Hyperhidrosis
UCSF Thoracic Surgery is innovating surgical treatment for adults with hyperhidrosis
At UCSF we focus on a multidisciplinary treatment of hyperhidrosis. Before considering surgery for hyperhidrosis we recommend evaluation by a Dermatologist to try treatment options such as medications, topical antiperspirants, iontophoresis and/or Botox. If non-surgical treatments do not effectively manage your hyperhidrosis, surgical sympathectomy in the chest can be considered if you have hyperhidrosis affecting your face/head, hands and/or underarms.
At UCSF, Dr. Coleman performs robotic selective sympathectomy. Using the DaVinci Surgical Robot, Dr. Coleman targets the smaller nerve fibers that connect to the main sympathetic nerve. This surgical technique leaves the main sympathetic nerve in the chest intact which minimizes the risk of compensatory hyperhidrosis (excessive sweating that can develop in other areas of the body after surgical sympathectomy).
While sympathectomy in the chest is not specifically for treatment of hyperhidrosis of the feet, using this technique, many of our patients also experience significant improvement in their foot sweating.
Hyperhidrosis
Primary hyperhidrosis is characterized by abnormal, excessive sweating that can occur in the head, face, hands, armpits and feet. For some, the abundant sweating is localized to one area, such as the hands, while others may experience increased sweating in a combination of areas.
Hyperhidrosis is rare, affecting almost 5% of the population. However, for those affected, the condition often interferes with their daily activities and can be rather embarrassing in social situations. Although the exact cause of this excessive sweating remains unknown, we do know that it is commonly controlled by the sympathetic nervous system, which normally responds strongly in situations of fear or stress.
Signs and Symptoms
Hyperhidrosis is characterized by abnormal, profuse sweating that can affect one or a combination of the following:
- Hands, called palmar hyperhidrosis
- Armpits, called axillary hyperhidrosis
- Feet, called plantar hyperhidrosis
The excessive sweating often interferes with daily activities, such as employment, personal relationships, and recreational activities, and may be a source of significant social embarrassment.
For example, patients with palmar hyperhidrosis have wet, moist hands that sometimes interfere with shaking hands or grasping objects. Those with axillary hyperhidrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress. Plantar hyperhidrosis, excessive sweating of the feet, makes ones socks and shoes wet, which can lead to increased foot odor or infections.
Symptoms of hyperhidrosis often become noticeable during childhood and adolescence. In many cases, the sweating can be quite severe, affecting everyday life and causing social embarrassment. While this sweating can be brought on by stress or anxiety, often occurs spontaneously.
The sympathetic nervous system controls sweating throughout the body. Often there is no identifiable cause, but excessive activity of the sympathetic nervous system is believed to be responsible in the majority of those affected. The sympathetic nervous system normally responds strongly in situations of fear or stress. It is not understood why individuals with hyperhidrosis appear to have constant increased activity of this system. The involved nerves branch from the sympathetic chain are found within the chest cavity.
Diagnosis
Hyperhidrosis is diagnosed by obtaining a thorough history and physical examination. Your doctor will ask multiple questions related to the excessive sweating to get a sense of the extent of its severity and to get a sense of the extent of your condition.
Some examples of the questions that may be asked are: How long you have been experiencing excessive sweating? What areas are affected (armpits, hands or feet)? How often do you experience the episodes of excessive sweating? What treatments have you tried to relieve the excessive sweating? How effective were they?
Treatment
Many patients with hyperhidrosis begin with treatments including oral or topical medications and botox. For some patients these treatments may only have temporary benefit. For some patients these treatments have no benefit. Surgery on the sympathetic nerves in the chest can provide long-term results. These nerves primarily affect blood flow to the skin and the function of the sweat glands. Interrupting the sympathetic nerves in the chest can reduce or sometimes completely stop sweating in the hands.
Endoscopic thoracic sympathectomy (ETS) is a minimally invasive procedure available to treat hyperhidrosis. Using very small incisions, the sympathetic chain is cut or clamped to eliminate the excessive sympathetic nerve activity. This is an outpatient procedure that is highly effective in eliminating excessive sweating of the hands in over 98 percent of patients. In addition, the risk of complications is very low. ETS also can be also applied in selected patients with axillary hyperhidrosis, or excessiving sweating of the armpits or in sweating of the face or blushing.
Surgical Treatment
At UCSF, robotic selective sympathectomy is performed through 3 small incisions on both sides of the chest. This safe, minimally invasive procedure is an outpatient surgery, meaning that you will be able to go home the same day, just a few hours after the surgery. Our Anesthesia team will also perform a nerve block after the procedure to provide improved pain relief when you are home.