Primary palmer and axillary hyperhidrosis is characterized by excessive sweating of the hands and armpits. This condition is usually made worse with physical activity and emotional excitation or anxiety. While not common, it affects roughly 1% of the western population and has an unknown cause. The emotional and psychological sequelae of this disorder can be debilitating, making it impossible for patients to confidently interact socially. Many jobs require interpersonal interactions that may be difficult because of the obvious perspiration and the lack of self confidence in the effected individual. Some people with hyperhidrosis completely avoid hand shaking and wearing tight fitting clothing as they become increasingly self conscious of their condition.

Treatment

Treatments have included various oral medications and topical ointments, creams and powders which often are suboptimally effective. Long term relief from the excessive sweating may be achieved in many patients by performing a thoracoscopic sympathectomy. In this minimally invasive procedure a small incision is made in the armpit. An endoscope and specialized instruments (similar to arthroscopic surgery performed on the joints) are passed into the chest cavity and the nerves (the sympathetic ganglia and chain) responsible for the sweating are resected. In most cases this results in immediate dry and warm hands and armpits when the patient awakens from the anesthesia. In most cases this surgery requires a one day hospitalization. Complications of the operation are very rare but may include compensatory increased sweating of the torso and feet, a Horners’s syndrome (constriction of the pupil of the eye, drooping of the eyelid and lack of sweating on the face), collapse of a lung and discomfort about the ribs (intercostal neuralgia). While the compensatory sweating of the torso may be significant, most patients state that this is preferable to the “wet” palms that they experienced prior to the sympathectomy procedure.