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Treating patients who sweat too much

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Palms dripping with sweat, a brow that needs continual wiping and badly stained clothing: “These are some of the unpleasant and socially debilitating effects of primary hyperhidrosis, when a patient experiences uncontrolled sweating of the axillae, palms, soles, face and groin,” explains Jay Steinberg, DO, Virtua endovascular and cardiothoracic surgeon. Its etiology is unknown. Its incidence: an orphan disease affecting less than two to three percent of the population.

Unlike functional sweating that results from exposure to high temperatures or exercise, primary hyperhidrosis is thought to be a regulatory autonomic nervous system disorder unaffected by temperature.

Dr. Steinberg: “In working up patients for excessive sweating, secondary hyperhidrosis, caused by hyperthyroidism, carcinoid syndrome or cancer, must first be ruled out before a diagnosis of primary hyperhidrosis is made.

Treatment for the disorder includes conservative alternatives such as anticholinergic medication to prevent stimulation of the sweat gland and botulinum toxin type A. For non-responding patients, thoracoscopic sympathectomy, a minimally invasive surgical solution may be appropriate.

Two-to-three small incisions are made at the apex of the chest cavity along the spine where the stellate ganglion controls the sympathetic and parasympathetic nervous system. Dr. Steinberg: “We divide or ablate the sympathetic nerve chain between the second and third thoracic vertebrae to interrupt the autonomic nervous connection and effectively stop the sweating.”

This can be performed in an outpatient setting as a one-day procedure under general anesthesia with excellent outcomes.