ST. PHILEMON'S CORNER

Hyperhidrosis is defined as an excessive and a non physiological amount of sweat produced by the body. It can be a generalized situation where excessive sweating appears all over the body or focal hyperhidrosis where the excessive sweating is situated in areas such as the hands, armpits, feet or the face.

        Initially the treatment for palmar hyperhidrosis was based on the elimination of the T2 sympathetic ganglia (nerve). This describes the anatomical annotation of the nerve segment responsible for this excessive sweating. Over the last 10 years the accumulated knowledge changed the focal treatment to the level T3-T4 which describes a segment somewhat lower to the one described above. This change and the utilization of titanium clips vs. destroying the nerve segment improved the current treatment. Another improvement is that now there are different surgical procedures available for different types of focal hyperhidrosis (Hands, Armpits, Feet).

       Over the last 15 to 20 years where more cases have been performed we realized that the most common denominator is genetic predisposition. In more than 50% in selected papers written by both Dr. Reisfeld and other authors it has consistently shown 50% or more have some genetic history. It is not always in successive generations as we have seen it skip generations. Other causes such as anxiety situations, dietary reasons have not proven to be a factor. On the other hand some trauma to the head and chest area can be traced to the source of hyperhidrosis in a very small amount of cases. There are other factors that may contribute to generalized total body hyperhidrosis and those are obesity, hyper thyroidism, infections, diabetes, etc.

        Since the genetic factors are the most important with regards to excessive focal sweating it is the belief of Dr. Reisfeld that one day genetic manipulation will be the ultimate treatment modality. Unfortunately, at present, this is a very futuristic hope because the knowledge and kno whow in its infancy stages.

       The wish to control excessive sweating with simple means such as pills, lotion, etc is a very old. Doctors have tried to treat excessive sweating with pills, lotions, deodorants, electric devices, acupuncture, bio-feedback. The success rate for the severe cases is extremely limited. Surgical treatments were available for the last 50 to 60 years. Obviously the initial surgical approaches were quite invasive and had complications. Since the development of optical surgical equipment, endoscopic surgeries became the yardstick for different procedures. Sympathectomy can be done now on an outpatient basis. There are minimal small incisions and the patient can return to normal activity in a short amount of time. Dr. Reisfeld has been a world leader in the development of endoscopic thoracic sympathectomy and now lumbar sympathectomy.

      For severe hand sweating endoscopic thoracic sympathectomy (ETS) is the preferred approach. For excessive armpit sweating as the sole presentation then axillary suction curettage is the recommended method. For those who suffer from excessive foot sweating as the primary presentation or when ETS did not help their sweaty feet then lumbar sympsathectomy is offered now as a surgical solution.

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