Sweating – Hyperhidrosis


Sweating is a natural phenomenon necessary for the regulation of body temperature.

The secretion of sweat is mediated in part by the sympathetic nervous system. For a number of people, about 1%, this part of the nervous system operates at an elevated level, far higher than is required for regulation of body temperature and is associated with excessive sweating. This condition is called hyperhidrosis.

Most people think that hyperhidrosis is a trivial problem. Excessive sweating is not a rare disease. According to some statistics, about 3% of the population suffers from this disorder.

This condition affects all aspects of a patient’s life, drastically impairing the quality of life and creating many psychological, social, and even physical problems. People with this issue avoid contact with others because of their constantly moist hands. It is sometimes so bad that they avoid touching things.

There are two types of hyperhidrosis;

Primary hyperhidrosis is more common than secondary. It usually begins in childhood or adolescence and persists throughout life. It can occur in one or more parts of the body, most commonly on the palms, soles and underarms. It is often accompanied by the unpleasant smell of sweat. Sweating palms can be a significant psychological problem because the hands are in contact in social and professional activities more than other parts of the body. Many people with sweaty palms are limited in the choice of profession due to inability to work with material that must not get wet, for example paper.

The most common is the focal hyperhidrosis: combined hyperhidrosis of palms and soles, in about 15-20% sweating occurs in the armpits and palms, 5-10% just below the armpit. Less common is facial sweating (aka Craniofacial sweating), which can cause emotional tension and be triggered in response to heat or spicy food.

Other localization of primary hyperhidrosis is on the trunk and thighs. For many people it appears as a combination of these forms of sweating. Nervousness and anxiety can aggravate sweating, but they are rarely the primary cause.

Hyperhidrosis is an inherited disease. In some 25 – 50% of cases there is a history of it in family members. If one parent has hyperhidrosis, there is a 25% probability that it will occur in the children.

Secondary forms of hyperhidrosis occur in cases of elevated body temperature, increased thyroid gland function, diabetes, menopause, obesity, alcoholism, drug abuse, use of certain drugs, etc…

Secondary hyperhidrosis is treated the same way as the primary disease.

In primary cases, the first treatments are prescribed medicines that reduce sweating – antiperspirants. Subsequently, oral medication can be added. In the treatment of excessive sweating of palms and soles iontophoresis (treatment with low voltage currents in special tubs with water and electrodes) can be used.

These treatments are effective in mild to moderate forms of hyperhidrosis. However, this method is difficult to apply to people with excessive sweating in the armpits.

In recent years, multiple hyperhidrosis is treated with repeated injections of Botox in the palms and axillary regions but still has only a temporary positive effect.

The operation of VAST Sympathectomy, in which two or three small incisions of 5mm are made on either side of the chest, is also a potential solution. Through these incisions a camera is introduced and instruments are used to locate and cut the sympathetic nerves responsible for excessive sweating. Around the world this operation has been performed for nearly three decades and has proven to be extremely effective, and has become the gold standard in the treatment of this condition.