Excessive sweating
Excessive sweating is often called hyperhidrosis by doctors. It can affect the hands and or the armpits and can be a disabling problem causing social embarrassment and difficulty with practical tasks such as holding a pen. Excessive sweating can also affect the feet and sometimes the face. When it affects the face in relation to eating food it is referred to as Frey’s syndrome.
Many people suffer from occasional episodes of excessive sweating, particularly when anxious or under stress and many can be managed with simple measures such as strong antiperspirants. Before considering Botulinum toxin injection or surgical intervention it is sensible to have tried simple measures and to be clear that there is a major problem that is persisting despite them.
What are the treatment options for excessive sweating?
Apart from simple measures such as antiperspirants mentioned above, another way of switching off sweat glands is with Botulinum toxin injection to the skin. Botulinum toxin blocks the nerve signals to the sweat glands. The effect usually lasts between six and nine months.
Botulinum toxin is a good way of treating excessive sweating in the armpits and may be better than surgery for some patients. The injections are not very painful and patients are usually very satisfied with the results of this treatment. Treating sweating in the hands requires a number of injections into the palms and fingers which can be unpleasant and can occasionally cause areas of (temporary) numbness and weakness. Botulinum toxin injections for excessive sweating are performed at Christchurch Vascular Group and take approximately 1 hour.
What is Endoscopic thoracic sympathectomy? (ETS)
The sympathetic nervous system is involved in control of body temperature including sweating and blood supply to the skin. Cutting the sympathetic nerve to a particular area switches off the sweating in that area.
The sympathetic nerve that controls the hand and part of the armpits runs inside the rib cage near the top of the chest. It has been known that cutting this nerve will turn off excessive sweating for many years (see diagram).
How successful is it?
ETS is very effective at stopping sweating of the hands in over 95% of cases; it is slightly less effective at stopping sweating in the armpits.
Over time sweating will recur in a few people but at 15 year follow up 93 % reported complete cure of sweating, 67% were fully satisfied and 27% were partially satisfied and would have the operation again. Seven percent said they would not have the operation again.
What are the disadvantages of ETS?
ETS is usually very successful and most people are very pleased with their operation. However, it is very important to know that ETS will usually result in increased sweating somewhere else on the body (compensatory sweating), usually the chest or back. This happens to some extent in almost everyone although in most people it is mild. It is usually much less of a problem having extra sweating somewhere other than on the hands and most people consider it preferable. Although most people are very satisfied with their operation, if they are dissatisfied this compensatory sweating is the commonest reason given. About 1% of people will have severe compensatory sweating. It is not possible to predict who will get this and it is important to realise that the operation is designed to be irreversible. Sometimes people will notice sweating when eating spicy foods (gustatory sweating).
What are the risks of ETS?
Usually there are no problems and the operation is straightforward. However, as with any operation, problems can occur and there is a small risk of injury inside the chest.
If there is air coming out of the lung or bleeding inside the chest it may be necessary to insert a drainage tube into the chest for a day or two. Very rarely it may be necessary to do a second operation on the chest through a larger cut (thoracotomy) to deal with such problems.
In about one in a hundred people sympathectomy will result in a droopy eyelid (Horner’s syndrome), this will usually recover over time but not always.
Very rarely the blood vessels at the top of the chest, as they pass into the arm can be injured.
How long will I be in hospital after ETS?
Usually an overnight stay.
What treatment is right for me?
The Specialists at Christchurch Vascular Group are happy to discuss the treatment options with you and answer any questions that you may have.
ETS for facial flushing
Most people blush on occasions, particularly when they feel embarrassed or stressed. A few people find that they blush so much that it becomes a major problem in their social and work lives. This can be part of a problem referred to as social phobia.
ETS will prevent facial blushing as the sympathetic nerves control the supply of extra blood to the skin. Blushing is caused by an increase in the amount of blood reaching the skin. Using ETS to treat facial flushing is not as well established as its use in the treatment of excessive sweating but it is effective. It works best for sudden surges of blushing. It is not useful for people with a reddish complexion. It is important to make sure that there is not an underlying skin condition causing the problem such as rosacea, or that the flushing is not occurring as part of the menopause. The potential drawbacks are the same as those of ETS for excessive sweating but in addition it is conceivable that if one side works and the other does not you could end up with half your face blushing.
This information is included in the PDF files below which you are welcome to download and read.
If you have any questions or wish to discuss anything further, please don’t hesitate to contact us.
