Hyperhidrosis

sweat

What is it?

It is a condition wherein the body or its part perspire excessively.

What are the types of hyperhidrosis?

It can be classified into primary and secondary.

How do they differ from each other?

The secondary hyperhidrosis is generally involving the whole body. The very common cause for this is hyperthyroidism. The thyroid gland producing excess hormone causes increased metabolism creating a lot of body waste and heat causing excessive generalized sweating.It is very important that this condition is ruled out because hyperhidrosis of the palms, face, armpit or feet that may be tolerable to a patient may become intolerable if accompanied by hyperthyroidism. The treatment for this is the treatment of the thyroid gland and not sympathectomy.

Primary hyperhidrosis is the localized hyperhidrosis and is amenable to surgical treatment. It may come as an isolated facial, hands, axillary or plantar hyperhidrosis.

However, they usually come in varied severity and combination of the stated parts.

What is/are the causes for primary hyperhidrosis?

Genetic is at the top of the possible causes as this is observed more commonly among patients who have one or more relatives affected. An Asian doctor who recently made extensive research on this claims to have identified the specific gene involved.

What are the possible treatment options for primary or local hyperhidrosis?

In general I don’t offer surgical treatment to patients who are young. In fact, the youngest in my operated series of more than two hundred patients is 14 years old, a high school student. The oldest being 62 years a Monsignor, catholic priest. I advise patients to try all available topical medications as long as they do not cause harm. If none of them work, I sit down with the patient and his/her family to discuss sympathectomy being the final option. Patients who would resort to injection and oral intake of medications for hyperhidrosis are the real candidates for sympathectomy.
The approach to primary hyperhidrosis is varied based on areas affected. Be careful because some patients may be thought of as psychiatric patient.

In my series of patients, there were some who were treated by psychiatrist with sedatives. It is true that some of them develop psychiatric problems becoming introvert, secluded, paranoid, antisocial, etc. These behaviors are only the products of the problem of hyperhidrosis. Not the psychiatric problem giving rise to the hyperhidrosis. Eventually it becomes a vicious cycle, the developed psychiatric problem aggravates the hyperhidrosis and the hyperhidrosis aggravating the psychiatric problem. Once they are cured of hyperhidrosis, they become extrovert, sociable, and achievers. They “live a new life”.

History of the Treatment For Hyperhidrosis

In 1930 a British Surgeon after doing Sympathectomy for a patient with a vascular deficiency syndrome of the hands noticed a dramatic alleviation of the patients associated Palmar Hyperhidrosis. The procedure then became known as the treatment for Hyperhidrosis. Because of the very invasive nature of the surgery, varied surgical approaches were designed. In 1950 Dr. Kux, a German Surgeon simplified the sympathectomy using the endoscope. This did not improve acceptance among surgeons because of the crude technology. In the early a980’s after attaching the same endoscope used by Dr. Kux to a camera projecting images on the television screen, reports of Sympathectomy for palmar Hyperhidrosis flooded the medical literatures.

The author has operated on a few cases of open sympathectomy before the technology reached the Philippines. In 1991, he did the first video endoscopic thoracic sympathectomy for palmar hyperhidrosis. In 1993, he wrote in the Journal of Philippine Medical Association. His experience on 30 patients operated for palmar hyperhidrosis. Subsequently, in 1994 he reported in the 1st Asian Congress of Stereotactic Functional and Computer Assisted Neurosurgery, in Singapore his experience on Endoscopic Thoracic Sympathectomy for Hyperhidrosis in 54 patients. The abstract of the report was subsequently published in the Stereotactic and Functional Neurosurgery, vol. 64, 1995, an international journal.

The very liberal guidelines and the simplicity of the Sympathectomy for palmar hyperhidrosis created a big number of patients complaining of a sequela, the compensatory Hyperhidrosis. Compensatory Hyperhidrosis is a condition that may come after sympathectomy where in a patient develops sweating anywhere in the trunk down to the lower extremities after sympathectomy.

The occurrence of the bothersome compensatory hyperhidrosis inspired surgeons to vary the Sympathectomy using the same simplified endoscopic thoracic sympathectomy.After a thorough review of my operated cases of sympathectomy for palmar hyperhidrosis from 1985, I modified the approach to sympathectomy and I am finding minimal compensatory hyperhidrosis post endoscopic thoracic sympathectomy; as recently reported by foreign surgeons.

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