The therapy of excessive sweating

How do you treat excessive sweating?

There are different approaches to treating hyperhidrosis / excessive sweating with different success rates.

• Psychotherapy, hypnosis, developing strategies for coping with stress.
  Since most patients suffer from excessive sweating in stressful situations, the psychotherapy to develop strategies for coping with stress. This form of therapy is practically risk-free and certainly worth a try.
  The chances of success are good in some cases, but unfortunately often the result is not satisfactory.
  At this point we would like to mention Jacobson's progressive muscle relaxation in particular. With the technique of progressive muscle relaxation, mental stress states can be favorably influenced by simple relaxation techniques.
  More about this topic can be found: progressive muscle relaxation

• Medication
  There are Medicationthat dampen the function of the "sympathetic" nervous system.
  Unfortunately, all of the functions of this nervous system are affected, so that there are often unpleasant side effects that patients cannot tolerate. Dry mouth and general tiredness are examples that patients complain about the most.

• Iontophoresis
  Iontophoresis is a special form of therapy in which an attempt is made to use ions of minerals to obstruct the sweat gland ducts. These are the hands and the Feet placed in water in which there are electrical conductors. A weak current then sets the mineral ions in motion, which then penetrate the ducts of the sweat glands.
  Iontophoresis works well in some patients. Unfortunately there are cases in which no improvement can be achieved.

• Botulinum toxin (Botox®)
  The botulinum toxin (Botox®) is a poison that is produced by bacteria Clostridium botulinum is released. Its effect is based on the blockage of the substance that transmits the nerve potential to the sweat glands. As a result, the nerve control of sweat production is canceled or at least greatly reduced.
  During therapy, botulinum toxin (Botox®) is injected extremely diluted under the skin of the body regions that are most affected because of the very strong effect of the toxin. Mostly it concerns the armpits and hands.
  This therapy has to be repeated at regular intervals because the botulinum toxin (Botox®) is broken down by the human body over time. The time required for this is individual for each person. However, some patients complain that this treatment is effective for only 3 monthsn.
  You can find further information under our topic: Botox®

• Aluminum chloride
  This is again an approach to clog the ducts of the sweat glands. The aluminum chloride is applied to the affected skin and reacts with compounds contained in sweat. This creates new chemical compounds that obstruct the sweat ducts. As a result, the sweat glands regress in the course. However, it takes a long time before it happens.
  The aluminum chloride is offered in solutions that are applied before sleeping. Initially, this treatment is carried out daily. In the course of time, the application intervals can increase.
  If this treatment is used consistently, the success rate is high. However, the known side effects of aluminum chloride, such as skin irritation and discoloration of clothing, are factors that discourage some patients from long-term use.
• Suction of the sweat glands
  The sweat glands can also be suctioned off. This is a surgical procedure that can be performed under local anesthesia.
  This method is often used when there is excessive sweat production in the armpit. However, the sweat glands tend to regenerate, so this treatment wears off after a few years.
• Severing the boundary line ("Endoscopic Thoracic Sympathectomy" or "ETS")
  If all other methods fail, surgical treatment of the hyperhidrosis is an option. Since the introduction of the minimally invasive procedure, the "endoscopic" operation has been possible. A camera and instruments are inserted into the chest (= thorax, therefore "thoracic") through small incisions.
  The trunk ("sympathetic") is sought out and the area of ​​the upper thoracic spine is tied off: sympathectomy. The ligature of the trunk is performed differently by different surgeons.
  While some surgeons only place a clip on the nerve cord, others prefer treating the cord at high temperatures, thereby interrupting the transmission of nerve stimuli. However, the safest method of tying off the trunk is cutting, which is also offered in most cases.
  For more information on the anatomy of the rib cage, see our topic: Thorax

When should an operation be performed?

Indication for the operation
The ETS (E.ndoscopic Thorakale S.ympathectomy) should be considered as a treatment if the non-invasive methods do not produce satisfactory results.
This operation is particularly successful with excessive sweating of the hands. If the face is affected, the trunk would have to be severed a little higher, reducing the risk for a Horner syndrome (see below) increases.

Surgical treatment is not indicated for isolated hyperhidrosis of the armpit area and feet. However, if the hands are also affected in such cases, ETS can be benefited because the patients develop better overall stress management.

Course of the operation
The patient is positioned on the side, the lungs are ventilated separately so that the Ventilation of the lung can be switched off on the side that is being operated on.
This provides a sufficient view in the chest, which allows the surgeon to seek out the trunk and to prevent it.
A small tube is then placed through which the air in the gap between the lungs and the chest wall ("pleural gap") can be sucked out. As a rule, the opposite side is operated on in the same session, after the patient is positioned accordingly and the opposite side lung is ventilated.
The drainage tubes are usually removed on the day of the operation and one X-ray image of the lungs to see any residual air in the pleural space.

Risks of the operation
Also with the ETS apply the general risks of surgery. Bleeding, secondary bleeding, wound healing disorders, especially in the case of inflammation, can occur.

As with any operation, neighboring organs or structures can also be damaged with ETS. In this case, the Rib cage operated on.
Next to the lungs, this is where this is heartwhose injury can be life-threatening. In addition, the organism's largest vessels run in the chest.
Not to be neglected is the liver on the right and the spleen on the left, which is above that diaphragm can also be injured.

Horner syndrome
Horner's syndrome occurs when a certain cluster of nerve cells ("Ganglion") is affected, which is located in the course of the boundary line. This ganglion is very close to the area in which the ligament of the border cord is made and is therefore endangered.
Horner's syndrome is a combination of facial changes caused by the failure of the sympathetic nervous system in the head area.
The consequences of this are that the pupil does not dilate properly ("Miosis") cancausing problems with vision in the dark. In addition, the eyeball is shifted backwards, into the interior of the skull ('Enophthalmos"). Furthermore, the failure of the autonomic nervous system in this area causes the upper eyelid to droop ("Ptosis').

Consequences of the operation
If one proceeds from the assumption that the excessive sweating is caused by a "misaligned target value", this will not change as a result of an operation.
This hypothesis could explain what is known as "compensatory sweating". This is an increase in perspiration on other parts of the body, such as the chest, stomach and back area, while the hands remain dry and warm. Compensatory sweating is accepted by most patients who undergo an operation. In rare cases there is so much increased perspiration that it is extremely annoying to the affected people. This is one more reason to think about the risks and consequences before the operation.

In case of a combined hyperhidrosis In the area of ​​the hands and feet, a regression of the sweat formation in the foot area is mostly observed after an ETS.
This is not a physiologically explainable fact. Rather, the improvement in the situation in the area of ​​the lower extremities is more related to the general increase in quality of life, which results from the certainty that the hands are now dry.

Overall, after the operation, people report a certain serenity in stressful situations. This is certainly due to the discrepancy with the condition before the operation.