Excessive abnormal sweating affects approximately 1-3% of the population

Hands, armpits, face, and feet.

These can be divided into the following 5 groups:
a) Antiperspirants- based on Aluminium chlorohydrate eg Driclor and anhydrol forte, Mitchum, Arrid cream.
b) Orally active drugs that can reduce overall body sweating eg beta blockers, robinul, clonazepam and anticholinergics
c) Iontophoresis (drionic machine)
d) Botulinum toxin (Botox) injections
e) Endoscopic Thoracic Sympathectomy (ETS).

Antiperspirants are topical applications that reduce sweating. They do not reduce odour- this is done by deodorants. Many proprietary preparations combine anti-perspirants and deodorants.

These are based on anticholinergics. One of the effects is to reduce sweating but there are many other effects of these drugs that can make treatment troublesome. Some examples of such drugs are: beta blockers, clonazepam or anticholinergics such as Robinul (glycopyrrolate). The latter seems to be well tolerated and is used by both hyperhidrosis sufferers as well as people with compensatory sweating after ETS.

Iontophoresis involves immersing the affected part of the body in a solution in which a small electrical current is passed for several hours. Whilst it can be very effective, treatment usually needs to be repeated every 4 to 8 weeks. It can clearly not be used for the treatment of facial sweating! This is probably the best choice for treatment of foot sweating.

Botox (Botulinum Toxin A) has become increasingly popular for its actions in paralysing facial muscles which effects is beneficial in avoiding facial wrinkling. It also can be used, when injected into the skin to block the action of sweat glands. It can be particularly helpful in axillary sweating, but the effect is not permanent and Botox injections need to be repeated on a regular basis.
We are currently investigating the role of Botox for some forms of blushing with encouraging results.

90-95% of patients are very satisfied with results of ETS.

Yes. From our experience and the experience of many other surgeons who perform this procedure, ETS is very effective in abolishing hand sweating.

It does help many patients, although Botox is far more effective and is the treatment of first choice for armpit sweating. See the contact us section if you wish to enquire about Botox injections at our unit.

Yes.

Unfortunately ETS is only good for hand, armpit and facial over-sweating. It is useless for whole body sweating. Note that sweating in response to warm weather is normal and helps the body get rid of the excess body heat. Abnormal sweating or hyperhidrosis is excessive sweating that occurs for no understandable reason. Some people have generalised sweating secondary to medical conditions eg overactive thyroid.

Again ETS helps hand, armpit and facial sweating only. A procedure called "lumbar sympathectomy" has been used in the past to treat plantar hyperhidrosis. However due to the risk of causing impotence it is not an accepted form of treatment for sweating of the feet. Iontophoresis which involves bathing the feet in a special bath where electricity is applied is perhaps the most useful treatment for the above condition. However the effect is temporary and usually lasts only for several weeks.

Yes! A T2 sympathectomy can be performed for the above condition with very good results.

If successful the answer is "yes", although reddening of the face after exercise may occur.

Some patients may experience "phantom blushing" after ETS. They have the sensation of blushing but without any colour change. Initially, this may be upsetting but looking oneself in the mirror when this occurs can be reassuring. Many patients learn to ignore this early on.

Our body has two types of sweat glands:
i) Eccrine that are responsible for producing odourless sweat and have a primary role in cooling the body down. This type of sweat glands is mostly found in the armpits, palms and soles.

ii) Apocrine which produce sweat by a different cellular mechanism and although apocrine sweat is initially odourless, when coming to contact with normal bacteria on the surface of the skin it develops odour. This type of sweat glands are mostly found in the armpits and pubic region

Hyperhidrosis primarily affects the eccrine glands by sympathetic nerve over-stimulation. As the mechanism of production of apocrine sweat is different and less dependent on the sympathetic system, a sympathectomy (or Botox) has minimal effect on the production of the scented sweat

Please click here to see a summary of the procedure.

The surgical part of the procedure takes approximately 15-20 minutes per side.

No. Incisions are made in the armpit to allow access of the tiny endoscopy camera into the chest cavity. Two incisions of approximately 2cm each or less are made.

The procedure causes some discomfort in the region of the scars. Most of the patients are able to get back to work within 2 to 5 days.

We advise patients to avoid flying after they have the procedure for at least 2 weeks.

You may ask him how many years he has been doing this for, how many cases he has done, whether he has published any paper on his surgical experience for example. There is a society being formed called the ISSS (International Society for Sympathetic Surgery) and they will in the future have databanks of experienced surgeons you can refer to.

There are risks with any operation but the worldwide experience of surgeons who regularly perform this procedure show that it is very safe. Horner's syndrome (a droopy eyelid) has been reported but this is rare in the hands of an experienced surgeon. Compensatory sweating (increased sweating elsewhere in the body, usually lower back or upper thighs) is a poorly understood phenomenon. It is rarely troublesome and most patients who report it say that it is preferable to the sweating problem for which they had the operation.

Many published studies report a 90-95% success rate even many years after the procedure.

This is true. Some patients opt to have the operation only on the dominant side as the incidence of compensatory sweating tends to be smaller. A unilateral ETS can be performed our unit.

Unfortunate patients who develop CS post ETS may see symptom improvement by taking Robinul, or in cases where CS is confined in a small area of the body may have this part treated with Botox.

Many surgeons in the UK perform this operation under the NHS. Contact your GP to see if he/she knows such a surgeon in your area. See the contact us section if you wish to find more details on how to be referred to our unit.

Yes, if your doctor has referred you to a specialist who agrees you have hyperhidrosis rather than just a generalised sweating problem.

The total costs of the operation and follow-up is between £4500 to £5000 (4800-5400 Euros). Go to the contact us section if you wish to find more details on how to have this operation done privately by our experienced surgeon

This depends on the private hospital involved. At our private practice: Bishops Wood Hospital (Northwood, London) have a special scheme set for instalments. Please CONTACT THEM DIRECTLY for more details on 01923 835814.

Most patients stay in hospital overnight although many patients choose to go home the same day.

ETS can be done at all ages. HOWEVER we rarely offer surgical treatment for those below the age of 16-17. In adult patients, we do not often see patients above the age of 50 asking for surgery perhaps because they have become used to their problem over the years.

Yes, Quality of life studies have shown significant improvement following surgery. See here for an example of such a study.

No, breakthrough sweating such as you describe can sometimes occur but the hand usually reverts to becoming dry again within a day or so.