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1. What is hyperhidrosis?
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Hyperhidrosis is excessive sweating. All of us sweat and when it is hot or we are embarrassed or anxious we sweat more. This is normal and it is only when the sweating is excessive and causes ruined clothing or extreme social embarrassment that it is called hyperhidrosis. Generalised hyperhidrosis may be the result of systemic disease such as chronic infection or an over active thyroid. Localised sweating confined to the armpits or hands is not usually associated with any generalised disease.
2. Where does sweat come from?
There are thousands of little glands in the skin that produce sweat. Sweat is one of the ways which the body uses to cool itself. The amount of sweat depends on how hot it is and on stimulation of the sweat glands by the nerves that supply them.
3. Do I need treatment?
Excessive sweating is not harmful in itself. Therefore treatment is only required if the sweating is so severe that it is causing embarrassment or difficulties at work. Some people suffer from severe facial blushing and / or sweating. This can also be treated successfully with this operation.
4. What treatment is available?
You may initially be prescribed a strong antiperspirant called aluminium chloride. This is applied at night and washed off in the morning. Antiperspirants work better in the armpits than on the hands. If medical treatment is unsuccessful in controlling the sweating, then an operation to divide the nerves that supply the sweat glands may be needed (Thoracoscopic Sympathectomy).
5. What is a thoracoscopic sympathectomy?
The nerves that supply the sweat glands in the armpit and palms can be cut to reduce the amount of sweating. These nerves lie deep in the neck, close to the spine and the traditional operations to divide them, using a neck or armpit incision, left a sizeable scar and were often accompanied by complications. The operation was therefore only done in very severe cases. However, thanks to the development of "keyhole" surgery the nerves can now be destroyed through 2 or 3 tiny holes in the chest using special instruments. This procedure is called a thoracoscopic sympathectomy or Endoscopic Thoracic Sympathectomy (ETS).
6. How is a thoracoscopic sympathectomy carried out?
You will have a general anaesthetic for the operation. When you are asleep, a small hole is made in the upper chest. The lung, on the side being operated upon, is allowed to collapse a little to make some working room. Meanwhile your other lung is capable of doing all the work. A camera on a thin telescope is then put into the chest to find the nerves which are to be divided One or two other small holes are made to put in the instruments that divide the nerves. The lung is then re-expanded and the instruments removed. Sometimes a small drain (plastic tube) is left in the chest for a few hours to make sure all the air is removed from the chest cavity. Usually, only one side is done at a time although it is possible to do both left and right sides at the same operation if required.
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