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Excessive Sweating: A Sticky Subject

WebMD goes to the experts to find out what may cause this embarrassing yet common condition and what can be done to treat it.

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Surgery: Best Solution or Last Resort for Excessive Sweating?

In a controversial procedure known as a sympathectomy, a surgeon cuts a portion of a nerve inside the chest, permanently interrupting the nerve signal that causes the body to sweat excessively. Joseph Coselli, MD, a surgeon at Baylor College of Medicine in Texas, says his patients are amazed to wake up from surgery with their hands completely dry for the first time in years. Unlike other treatments, a sympathectomy is designed to be a one-time, permanent procedure.

In the past, a sympathectomy was a major surgery because it required opening up the chest or back. Today, it is performed with tiny instruments and a camera that are inserted into the body through a small incision, a method known as endoscopy. This has turned it into an outpatient procedure. But the surgery remains controversial because of a phenomenon called compensatory hyperhidrosis. While sweating may have disappeared from the hands and armpits, sweating may increase elsewhere in the body, such as chest, back or legs. In people with hyperhidrosis, says Coselli, "the sympathetic nervous system is hyperactive. When you knock out part of it, other parts rev up and take over."

Glaser says the surgery should be considered a treatment of last resort because half or more of sympathectomy patients suffer from compensatory sweating. "Some people wish they'd never had the procedure," she says.

But Whitney Burrows, MD, a surgeon at the University of Maryland Medical Center who conducts sympathectomies, says that many of his patients are so "euphoric" to have reduced sweating in their feet or underarms they are not disturbed by compensatory sweating in less visible areas. To increase your odds of successful surgery, Burrows suggests seeking out a surgeon with considerable experience in the procedure.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 09, 2009

Sources

SOURCES: Crystal Barry, St. Louis. Brian Olds, Imperial, Mo. Dee Anna Glaser, MD, vice chairman, department of dermatology, St. Louis University School of Medicine, St. Louis. Harold Brody, MD, clinical professor of dermatology, Emory University, Atlanta. Joseph Coselli, MD, chief of heart surgery, Baylor College of Medicine, Houston. Whitney Burrows, MD, assistant professor of surgery, University of Maryland School of Medicine, Baltimore. Strutton, D. Journal of the American Academy of Dermatology, August 2004; vol 51: pp 241-248.

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