Surgery can help excessive-sweating condition
A simple, one-hour surgery performed by one of UT Southwestern's cardiovascular and thoracic surgeons is relieving a condition that may not sound like a major medial concern to some, but limits the daily activities and affects the personal and professional lives of people affected with the disorder.
Excessive sweating, or hyperhidrosis, affects about 1 percent of all Americans. This condition usually occurs in the hands, feet and underarms.
" These individuals do not have a mild sweating disorder," said Dr. Dan Meyer, associate professor of cardiovascular and thoracic surgery and holder of the Sarah M. and Charles E. Seay Distinguished Chair in Thoracic Surgery. "They actually have sweat dripping from their hands, feet or even underarms. Many of these individuals, for example, often choose a job or profession that doesn't involve too much social interaction, especially that which involves handshaking."
Although the precise cause of this condition is unknown, doctors do know that sweating is controlled by the sympathetic nervous system -- a part of the nervous system that serves to accelerate the heart rate, constrict blood vessels and raise blood pressure. Stress, emotion and exercise trigger sweating, and in individuals with hyperhidrosis it can occur spontaneously.
Meyer is helping people with the condition by performing surgery, an endoscopic thoracic sympathectomy, that is nearly 100 percent effective in stopping the overproduction of hand perspiration and about 80 percent effective for relieving sweaty underarms. Approximately 50 percent of patients with hyperhidrosis of the feet will benefit from this surgery, but the procedure is not the primary treatment for this particular type of excessive sweating.
The surgery has become so popular that Meyer has performed as many as three surgeries a day. He often performs six procedures weekly.
The outpatient operation involves ablating, or removing, a specific portion of the main sympathetic nerve. Surgeons make three small incisions, about three millimeters each, on the side of the chest lateral to the breast fold, then guide a tiny telescope to identify the nerve that controls sweating in a specific area. The same procedure is repeated on the opposite side of the chest.
Nonsurgical treatments include topical agents that are astringents to dry up the sweat glands. Another treatment, called iontophoresis, involves electrical stimulation where patients place their hands in a bath through which an electrical current is passed. This treatment decreases the secretion of sweat for six hours to one week. A relatively new treatment is the injection of botulinus toxin (Botox). The toxin affects nerve endings and decreases the transmission of nerve impulses to the sweat glands, which results in decreased sweating.
"By the time they see us, they've tried all of the alternative treatments," Meyer said. "Surgery is only recommended when these medical treatments are not effective."
Although this surgery is safe and effective, Meyer said that there are side effects associated with this procedure. The most common is compensatory sweating, which occurs in 50 percent to 60 percent of patients. This condition occurs when the body compensates for the loss of cooling through sweating of the hands by increasing perspiration in other areas such as in the lower back and abdomen.
"This side effect typically does not occur spontaneously, and usually occurs in less socially problematic areas. This side effect improves within four to six months after the surgery," Meyer said.
Meyer is currently working on methods to minimize this problem.
Media contact: Stephen O'Brien