Hyperhidrosis surgery

Often neglected by health care personnel

Hyperhidrosis is usually not a part of the curriculum at most medical schools around the world. This means that many doctors, both GP:s and dermatologists, lack understanding of the depth of how hyperhidrosis affects daily life and life quality. In many cases they also lack knowledge about the wide variety of hyperhidrosis treatment options. Depending on the areas of sweating, you might experience a different approach from healthcare personnel.

If you have palmar hyperhidrosis, sweaty palms, you are more likely to get help since most scientific studies are based on palmar or axillary hyperhidrosis. This doesn't mean that sweaty feet, face, chest or groin area, for example is less hard to live with, but this is what the world looks like today for hyperhidrosis patients.

Available treatment options

If you book an appointment with your GP, you might be recommended to try a prescription antiperspirant with aluminum chloride. This is a treatment that can work for some but it usually depends on the amount of sweat. If you are sweating too excessively the hydrogen from the sweat might react with the chloride from the Aluminum chloride and create an acid that burns the skin causing a rash.

In some cases you might get a prescription of oral medications for example Beta Blockers or Anticholinergic pills. They might help you, especially later, since they are blocking medications that prevent the nerve signals from reaching the sweat glands. Anticholinergic medication is associated with some side effects that vary from person to person, like dry mouth, gastrointestinal problems and well as cognitive problems in some cases.

Depending on your GP they might send a referral to another doctor, usually a dermatologist, straight away. Hopefully you will get good hyperhidrosis care there but unfortunately one can not be sure of this and coming prepared is recommended. The dermatologist can recommend different topical medications, prescription creams or to use antiperspirant with aluminum chloride. They might also talk to you about b.toxin injections that can give a good sweat reduction for a while but the duration of the effect depends on the treated area. For example, the effect often lasts longer in the underarm area then on the face or the feet. Iontophoresis, a medical device that can be used at home, is often very good to use on palms, feet and armpits.

There is also a sort of microwave therapy called Miradry for the underarm area that in some cases can give a long lasting or even permanent result. Do keep in mind that this a more invasive technique than injections and should be carefully considered due to the risk of side effects.

For people with generalized hyperhidrosis, a combination of treatments is usually needed to gain satisfactory results. For example some people get injections in certain areas, like the armpits and then use topical anticholinergic wipes on the forehand and also take Anticholinergic medicine for special occasions or during workdays.

Hyperhidrosis surgery information

There are also more invasive procedures to treat hyperhidrosis. We have covered Miradry which is not a surgery but instead microwaves applied to the armpits to "boil" the sweat glands. There are also surgical treatments like for example Axillary evacuation which basically means sweat gland removal. The glands can be cut out, or, a more modern version, sucked out, pretty similar to liposuction.

ETS surgery

There is also another surgical procedure to treat hyperhidrosis which is called endoscopic thoracic sympathectomy, also known as ETS or ETS surgery. ETS is usually performed as an outpatient procedure. It is performed under general anesthesia The surgeon cuts small incisions on both sides of the thorax, near the armpit area. The lung is deflated, one at a time so that a small camera can be inserted into the chest cavity so that the surgeon can localize and then cut, clip or in other ways destroy the nerve paths associated with the excessive sweating. This surgery is aggressively marketed in clinics around the world. I quote the International hyperhidrosis society: "This is a major surgery (even though it is called minimally invasive) with significant risks and limited success." I often come across hyperhidrosis sufferers that are looking for a cure. That this invasive surgery is marketed as just that is to me just horrible! I have read a lot of scientific papers on ETS surgery and spoken with many who have undergone this procedure.

I also studied the legal process that took place in my home country, Sweden, regarding this medical procedure, in the early 00's. In my opinion it seems like the information that the patients are getting is often not accurate nor complete. It also seems to me that the right questions have not been asked and long enough follow-up studies have not been made, to fully grasp the consequences of the ETS surgery on a group basis.

When I look around, internationally, I see reports, commercials and texts about ETS, a minimally invasive, quick and easy cure for hyperhidrosis. Only a slight amount of compensatory sweating might occur. But to me as a doctor, I find this hard to believe, so I know that the design of the studies made so far must be faulty. When you cut parts of the Sympathetic nerve you must understand that this nerve is not just associated with the sweat glands but more like a highway for the sympathetic nervous system through the body. Sure, most patients stop sweating from their palms right after surgery but what happens to them apart from that? We know that there have been cases with severe side effects like brain damage and even deaths cause by this surgery. I have also personally met a lot of patients suffering from severe, generalized compensatory sweating on large areas of their body. This is a very hard condition to treat compared to palmar hyperhidrosis where you have iontophoresis, injections etc.

Read more on hyperhidrosis and read other people’s stories. We recommend that you check out support groups on Facebook, and that you follow our MD Dr Sandra Eriksson Mirkovic on Instagram: dr_sandra_hyperhidrosis