Common Thoracic Problem

Hyperhidrosis

Primary hyperhidrosis (原發性多汗症)

Over-sweating is common yet troublesome condition especially in tropical region like Hong Kong where humidity and temperature are high. Emotional related sweating are sometimes very excessive causing severe social embarrassment and incapacitating work with paper or food. (for example lawyers, students and baker)

Over-sweating can be generalised or regional. Emotion related sweating is mostly found on palms and upper limbs. Hormone (endocrine) related ones are associated with odorous armpit sweating. Other conditions such as plantar hyperhidrosis. head over-sweating, facial flushing and armpits over-sweating are related problems.

The natural history is worsening condition and progress with time. Dehydration, summer season, stress and nervousness are exacerbating factors. Shyness and personality play some contributing factors but emotional sweating are exaggerated physiological response. (is severe in patients with hyperthyroidism)

Initial treatment include avoidance of heated area and clothing adjustment. Topical application of an-hydrant and aluminum products. These stop sweating temporarily by occluding the sweat gland ducts. Antiperspirants or anti odor agent only prevent sweating for short period of time.

Ionotophoresis can stop hand sweating for few weeks or even months by immersion of hand and sweating skin surface into electrolyte solution and passing current.

This is a painful procedure and time consuming and good effect are at most short lasting. The mechanism is unknown but temporary blockade of nerve stimulation of sweat glands may be a factor.

Injection of Botox is painful and short lasting

Magnitude of the problem

Primary hyperhidrosis approximately 0.6 - 1 % of all adults.  It began since birth.

Localized  palmar hyperhidrosis is more common at 1.5 – 2% and usually begin from childhood or puberty.  It may be related to an inherited trait.

Localized odorous axillary hyperhidrosis affect 1.4 -5% individual and especially troublesome in ladies.

Treatment modality for localized non-palmar hyperhidrosis

  1. local application of Botox
  2. Surgical removal of sweat gland containing skin or destruction of sweat gland
  3. Laser removal of hair follicle
  4. symphaphectomy including T4
  5. Microwave heat treatment to ablate hair follicle and sweat gland in armpit (http://www.miradryhk.com)

Palliative measure of sweat gland duct occlusion or deodorant is not useful.
Method 4 and 5 are permanent.

Treatment for primary palmar hyperhidrosis:

  1. Sympahtectomy (T2 - T3/T4)
    a) endoscopic diathermy destruction
    b) thoracoscopic division
  2. Iontophoresis - need to be repeated periodically
  3. Topical an-hydrant - talcum powder

Only sympahtectomy is effective for nervousness related hyperhidrosis.  Thoracoscopic sympathectomy has immediate success in 0ver 90% of patients with good recovery to work after 2 days.

Complication of hyperhidrosis surgery

  1. compensatory trunk hyperhidrosis = over-sweating in body especially the back
  2. injury to first ganglion causing Horner's syndrome on affected side: drooping of eyelids, pupil small  and lack of sweat on the affected side's face.
  3. relapse
  4. pneumothorax
  5. Haemothorax (rare)
So a good experienced surgeon is required for this surgery to avoid major complication. Factor 2 to 5 is avoidable in good hands.