sweat so profusely that the sweat drips to the floor. Other patients suffer with hands that are discolored, cold and clammy. Handshakes are awkward, embarrassing. Reading a newspaper results in stained hands and smeared ink. Needlework can be impossible to manage.

While the sweating is involuntary and cannot be consciously controlled, many patients report a tingling in their fingers or a sensation that feels as if the skin pores are opening.

Axillary Hyperhidrosis is a medical condition caused by over stimulation of the underarm sweat glands by the sympathetic nervous system. Patients with Axillary Hyperhidrosis may suffer with excessive sweat dripping from their underarms, down their arms and side of chest wall to the waist.

Axillary sweating may occur independently or in combination with sweating of the hands, face, scalp or feet.

Patients with Axillary Hyperhidrosis cannot wear light colors or certain types of fabrics such as nylon or silk. Clothes become stained, colors may run, and fabrics may be ruined.

The sweating and odor associated with Axillary Hyperhidrosis is constant and resistant to all deodorants. Axillary Hyperhidrosis may even be resistant to Drysol®, the first line of therapy.

The Hyperhidrosis Disease Severity Scale (HDSS) is a four-point scale for categorizing the severity of primary Axillary Hyperhidrosis. The following scale, with 1 being mild and 4 being severe, is utilized to determine the degree of suffering:

1. Never noticeable and never interferes with my daily activities;

2. Tolerable but sometimes interferes with my daily activities;

3. Barely tolerable and frequently interferes with my daily activities; or

4. Intolerable and always interferes with my daily activities.

Pedal Hyperhidrosis is defined as excessive sweating of the feet. This medical condition results from over stimulation of the sweat glands in the feet by the sympathetic nervous system. Unlike Hyperhidrosis that affects the hands and underarms, the sympathetic nerve fibers that stimulate sweating of the feet arise from both the thoracic and lumbar sympathetic nerve chains.

Facial Hyperhidrosis is a genetic condition characterized by extreme facial blushing, excessive facial sweating or both. The condition is not related to a person being overweight. Persons with the condition oftentimes will avoid outdoor social functions, preferring to stay in cold rooms.

Facial blushing is an abnormal response to a variety of emotional stimuli and is caused by an over stimulation of the sympathetic nervous system. The mechanism is involuntary and aggravated or heightened by anxiety; however, it may occur without any stress or anxiety.

Physiologic blushing occurs in many individuals without Hyperhidrosis, with the blush occurring only in special situations, coming on quickly and fading rapidly. For persons with Hyperhidrosis, the blushing is intense, constant and continues for a prolonged period of time. Prior to the onset of the blushing, the person usually experiences intense facial heat. Then, the face and neck glow a bright red. The glow may spread across the cheeks, radiate onto the forehead and neck, even cover the ears.

Individuals who suffer from facial blushing respond to a multitude of stimuli with exaggerated blushing. The triggering stimulus may be internal or external, often being subtle. At times, persons with the condition experience several facial blushing even without any apparent stimuli while alone, relaxing, reading or watching a movie.

Facial blushing may occur independently or in combination with sweating of the hands, face and scalp, underarms or feet. The most common symptom occurring with facial blushing is severe hand sweating. Patients with several facial blushing often also suffer with some degree of palmar Hyperhidrosis. Typically, the patient will focus on his/her facial blushing, without being aware of the sweating hands.

Facial sweating may occur singularly or with the facial blushing. Slight increases in temperature and humidity are the stimulus for the condition. Man and women suffer with this condition. Facial sweating usually involves the entire scalp and face.

Persons with facial Hyperhidrosis find themselves soaked with sweat on the face and scalp during the most minimal of activities. Women with this condition usually opt for short hart and avoid makeup as the excessive sweating will case cosmetics to run.

SYMPATHECTOMY - Surgical Treatments or Hyperhidrosis of the hands and underarms.

The main indication for a sympathectomy is for hyperhidrosis of the hands or hyperhidrosis of the hands and underarms combined.

Many patients, especially those with mild forms of Hyperhidrosis, can live with or adequately control symptoms with non-surgical therapy. However, others eventually reach a stage in their lives where they no longer want to live with the agony of Hyperhidrosis.
In the past, the only options were long-term medical therapy (oral medications in most cases) and traumatic surgeries. The surgical procedures involved significant discomfort and a prolonged recovery period. Recently developed Endoscopic techniques now allow for the very effective Sympathectomy procedure to be performed with a substantially higher rate of success, minimal discomfort, fewer and milder side effects and a rapid return to normal activities.

The ETS has evolved over the past 60 years. Initially, the surgery was performed as an open chest operation, but now small scopes and cameras are utilized making the procedure less invasive and recovery quicker. Today, the sympathetic nerve trunks are cut during the procedure.

The procedure is done under a light general anesthesia by a Board Certified Anesthesiologist. A small camera is inserted through a small incision in the left underarm. The sympathetic nerve is located in front of the ribs along the back of the chest space. After the appropriate nerve is found, the sympathetic nerve is then cut. Once this is accomplished, the camera is withdrawn and the same procedure is done on the right chest. The patient is then sent to the recovery room for about an hour and then discharged.

T3 sympathectomy for palmar (hand) hyperhidrosis or hyperhidrosis of the hands and underarms combined.

The Endoscopic Transthoracic Sympathectomy (ETS or T3 Sympathectomy) cuts only the 3rd nerve trunk. This procedure is effective in eliminating sweating of the hands in 98% and underarms in the majority of cases.
Following a T3 Sympathectomy, the hands no longer become "sandpaper dry," a condition which can result with the standard T2 Sympathectomy. A T2 Sympathectomy can also lower the heart rate while the T3 Sympathectomy does not affect the heart rate.

Intense pulsed light for facial blushing

The most effective and least invasive treatment for Facial Blushing is Intense Pulsed Light. One or two treatments usually diminish the most severe cases of Facial Blushing. We do not recommend an ETS for Facial Blushing or Sweating.

Who should not undergo a Sympathectomy 

Years of experience have led to the conclusion that those who have Generalized sweating are not good candidates for a Sympathectomy. Generalized Hyperhidrosis includes people who sweat on the hands but also sweat on the back, abdomen or groin during the times that the hands sweat. Examples: people who frequently have damp underwear and leave sweat stains on their seats even while in cold rooms or those who have sweaty backs and chests with minimal exertion. In other words, these patients tend to sweat all over. The patients with this type of sweating will usually develop Severe Compensatory Sweating after a Sympathectomy. Those with Focal Hyperhidrosis of the Hands are the best candidates for a Sympathectomy.

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