Hyperhidrosis

Overview

Hyperhidrosis is characterized by abnormal, excessive sweating. This may occur in one area, such as the hands, or in several areas, such as some combination of hands, feet, armpits and lower back. When just the hands are affected, it's called palmar hyperhidrosis; just the feet, plantar hyperhidrosis; just the armpits, axillary hyperhidrosis. The condition often shows up in childhood or adolescence.

Affecting about 1 percent of the population, this rare condition is equally common in boys and girls. While hyperhidrosis doesn't pose a health risk, it can have a serious impact on quality of life. Severely sweaty palms can make it hard to hold a pencil, keep school papers dry or use a touch screen. Children may feel embarrassed and anxious about interacting with or touching other kids.

Excessive sweating can be a symptom of certain underlying medical conditions, but in most cases, the cause is unknown. What's understood is that it's linked to the sympathetic nervous system, which stimulates the physical response to fear and stress. People with hyperhidrosis seem to have an overactive sympathetic nervous system.

Signs & symptoms

Excessive sweating regardless of the temperature or emotional factors is the hallmark of hyperhidrosis. Hands may be so moist that it's difficult to grasp objects. Soaking-wet clothes, socks and shoes may lead to increased body odor.

The problem is often first noticed when it starts to interfere with school and social activities. At times, it may be associated with stress, strong emotions or exercise.

Diagnosis

Hyperhidrosis is diagnosed with a physical exam and a detailed evaluation of your child's symptoms. The doctor will want to rule out other causes of abnormal sweating, such as high blood pressure, low blood sugar or hyperthyroidism.

Treatment

At UCSF, we offer a variety of approaches to hyperhidrosis. These include:

• Medications – Our dermatologists may recommend prescription-strength antiperspirants containing aluminum-based solutions that temporarily plug the sweat glands. There are also oral medications that calm the nervous system by blocking the action of acetylcholine, a neurotransmitter. These treatments may reduce sweating but won't cure it.
• Iontophoresis – This treatment is done at home using a special machine that shuts down the sweat glands by sending a gentle electrical current through water. The hands or feet rest in trays of water, or pads are used to treat the armpits. Multiple sessions are required, and some people need the treatment on a regular basis.
• Minimally invasive surgery – Our team is experienced in two surgeries that work by interrupting nerve pathways leading to the sweat glands: Endoscopic thoracic sympathectomy (ETS) is performed for excess sweating in the hands and underarms, and endoscopic lumbar sympathectomy (ELS) is for excess sweating in the feet.

These surgeries use the same minimally invasive technique and are performed under general anesthesia (the patient is completely asleep). Working through very small incisions in the chest or back, the surgeon uses special instruments to access and cut or clamp off the sympathetic nerve chain triggering the excessive sweating.

Most patients leave the hospital in less than 24 hours and are fully recovered within two weeks. Surgery is highly effective in providing lasting results, though about 20 percent of patients develop excessive sweating in other body parts (called compensatory sweating). To address that problem, UCSF pediatric surgeon Sunghoon Kim developed a way to more precisely locate where the nerve chain should be interrupted. His method dramatically reduces the risk of compensatory sweating.