Hyperhidrosis is a medical condition characterized by excessive sweating. Excessive sweating can occur in the hands (palmar hyperhidrosis), underarms (axillary hyperhidrosis), feet (plantar hyperhidrosis) or face (facial hyperhidrosis). Although its exact cause is still unknown, most medical professionals believe that it is caused by the hyperactivity of the sympathetic nerve chains. The sympathetic nervous system is responsible for involuntary bodily functions and one of which, is the production of sweat, which is essential in regulating body temperature.

Hyperhidrosis is often a distressing, socially debilitating condition, affecting a small but significant proportion of the world population. While symptoms usually begin during adolescence, it can also occur in other age groups.

Treatment options given to patients who suffer from hyperhidrosis usually depend on the severity of their case and which body area is affected. Non-surgical treatments such as oral medications, anti-perspirants, ointments, botox injections and iontophoresis, are the usual initial options given to patients. When none of those treatments prove beneficial or effective, there are also surgical treatments available to patients seeking more permanent results.

In the past, surgical procedures done for hyperhidrosis cases usually involve a painful incision either at the chest, back or neck (e.g. upper thoracic sympathectomy). Most often than not, these highly invasive procedures result to complications such as brachial plexus, phrenic nerve injury, or Horner’s Syndrome, a condition that can cause dropping of the upper eyelids and eye dryness. In rare cases, excessive bleeding may likewise happen. Due to recent technological advances, minimally invasive surgical methods, such as thoracoscopic sympathectomy or otherwise known as endoscopic thoracic sympathectomy (ETS), were made possible.

ETS is a surgical procedure that intends to interrupt sympathetic nerve impulses sent to the sweat glands and prevent localized excessive sweating (usually in the hands and face). While the patient is under general anesthesia, a 5-mm. endoscope is inserted into a small incision made below the underarm to identify the second through fourth ganglia. The identified branches to the main sympathetic chain at each level are divided before the main chain is removed. The same procedure is done on the patient’s other side, which is crucial in preventing symptoms from recurring years later.

ETS is most effective in treating excessive hand and facial sweating, with a success rate of more than 98%. It also gives additional relief to excessive feet sweating. While it is a highly effective procedure with permanent results, it has very minimal complication rate. Incident of Horner’s Syndrome for instance, is about less than 1%.

As with most surgical procedures, ETS also has some side effects and the most common of which is compensatory sweating. Compensatory sweating occurs in about 50% of ETS patients. Also, there are reported cases of small pneumothorax after the operation, but in this case, no medical intervention is required and patients can usually go home after 24 hours.

While ETS is generally safe and a highly effective method in treating hyperhidrosis cases, it is still best for patients to look only for experienced, highly competent and certified surgeons for excellent and long-term results.

Hyperhidrosis is a condition in which a person experiences excessive sweating in their hands (palmar hyperhidrosis), underarms (axillary), face and/or feet (plantar). Everyone perspires more when they get nervous or excited or when they exercise, but people with this condition perspire excessively, often for no apparent reason. The sympathetic nervous system, which controls involuntary responses such as sweating, blushing, and salivation, simply fails to regulate sweating in these body areas. Consequently, people with hyperhidrosis often experience sweating so severe that it becomes a source of embarrassment, making them reluctant to shake or touch hands.

It also can interfere with everyday activities such as writing, driving, taking tests, making presentations or even holding or grasping objects. The severity of the condition varies from person to person, but in most cases the sweating proves problematic both socially and professionally. The prevalence of hyperhidrosis is not well-documented, but it is estimated to affect up to one percent of the U.S. population.
The most common non-surgical treatments for this condition include:
Topical anti-perspirants, such as aluminum chloride. Drysol, a topical lotion applied two to four times a day, is usually the first medication tried. It is often very effective for those patients with the mildest symptoms, but it can cause chapping and cracking of the skin.

