Excessive sweating, also called hyperhidrosis, can be very disabling and can significantly affect your professional and personal activities. At the Hyperhidrosis Center at the Northwell Neuroscience Institute, one of the leading hyperhidrosis centers in the country, we are staffed with a senior neurosurgeon and thoracic surgeon, both of who have many years of experience in treating this relatively uncommon condition. Our hyperhidrosis specialists use the most sophisticated techniques for the treatment of excessive sweating. Most patients who come to our center have already tried various local and systemic (by mouth) therapies. In carefully selected severe cases of hyperhidrosis, minimally invasive endoscopic surgery is very effective. This is especially so in patients in whom palmar hyperhidrosis is the primary problem. This surgery is done by a collaborative surgical team of Raj Narayan, MD, a neurosurgeon and Lawrence Glassman, MD, a Thoracic Surgeon, both of whom are highly experienced in endoscopic thoracic sympathectomy (ETS) - a minimally invasive surgical procedure that has an extremely high success rate in properly selected patients.
Hyperhidrosis is a medical condition that causes uncontrollable and excessive sweating in particular parts of the body, such as the palms of the hands (palmar hyperhidrosis), armpits (axillary hyperhidrosis), feet (pedal hyperhidrosis) and face (facial hyperhidrosis). Sometimes, it can affect the entire body, and may be associated with a pungent odor (bromhidrosis). The problem is generally worse in warm weather, although people with hyperhidrosis can sweat excessively even when their body is cool, or when they are just resting.
There are two broad classes of hyperhidrosis – primary focal hyperhidrosis and secondary generalized hyperhidrosis:
- Primary Focal Hyperhidrosis: is concentrated in the hands, axillae, groin or feet. It is not associated with any other medical condition. It usually begins in childhood or adolescence and is less during sleep.
- Secondary Generalized Hyperhidrosis: This is associated with an underlying medical disorder or medication, is usually all over the body, commonly occurs in adults and persists during sleep. This requires a consultation with an internist or family doctors for an evaluation.
Hyperhidrosis can be very disabling, since it commonly interferes with various professional and personal interactions. Severe hyperhidrosis often causes social anxiety and may lead to the loss of a person’s sense of well-being, extreme embarrassment, psychological problems and depression. Even though anxiety and stressful situations can make the symptoms worse, our studies have shown that hyperhidrosis is not primarily a psychological disorder. When it is severe, hyperhidrosis does not generally respond well to medical therapies and may require surgery.
The Biological Basis of Primary Focal Hyperhidrosis
The hypothalamus (an area of the brain that produces hormones) works with the sympathetic nervous system to regulate sweat-related functions. It sends sensory signals to sweat nerves, which is the sympathetic chain located inside the chest. These nerves send signals to the sweat glands, causing them to produce sweat. Hyperhidrosis is the result of the over-production of sweat in response to abnormal stimulation by these nerves. This excessive sweating is often noticed on a person’s sweaty palms, underarms, face and feet. In the majority of patients with hyperhidrosis, no cause can be found. There may be a genetic predisposition to this disorder, and a family history of hyperhidrosis is common seen.