Focal, or primary hyperhidrosis (excessive sweating) can be present in patients with sympathetic hyperactivity. Patients afflicted with this disorder can exhibit severe sweating of the hands, underarms and feet, which can be so debilitating that it can affect job performance and a patient’s social well-being. Severe focal hyperhidrosis may affect as much as 3% of the population, appears to be genetically related and is not part of the body’s normal temperature regulation. Unfortunately, in patients with a severe case, topical ointments and treatments with iontophoresis devices are unlikely to be effective.What are the symptoms of focal hyperhidrosis?
Symptoms include: sweaty palms and/or soles of the feet; sweaty armpits; a change in the amount of sweating; a change in the pattern of sweating; or a change in the odor produced during sweating.What are the risk factors for focal hyperhidrosis?
This is a genetic disorder.What tests can I expect?
There are no specific tests for focal hyperhidrosis. However, your doctor may recommend a starch-iodine test on your armpits to determine the areas of the most active sweat glands. If your doctor suspects a particular underlying medical condition, he or she will order appropriate tests.What are my treatment options?
Treatment options include: lifestyle changes, such as frequent clothing changes and more careful washing of your body; topical ointments and treatments with iontophoresis devices are unlikely to be effective; botulinum toxin infections, which may be effective in some patients especially those with axillary sweat. However the duration of effect is limited and repeat treatments are the norm.
MINIMALLY INVASIVE TECHNIQUES
Endoscopic thoracic sympathectomy (ETS)
In select patients, especially those with severe palm sweat or combinations of other areas with palm sweat, ETS is the preferred method of treatment. This treatment involves the destruction of nerves in the upper back chest cavity that stimulate sweating mostly to the palms, and to some extent, the armpits.