Oral medicines: Anticholinergic medicines (such as Robinul) are used to block certain receivers on nerve receptors at involuntary nerve sites. In people with hyperhidrosis, this leads to decreased sweating. Some psychotropic drugs (drugs that affect mental function), like amitriptyline, have also been prescribed for hyperhidrosis.
Iontophoresis (Drionics): This involves applying low-intensity electrical current to the hands or feet while they are immersed in an electrolyte solution. When used daily, it can decrease the problem or even solve it temporarily. However, the procedure is time consuming and can be mildly to moderately painful.

Botox: This substance, a derivative of the deadly botulism toxin, is injected into the affected area. The success rate is only fair for axillary hyperhidrosis and even less so for palmar symptoms. Although it can sometimes work, its effectiveness wears off after 3 to 4 months. Therefore, the person has to undergo periodic and potentially painful injections.

While these treatments can help many people with hyperhidrosis, they do not work for everyone and their effectiveness can even decrease over time. Moreover, they often don’t provide a permanent solution to the problem. Consequently, many people with hyperhidrosis are now considering the minimally invasive surgical treatment known as thoracoscopic sympathectomy, sometimes called endoscopic transthoracic sympathectomy (ETS).

Iontophoresis is the procedure of passing an ionized substance through intact skin through the use of a direct electrical current. It’s a common treatment for hyperhidrosis, and a variation, tap water iontophoresis, is used by many dermatologists to treat the hyperhidrosis (excessive sweating) of the palms and soles. Treating axillary hyperhidrosis through tap water iontophoresis is more difficult to administer, but still possible. Clinicians also use iontophoreiss to administer drugs such as anticholinergics to areas affected by the skin condition.

To date, there are two types of iontophoresis devices that are currently seeing use in the United States: (1) The Drionic Iontophoresis unit, and (2) the Fischer Model MD-1a Iontophoresis unit. These two iontophoresis devices have received approval for treating hyperhidrosis from the United States Food and Drug Administration.

The use of electricity to treat human diseases has been studied for more than two centuries, not long after its discovery in the 18th century. It’s been mentioned in a few studies that Pivati introduced the use of iontophoresis in the treatment of arthritis in the 1740’s. Further studies in the following two hundred years have confirmed the efficiency of the procedure in administering drugs through a patient’s skin.

The use of iontophoresis to treat hyperhidrosis gained popularity in the 20th century:

1936 – Ichikasa realized that drugs administered through iontophoresis resulted in reduced sweating activity in the affected area.
1940’s – In a study independent from Ichikasa’s, Takata and Shelley successfully obtained anhidrosis (the reverse of hyperhidrosis) through iontophoresis with tap water.
1968 – Levit published his ideas on a practical device that administered iontophoresis to patients, further boosting the procedure’s popularity.

Studies have also shown that the skin’s sweat glands provide the least amount of electrical resistance during an iontophoresis procedure, indicating that drugs mainly enter the patient’s skin through these channels. While iontophoresis have been used by dermatologists in attempts to treat other medical conditions (such as scleroderma and vitiligo), hyperhidrosis seems to be the only medical condition readily treated by the procedure, owing to its widespread popularity and high success rate.

Iontophoresis delivers a charged molecule across the skin. This is done by placing it near an electrode of the same charge as itself, while another electrode of opposite charged is placed on another part of the body. While this explains how drugs are transported across the skin, it does not explain how tap water iontophoresis reduces sweat output. Exactly how this is done is still a mystery, although several theories have been suggested.

One early theory suggested that iontophoresis plugged sweat gland ducts, since iatrogenic miliaria developed when iontophoresis was administered on the back, chest, or arms of patients. Microscopic analysis did show keratin plugs blocking sweat ducts, but light and electron microscopy found no such blockages in a patient treated for palmar hyperhidrosis.

It would seem that iontophoresis may cause an impairment in a sweat gland’s function instead of a blockage. Other theories suggest that the procedure raises the threshold for transmission of sympathetic nerve impulse, or that it changes the physiology of cellular secretory system. Neurotransmitter levels in the eccrine gland or surrounding microciruclation remain unchanged after iontophoresis, however, so the subject still remains open to debate.

Iontophoresis treatment regimens vary with the device used, the areas of the body to be treated, and whether the procedures will be done at home or at the clinic.