Normal sweating aims to promote heat removal through the skin, and thanks to this, control body temperature. However, some people suffer from hyperhidrosis: excessive sweating or greater than what the body needs. This, due to an increased stimulus of the sympathetic nervous system, which contains the nerve fibers that control the secretion of the sweat glands of the body.
“Hyperhidrosis has a very significant impact on patients’ quality of life. There are people who drop out of school or work because they have difficulty relating to their peers or others; they can’t handle documents or instruments, wet clothes or continually sweat their faces. They can even isolate themselves at home so as not to interact even with their relatives,” explained physician José Ortega, chest surgeon at Clínica Bupa Santiago and specialist in this condition.
There are also two types of hyperhidrosis: secondary (generalized), which affects the entire body and is usually the product of another disease, and primary hyperhidrosis (usually localized), the cause of which is unknown and which can affect the face, the hands, armpits or feet (or a combination of these). In addition, there is the pathological facial blush; table in which patients blush excessively in the face of small stimuli, or without obvious cause, altering their social relationships.
Between 2% and 3% of the population suffers from the pathology, and usually begins in childhood or puberty. Although its origin is uncertain – it can occur spontaneously and intermittently without a gatilante – it is believed that there is a relationship with emotional stress. For its part, it affects more women than men, where up to 40% of patients suffering from hyperhidrosis have a family member who also suffers from it.
Treatment choice determines outcome
Sometimes sweating can be caused by a mixed fungal or bacterial infection, and can be controlled with medications. In case of anxiety, psychological or anxiolytic therapy may relieve symptoms.
The main treatments available are some antiperspirant solutions that may include an aluminium chloride or methamine solution. However, in most cases it is necessary to resort to other treatments such as iontophoresis, a technique that introduces into the skin substances that inhibit perspiration through electric current.
In addition, botulinum toxin, better known as Botox and applied locally intradermally, has improved the condition with great effectiveness. Its effects remain around seven months.
Among its drawbacks are its high price, the pain it causes in certain areas and its limited duration. Specialists recommend a second application when you start to notice a return to excessive sweating, which usually happens after four to nine months.
There are also solutions with local surgery that definitively removes sweat glands from a specific area by means of a subcutaneous curettage.
Effectiveness of sympathectomy
One of the most approved solutions is sympathectomy. “There are multiple treatments, from topical alternatives, anticholinergic medications, iontophoresis or botulinum toxin. All have poor adhesion and are reversible, even some with rebound effect. In addition, they generally have a high economic cost. Treatment that has had better long-term results is thoracic sympathectomy; minimally invasive surgery used to manage craniofacial hyperhidrosis, palm and armpit, as well as facial flushing. It is important to note that it is not applicable for patients who have only plantar hyperhidrosis (of the feet)”, says Dr Ortega.
Thoracic sympathectomy is a surgical procedure where the sympathetic chain is sectioned, which carries the nerves responsible for stimulating the sweat glands in both chest cavities; that is, they are two sequential surgeries in the same procedure.
It is performed under general anesthesia and two small incisions are used in each armpit. It lasts about an hour, requires one-day hospitalization and the result is appreciated since the patient wakes up from anesthesia.
“A lot of patients who meet the criteria of surgery decide to have surgery, especially those who have an alteration of their usual life. It is very important that those who decide to have surgery talk with their treating surgeon in relation to the main complication of surgery, which is compensatory sweating, since it is an irreversible procedure,” the specialist added.
Compensatory sweating is increased sweating elsewhere in the body after sympathectomy. The reason for it is unknown and occurs in up to 60% of patients. However, most of them are mild and patients can manage it.