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How Can an Operation Cure Excessive Sweating?

By: Kathryn Senior PhD - Updated: 18 Sep 2012 | comments*Discuss
Excessive Sweating Hyperhidrosis

Everyone sweats during exercise, in hot environments and when they are anxious. It’s a normal physiological response and some people sweat more than others. But, for a minority of people, excessive sweating can become a real problem and it can be so bad that it ruins their social life, their job and makes relationships and activities difficult.

The medical term for excessive sweating is hyperhidrosis and it can occur for several different reasons. Some people inherit a genetic tendency towards producing extreme amounts of sweat, not because they have more sweat glands than normal, but because the nerves that supply the sweat glands become overactive. Their sweat glands work at full blast all of the time; they never switch off. In others, underlying health conditions can cause excessive sweating. These include diabetes, some types of tumour, the menopause, problems with the thyroid or pituitary gland and adverse reactions to some drugs.

Surgical Treatment for Excessive Sweating

There are two main forms of surgical treatment for hyperhidrosis. The first is called endoscopy thoracic sympathectomy (ETS). This involves destroying the sympathetic nerves in the chest using a keyhole technique. The sympathetic nerves are the ones that supply the sweat glands with their ‘on’ signal and once they no longer work, production of sweat by that particular gland is greatly reduced.

Destroying the sympathetic nerves in the chest may cut down sweat production in the palms of the hands and some surgeons claim it also helps with facial sweating and excessive blushing. The surgery is not without risk. In some people, the body compensates by upping production of sweat by other sweat glands around the body. Losing the function of these nerves can also reduce the capacity to feel alert or to feel fear and it can affect the body’s ability to regulate its internal core temperature.

Despite the drawbacks and the fact the evidence that the surgery works is more anecdotal than from scientific research involving large numbers of people, more people affected by hyperhidrosis are having surgery privately as a last resort.

Sweat Gland Suction

A newer and apparently safer technique to reduce excessive sweating involves surgical removal of sweat glands just under the skin. This type of surgery is a modified form of liposuction, the cosmetic treatment that is used to remove excess fat in body sculpting and body lifts. If excessive sweating is localised to particular parts of the body, the technique can remove the majority of the sweat glands in that area. The skin is first made soft using a skin softening solution and a local anaesthetic is applied. Tiny incisions are then made in the skin and the liposuction tool is used to quickly suck out the softened glands.

Although the procedure sounds painful, it is actually not that invasive as only the glands just under the skin are removed. It can be done as an outpatient procedure. Again, there is little published evidence that the technique works but reports from patients claim that there is a 95% success rate, with less discomfort, less embarrassment and far less sweating.

Does Surgery to Relieve Sweating Work?

Neither surgical technique can claim to be backed up by an enormous amount of published evidence but it is unlikely that large clinical trials could ever be carried out on such a procedure. Clinical trials are hugely expensive, often costing millions of pounds to run. For a health problem that is more inconvenient than life-threatening, it just doesn’t make financial sense, no matter how badly people affected by hyperhidrosis feel about their condition.

In the absence of reliable evidence, the only thing that someone who is very badly affected by excessive sweating can do is to get the advice of an experienced specialist who has personal knowledge of the surgical techniques. A good surgeon will explain exactly what is involved and what the likely side effects are but, ultimately, the choice of whether to have this sort of treatment rests very much with individual.

Are There Alternatives to Surgery?

Some drugs do reduce sweating and can help in less severe cases. Botox injections have also been shown to be successful in some people. Neither is likely to be able to have very much impact on the most severe cases, however, which leaves people little choice but to consider surgery. It is possible to have the sympathetic nerves clamped, rather than cut, using a modified ETS procedure that can later be reversed if side effects are unbearable. Some surgeons have used this technique in combination with drugs and Botox in a multi-pronged approach that has been successful for some patients.

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