Hyperhidrosis

Abstract

Primary hyperhidrosis is a frequent disorder of unknown aetiology that most often affects the palm of the hands, the axillae, or the face to such an extent that it becomes a professional, psychological, and social burden to many patients. Non-surgical management by dermatologists is the first line of treatment, but if medical treatment fails, sympathectomy surgery is effective and offers the only permanent treatment option. Surgery basically blocks transmission of nerve impulse to the eccrine sweat glands by transecting, ablating, resecting, or clipping the sympathetic chain, and technically these are not difficult for the experienced VATS surgeon. The difficult part, and the most important key to success in sympathectomy surgery, is the critical and meticulous patient selection that includes thorough information about frequent side effects. Compensatory sweating is the most common, but gustatory sweating and bradycardia are also quite frequent. In some patients side effects are severe enough to regret surgery, which is considered irreversible by most. At present, application of a metal clip on the sympathetic chain is promising because of potential reversibility in theory, but the question of true reversibility remains controversial. Ideal patients, who are treated by sympathectomy, are among the most satisfied patients that thoracic surgeons will ever meet.