Top Health Science 
What Is Hyperhidrosis?
Hyperhidrosis refers to excessive sweating caused by abnormalities in the sympathetic nervous system. It is categorized into:
- Primary (Idiopathic) Hyperhidrosis: The cause is unknown.
- Secondary Hyperhidrosis: Associated with systemic conditions such as hyperthyroidism, obesity, anxiety, menopause, or pheochromocytoma.
The most common form is primary palmar and plantar hyperhidrosis, affecting the hands and feet. Other types include facial hyperhidrosis, where excessive sweating occurs on the face, and axillary hyperhidrosis, which affects the underarms.
Primary hyperhidrosis usually does not have a family history and often begins in childhood but worsens with age. It does not resolve on its own. People with this condition may struggle with social interactions such as handshakes and tasks requiring dry hands, which can lead to emotional distress and social difficulties.
Treatment of Hyperhidrosis
Non-Surgical Treatments
- Aluminum-based lotions: Applied to reduce sweating.
- Oral Anticholinergic Medications: Help reduce sweating but may have systemic side effects.
- Botox Injections: Temporarily block sweat gland activity but require repeat treatments.
⚠️ Limitations of Non-Surgical Treatment:
These methods often do not provide a permanent solution and may cause undesirable side effects.
Surgical Treatment: Thoracoscopic Sympathectomy
With advancements in video-assisted thoracic surgery (VATS), endoscopic thoracic sympathectomy (ETS) is considered the most effective and widely accepted surgical treatment for hyperhidrosis.
- Since 1997, the use of microsurgical instruments has improved surgical outcomes, reducing visible scarring.
- Surgery is commonly performed during adolescence when symptoms become more apparent.
- Modern VATS procedures allow same-day discharge and involve minimal pain or complications.
Surgical Procedure
The most commonly performed procedure is thoracoscopic sympathetic nerve blocking:
- Performed under general anesthesia.
- Both sides of the sympathetic nerve are targeted.
- Two small incisions (~2mm each) are made on both sides of the chest. These are strategically placed to minimize visible scarring.
- The procedure takes 30 minutes to 1 hour.
⚠️ Exception:
Patients with a history of tuberculosis or pneumonia may have pleural adhesions, which can complicate or prevent thoracoscopic surgery, requiring an open chest surgery instead.
Postoperative Care
Day of Surgery
- Patients receive pre-surgical instructions the day before.
- Hospital admission is not required; patients can be discharged the same day once stable.
- Food intake is allowed six hours after surgery.
Wound Care
- Bandages are removed on the second day after surgery.
What Is Compensatory Hyperhidrosis?
Compensatory hyperhidrosis (CH) is an inevitable response following sympathectomy.
- After surgery, hand sweating is significantly reduced, but the body compensates by increasing sweat production in other areas, such as the face, back, abdomen, groin, or feet.
- This is not considered a complication but rather a natural post-surgical adaptation.
- CH varies from person to person; most patients experience mild symptoms, but approximately 5% develop severe compensatory sweating.
Prognosis of Hyperhidrosis Surgery
- 95% of patients experience satisfactory results after thoracic sympathectomy.
- However, some cases may not respond due to abnormal sympathetic nerve branches.
Possible Complications (Rare but Notable):
- Pneumothorax (collapsed lung)
- Bleeding
- Postoperative nerve pain
- Recurrence
- Excessive hand dryness
Despite these risks, sympathectomy remains one of the most effective treatments for hyperhidrosis.
