Hyperhidrosis Treatments

Do you have sweaty palms? Do they embarrass you? Do they sweat so much that they keep you from doing things you would like to do—from shaking hands, playing an instrument or a sport or doing the kind of work you would like to do? Do you carry a towel or tissue to keep your hands dry enough to get through the day? Have you had sweaty hands since your childhood or teen years?

If so, you probably have hyperhidrosis, a problem in which the sympathetic nervous system does not "shut off" the sweat reflex properly. The body naturally perspires to regulate body heat. In hyperhidrosis, your hands sweat profusely with no useful purpose, regardless of how hot or cold it is. Your feet probably sweat, and you may also have excessive armpit and facial sweating, as well as facial blushing.

The good news is that there is a cure. It is fast, safe and effective. At Cedars-Sinai, video-assisted thoracic sympathectomy is providing permanent relief from this chronic and debilitating condition. Now you can throw out the antiperspirants, the medication and the electrophoresis machine, realize it is not in your head, and get real help.

Causes and Risk Factors

One to two percent of Americans are affected by essential hyperhidrosis. The cause remains unknown, but hyperhidrosis may be genetic. There is a 70 to 80 percent familial incidence—that is, there are other family members with the condition.

Hyperhidrosis affects people of all ages and walks of life. Although the majority of patients have been young adults, cases have been noted in infants and young children. Treated patients have ranged from teenagers to those in their 60s. Among them are an FBI agent, an Olympic athlete, a grandmother fearful of dropping her grandchild and a mother and her baby.

Other Treatments for Hyperhidrosis

Over the years, doctors have tried many other treatments for this frustrating condition. None of them work consistently, and some do not work in cases of severe hyperhidrosis. These treatments have included powerful antiperspirants, tapwater iontophoresis, medication and psychotherapy.

Antiperspirants (e.g., Drysol) may be applied to the hands and armpits at night and then removed in the morning. This treatment is generally tried first and may be effective in mild cases.

Tapwater iontophoresis can provide temporary relief in mild cases of primary hyperhidrosis, but it is uncomfortable, expensive and time consuming. Several times a week for several weeks, the hands are placed in an electrolyte solution with a low-level electrical current. Patients may purchase the equipment to do this at home.

Anticholinergic drugs (e.g., Atropine or Robinol) are a possibility. They can reduce the perspiration but may also cause annoying side effects, such as dry mouth, urinary problems or vision difficulties.

Psychotherapy fails to treat the underlying medical problem and it may be helpful only for coping and social skills.

When researchers confirmed that the sympathetic nervous system was involved, surgery made the most sense. Sympathectomy has been performed for many years, but until recently, it required a painful, open-chest operation with the spreading of the ribs to access the nerves along the spinal column. Using an endoscope (a small fiber-optic cable with a camera on it) and miniature instruments, doctors now only need to make 2 very small (½ inch) incisions between the ribs. The patient walks out the door a few hours later—with dry hands.