The content on this website is intended to provide you with a better understanding of coronary artery disease, beating heart bypass surgery and endoscopic vessel harvesting. The procedures described in this website and related links may not be appropriate for all patients. The information on this website and maintain an open dialogue with you and your an informed discussion with a physician, and is not an endorsement or recommendation of any particular physician.
Alexander Marmureanu
Alexander Marmureanu
Treatments for Hyperhidrosis
Medical Therapy
There are many non-surgical alternatives to treat patients with hyperhidrosis. Some patients with hyperhidrosis have mild symptoms, which can be helped without the need for surgery. It is important to have a medical evaluation, to be certain that symptoms are not the result of an endocrine or hormonal imbalance, before trying any over-the-counter remedy. Botox® therapy can effectively treat palmar and axillary hyperhidrosis, however it is not a permanent solution and symptoms may recur after four or six months. Occasionally, temporary relief is only necessary, such as prior to a major social event. In those instances, Botox® therapy can be considered. Dr. Marc Grossman has many years of experience with Botox® therapy for both facial cosmetic procedures and the treatment of hyperhidrosis.
• Drysol
• Drionics®
• Herbal Therapy
• B-Blockers
• Botox® injections
• Anticholinergics
•
Tap water ionotophoresis
Patients with severe symptoms who fail to respond to these non-surgical remedies
can be referred for surgery.
Surgical Therapy
The goal of surgery is to eliminate the constant autonomic stimulation of the palmar sweat glands while maintaining other sympathetic nerve function, and minimizing trauma to the surrounding tissue. This is best accomplished by Endoscopic Thoracic Sympathectomy, also known as ETS.
ETS Procedures
ETS is performed through two microscopic incisions in the armpit or axilla. The procedure
is performed under general anesthesia, and local anesthetic is infiltrated into the
skin and soft tissue to minimize any pain in the early post operative period. Insufflating
CO2 into the chest cavity through a tiny needle displaces the lung. We than insert
two small instruments into the chest cavity: a telescope attached to a magnifying
camera, and a dissecting instrument. The sympathetic nerve is dissected from the
surrounding tissue with the dissecting instrument as it crosses over the ribs. After
we've isolated the ganglia, a 5mm clamp is placed across the nerve. The advantage
of clamping is that it allows the option for reversing the procedure, should the
side effects be bothersome, though this is rarely required. After completing the
sympathectomy and removing the CO2 from the chest cavity, the lung re-expands, and
the two incisions are closed. The procedure is completed on both the left and right
side, and then the patient is awakened and moved to the recovery room. Patients generally
leave the hospital within hours of completion of the operation.
Analysis of long-term follow-up data indicates that not all patients with hyperhidrosis are the same, and that surgery needs to be tailored to the individual patient. Dr. Gorenstein also believes that ETS surgery needs to be individualized to reduce the side effects of surgery.
Palmar Hyperhidrosis
The majority of patients who have disabling hyperhidrosis, complain of excessive palmar (hand) sweating, either alone or in combination with plantar (feet) sweating. ETS is the best treatment choice for this condition, when symptoms are severe, as the other treatment options cannot control symptoms in severe cases. We perform a T3 sympathectomy for palmar hyperhidrosis, which consists of placing a clamp above and below the T3 ganglia. This procedure completely eliminates excessive palmar hyperhidrosis, yet does not result in the same amount of compensatory sweating that occurs after a T2/T3 sympathectomy. Having performed only a T3 sympathectomy for palmar hyperhidrosis in several hundred patients over the past 4 years, we are very pleased with the results and patient satisfaction.
Axillary Hyperhidrosis
Some patients experience hyperhidrosis limited to the armpits (axillae). In those situations there are several treatment options, both surgical and non-surgical. We recommend patients trying a topical regimen such as drysol initially. If that fails to adequately control symptoms, then axillary Botox® can be effective.
A surgical option, when there is only axillary hyperhidrosis is surgical removal of the axillary sweat glands. Through small incisions in the axillary skin crease, the dominant sweat producing areas are removed. This procedure is also done as an outpatient; there is very little discomfort aside from the incisions. In suitable candidates this can permanently and effectively reduce embarrassing sweating in the armpits.
Some patients experience severe axillary and palmar hyperhidrosis. ETS of both T3 and T4, or T3/T4 sympathectomy, is an option. The procedure is performed in the same way as T3 sympathectomy for palmar hyperhidrosis, but the lower ganglion (T4), is also blocked with a clamp.
Facial Blushing
Facial blushing is another manifestation of an overactive sympathetic nervous center. Patients complain of embarrassing blushing over their upper chest, neck, and face during stressful situations, such as public speaking or job interviews. There is some controversy regarding the benefits of ETS for facial blushing. A modified T2 sympathectomy is performed, where a block is placed only above the T2 ganglion, rather than both above and below the T2 ganglion. This technical modification of T2 sympathectomy, seems to have reduced the severity of compensatory sweating, the most common side effect that affects patients after ETS for facial blushing.
ETS Results
Most patients who undergo ETS have suffered for years with the socially disabling stigma of severe hand sweating or facial blushing. Following ETS, patients are overwhelmed by the instant relief of their symptoms and the dramatic effect this has on their quality of life. Everyday social interactions that previously would be avoided are no longer stressful, or anxiety provoking. The relief of severe hand sweating is immediate and permanent. Relief from plantar hyperhidrosis following T3 sympathectomy, is very dramatic and satisfying. The decrease in palmar sweating is the same as with T2, but with far less compensatory sweating and therefore the overall satisfaction rate in patients with severe palmar hyperhidrosis who undergo ETS is greater than 95%.