Dr Davin S. Lim
Sweat Free Clinics
Sweaty hands or palmar hyperhidrosis is one of the most commonly encountered areas of sweating. This condition starts off in childhood, and has a significant impact for the patient. Children’s schoolwork can often be affected due to the excess sweat production, and often need more time in exams. Work, relationships, and social interactions such as a simple handshake can be stressful to the patient. It can’t be overstated the importance of treating palmar sweating.
Treatments are readily available, and successful in the majority of patients. I approach treating sweaty hands in the following way- a combination of antiperspirants, creams, and iontophoresis sorts out 50-80% of patients. Sweat stopping treatments can help an additional 20% of people, however I don’t usually perform this procedure on children, and never perform this before iontophoresis. Our team works closely with Vascular surgeons, and if all else fails, a procedure called ETS, or endoscopic thoracic sympatectomy has a very high success rate. I rate ETS as a better procedure than sweat stopping treatments, as ETS has a very high cure rate, sweat stopping treatments just gives remission for 3-4 months. (For axillary hyperhidrosis, the reverse applies as it is PBS listed, and lasts 6-7 months)
Dr Andrew Cartmill
B.Sc., M.B.B.S. (Hons), F.R.A.C.S. (Vasc)
Vascular and Endovascular Surgeon
Sweat Free Clinics, Queensland Vascular Group
In many cases, symptoms of palmar hyperhidrosis are relatively mild and are well controlled without the need for surgery. In more severe cases or after failure of medical therapy, patients are often considered for minimally-invasive endoscopic thoracic sympathectomy (ETS). The aim is to reduce the sympathetic outflow the palms whilst preserving other sympathetic nerve functions.
This is achieved through 2 small intercostal incisions beneath the armpit for endoscopic access to the chest cavity. Unilateral lung deflation is performed under general anaesthesia, to facilitate exposure of the sympathetic chain on each side. For palmar hyperhidrosis, the aim is the interruption of the T3 ganglion only by direct division of the chain. This will prevent sympathetic signals to the hands to reduce sweating, whilst minimising the likelihood of compensatory hyperhidrosis in other regions of the body, which is a risk particularly with higher T2 ganglion transection. The lung is reinflated over a drain tube, which is removed on the first post-operative morning prior to discharge home.
ETS is a very well-tolerated procedure which carries a success rate for eliminating palmar hyperhidrosis of over 90%. The main risk to be considered is the chance of ‘compensatory hyperhidrosis’ which may occur in 25-50% of cases. As expected, not all sympathetic outflow can be eliminated, and compensatory sweating particularly in the chest and abdomen can occur. Usually this is mild, well-tolerated, and much less severe than the palmar sweating the procedure was originally performed for. Indeed most patients who develop this find it much less debilitating than the palmar symptoms prior to treatment. Provided patients are well informed through a comprehensive pre-operative discussion about expectations, this risk is not a major concern. Other risks include small pneumothoraces which spontaneously resolve, bleeding, infection and Horner’s syndrome. This last risk can be caused by interruption of the T1 (Stellate) gangion and is therefore a very rare occurrence.
There is usually minimal pain aside from some transient generalised chest discomfort and surgical site pain. These both rapidly subside. Patients can expect to be in hospital for 1 night after the procedure, and usually return to work duties, schooling and regular activities within a few days.