Hyperhidrosis means excessive sweating. Perspiration is a normal bodily function, controlled by the autonomic nervous system. Perspiring is a normal physiologic response. Sweat glands are found in the skin throughout the body, however are present in higher numbers in the skin of the hands, feet, armpits and the genital regions. Perspiring is a normal physiologic response of the body when the internal or body temperature rises. Stressful situations can also stimulate the autonomic nervous system which then increases sweat production by the glands highly concentrated in the hands, feet, or other regions. In most people, the autonomic response in the sweat glands to stress is not excessive. For people with hyperhidrosis, however, the autonomic stimulation of the sweat glands in response to stress is hyperactive. Normal everyday encounters, such as taking notes in school, holding or shaking someone’s hand are embarrassing, yet the physiologic response of the autonomic nervous system to exercise or high temperature is normal.
Approximately 1% of adults suffer from hyperhidrosis. Typically excessive sweating begins in childhood or early adolescence and increases in severity through puberty and into adulthood. Men and women are equally affected. In many patients, the symptoms are mild, and not socially disabling.
Palmar hyperhidrosis, or sweaty palms is the most common manifestation, and the most socially disturbing. Sufferers fear any situation which may require hand contact. This impacts on one’s ability to interact effectively in the work place, and can have devastating effects on one’s social interactions.
Many patients can simultaneously experience plantar hyperhidrosis (soles of feet), axillary (arm pits) hyperhidrosis, or facial blushing. The different combinations of symptoms can vary between individuals, however, palmar sweating is the most difficult to control and is the most troubling.
There are many non-surgical hyperhidrosis treatments. Some patients with excessive palmar sweating have mild symptoms, which can be treated without the need for surgery. It is important to have a medical evaluation, to be certain that symptoms are not the result of an endocrine or hormonal imbalance, before trying any over-the-counter remedy.
People with excessive sweating often struggle to find treatment for hyperhidrosis. At the Center for Hyperhidrosis at Columbia University Medical Center, a team approach is used to evaluate and treat all patients with hyperhidrosis. Under the guidance of our physicians, a trial of topical remedies, or iontophoresis may be recommended if they have not yet been tried. Occasionally, temporary relief is only necessary, such as prior to a major social event, in that case Botox® for excessive palmar sweating may be an ideal solution. Patients with severe symptoms who fail to respond to these non-surgical remedies can be referred for ETS.
The majority of patients who have disabling hyperhidrosis, complain of excessive palmar (hand) sweating, either alone or in combination with plantar (feet) sweating. ETS or Endoscopc Thoracic Sympathectomy is the best treatment for hyperhidrosis, when symptoms are severe, and medical therapies have failed to reduce excessive sweating. ETS-T3 sympathectomy for excessive palmar hyperhidrosis, is a minimally invasive safe procedure whereby a small titanium clamp is place on the sympathetic nerve above and below the T3 ganglia. This procedure completely eliminates excessive palmar hyperhidrosis, yet does not result in severe compensatory sweating. Having performed only a T3 sympathectomy for palmar hyperhidrosis for over 15 years, we are very pleased with the results and patient satisfaction exceeds 98%.