Compensatory hyperhidrosis usually occur after a surgical operation for axillary and palmar hyperhidrosis (sympathectomy). It’s the most common and notable side effect of sympathectomy. Other side-effects include gustatory sweating (sweating when eating), and neuralgic pain, but these are relatively rare.

Excessive sweating occurs in untreated body areas, usually in the upper or lower back and trunk, to compensate for reduced sweating in the treated areas (armpit and hands). The brain is responsible for shifting sweat production to a different body location to get rid of the perceived excess body heat. It’s actually a reflex response of the brain when it senses that it’s not cooling the body enough. The brain sends signals to the body to sweat more through the existing and undamaged sweat channels.

The symptoms of compensatory hyperhidrosis, such as profuse sweating and feeling of hotness (or sometimes coldness), may happen at irregular intervals or be constant throughout the day. Excessive sweating may occur in the lower and upper back, lower chest, abdomen, buttocks, groin and backs of the thighs. Patients who experience compensatory hyperhidrosis sweat profusely with the slightest thermal increase and physical activity.

Patients who have undergone sympathectomy for hyperhidrosis may develop compensatory hyperhidrosis soon after the operation, or later for some. On the average, sweating symptoms will remain stable six months after, but may continue to occur long after the operation.

It’s impossible to accurately predict who will and won’t develop severe compensatory hyperhidrosis after surgery. Likewise, it’s impossible to know in advance how intense the symptoms will manifest in certain patients. What’s certain is that almost all patients who undergo any form of sympathectomy experience some degree of compensatory hyperhidrosis. Its severity, however, will depend upon the levels of the interrupted sympathetic chain.

Research shows that a significant reduction in compensatory hyperhidrosis symptoms can be done by dividing the sympathetic chain at a single level (T2 sympathectomy). For older patients that have increased body mass index (BMI), it may be recommended that they undergo a temporary sympathetic block prior to permanent sympathectomy. This should help determine if compensatory hyperhidrosis would be a significant side effect for them after the operation.

Degree of tolerance for compensatory hyperhidrosis as a side effect of sympathectomy varies. Some patients may regret the surgical procedure because of the severity of the symptoms of compensatory hyperhidrosis, but this is relatively rare. Still, a majority of patients who have undergone this procedure can very well tolerate mild to moderate compensatory hyperhidrosis symptoms, which, for them, is an insignificant price to pay compared to a lifetime of trouble and discomfort from profuse underarm or hand sweating.

Since sympathectomy is a surgical procedure that’s irreversible, it’s still important that the patient be made aware of its side effects. Although most patients report that it’s an acceptable trade-off for getting rid of axillary and palmar hyperhidrosis, compensatory hyperhidrosis is something real and could be permanent, with no known cure. An informed choice is still the best privilege any patient could possibly have.