There are different approaches for the treatment of hyperhidrosis excessive sweating, which have different success rates.
- Psychotherapy, hypnosis, development of strategies for stress management. Since most patients suffer from excessive sweating in stressful situations, psychotherapy focuses on developing strategies for stress management.
This form of therapy is practically risk-free and certainly worth a try. The chances of success are good in some cases, but unfortunately there is often no satisfactory result. At this point we would like to mention especially the Progressive Muscle Relaxation according to Jacobson.
Through the technique of Progressive Muscle Relaxation, mental stress states can be influenced favourably by simple relaxation techniques.
- Aluminum chlorideThis is again an attempt to clog the channels of the sweat glands. The aluminum chloride is applied to the affected skin and reacts with compounds contained in perspiration. This leads to the formation of new chemical compounds that block the channels of the sweat glands.
This causes the sweat glands to recede in the course of time. However, it takes a longer time before this happens. Aluminium chloride is offered in solutions that are applied before sleeping.
Initially, this treatment is performed daily. In the course of time, the intervals between applications can be extended. If this treatment is applied permanently, the success rate is high.
However, the known side effects of aluminum chloride, such as skin irritation and discoloration of clothing, are factors that discourage some patients from using it permanently.
- Suctioning off the sweat glandsThe sweat glands can also be suctioned off. This is a surgical procedure that can be performed under local anesthesia. This method is often used in cases of excessive sweat production in the armpit.
However, the sweat glands tend to re-form, so the effect of this treatment wears off after a few years.
- Cutting of the borderline strand (“Endoscopic Thoracic Sympathectomy” or “ETS”)If all other methods fail, surgical treatment of hyperhidrosis is recommended. Since the introduction of minimally invasive procedures, the operation is possible “endoscopically”. A camera and instruments are inserted through small incisions into the thorax (= thorax, therefore “thoracic”).
The borderline strand (“sympathetic nervous system“) is located and area of the upper thoracic spine is blocked: Sympathectomy. Different surgeons perform the interruption of the sympathetic cord in different ways. While some surgeons place only one clip on the nerve cord, others prefer to treat the cord with a high temperature, thereby interrupting the transmission of nerve impulses.
However, the safest method of preventing the border strand is to cut it, which is also offered in most cases.
Indication for surgeryETS (Endoscopic Thoracic Sympathectomy) should be considered as a treatment if the non-invasive methods do not yield satisfactory results. This operation is particularly successful in cases of excessive sweating of the hands. If the face is affected, the borderline strand would have to be cut somewhat higher, which increases the risk of Horner’s syndrome (see below).
Surgical treatment is not indicated for isolated hyperhidrosis of the armpits and feet. However, if the hands are also affected in such cases, ETS may be beneficial because patients develop better overall stress management. The patient is positioned sideways, the lungs are ventilated separately, so that ventilation of the lungs on the side being operated on can be switched off.
This provides sufficient visibility in the thorax to allow the surgeon to locate and stop the borderline cord. A small tube is then inserted through which the air in the gap between the lung and the chest wall (“pleural gap”) can be sucked out. As a rule, the opposite side is operated on in the same session, after the patient is positioned accordingly and the opposite lung is ventilated.
The drainage tubes are usually removed on the day of the operation and an X-ray of the lungs is taken to see any residual air in the pleural gap. Risks of surgeryThe general risks of surgery also apply to ETS. There may be bleeding, secondary bleeding, wound healing disorders, especially in the case of inflammation.
As with any surgery, adjacent organs or structures can be damaged in ETS. In this case, surgery is performed in the chest.In addition to the lungs, the heart is located here, whose injury can be life-threatening. In addition, the largest vessels of the organism are located in the thorax.
Not to be neglected are the liver on the right and the spleen on the left side, which can also be injured via the diaphragm. Horner’s syndromeHorner’s syndrome occurs when a certain accumulation of nerve cells (“ganglion“) located along the border strand is affected. This ganglion lies very close to the area where the ligament is interrupted and is therefore at risk.
Horner’s syndrome is a combination of facial changes caused by the failure of the sympathetic nervous system in the head region. The consequences of this are that the pupil cannot dilate properly (“miosis”), resulting in visual difficulties in the dark. In addition, the eyeball moves backwards, into the interior of the skull (“enophthalmos”).
Furthermore, the failure of the autonomic nervous system in this area causes the upper eyelid to droop (“ptosis“). Consequences of the operationIf one assumes that excessive sweating is caused by an “adjusted target value”, this value does not change with an operation. This hypothesis could be an explanation for so-called “compensatory sweating”.
It is an increased sweating of other parts of the body, such as the chest, abdomen and back, while the hands remain dry and warm. Compensatory sweating is accepted by most patients who undergo surgery. In rare cases, the increased sweating is so severe that it is extremely disturbing for the people concerned.
This is one more reason to think about the risks and consequences before the operation. In case of combined hyperhidrosis in the area of the hands and feet, a reduction of sweat formation in the foot area is usually observed after ETS. This is not a physiologically explainable fact.
Rather, the improvement in the situation in the lower extremities is more related to the general increase in quality of life that results from the certainty that the hands are now dry. Overall, people report a certain calmness in stressful situations after the operation. This is certainly due to the discrepancy to the condition before the operation.
