Minimally Invasive Surgical Procedure Helps Teenagers Suffering From Hyperhidrosis (Excessive Sweating)

Main Category: Endocrinology
Also Included In: Neurology / Neuroscience;  Dermatology
Article Date: 06 May 2009 - 2:00 PDT

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An estimated 3 percent of the world population, or about 197 million people suffer from some form of hyperhidrosis (excessive sweating), many of whom do not receive proper diagnosis or treatment. Hyperhidrosis is a medical condition in which the body sweats three to four times the normal amount. This can lead to excessive sweating of the hands, underarms, feet, or face, and in severe cases, impede day-to-day functions most people take for granted. While the exact cause of hyperhidrosis is unknown, researchers have linked it to over activity of the nerves that send signals to the sweat glands in the skin.

Teenagers suffering from hyperhydrosis often experience social, emotional, and physical problems, exacerbating what is often an already vulnerable period of growth and maturity. This problem is sometimes initially discovered when teenage boys and girls are forced to forgo participation in recreational/sports activities, cheerleading, dancing, or gymnastics. Excessive sweating results in perspiration-soaked hands, causing considerable embarrassment, and making it very difficult to hold objects.

Researchers investigated the use of a minimally invasive surgical technique to treat adolescents with hyperhidrosis. The results of this study, Biportal Thoracoscopic Sympathectomy for Hyperhidrosis in Adolescents, will be presented by Scott D. Wait, MD, 3:50 to 3:57 pm, Tuesday, May 5, 2009, during the 77th Annual Meeting of the American Association of Neurological Surgeons in San Diego. Co-authors are Curtis A. Dickman, MD, Brendan D. Killory, MD, and Gregory P. Lekovic, MD, PhD.

Hyperhidrosis can affect any of the following areas: the palms (palmar hyperhidrosis), the underarms (axillary hyperhidrosis), the feet (plantar hyperhidrosis) or the face (facial hyperhidrosis). Treatment for hyperhidrosis depends on the area of the body affected, but the first treatment approach is one of these nonsurgical options: botox injections, topical agents i.e.: drysol, certain dry, anticholinergic medications, and iontophoresis (drionics). Unfortunately, these nonsurgical approaches are usually ineffective for severe forms of palmar and axillary hyperhidrosis. They typically provide temporary or partial relief of symptoms for a limited duration. Frequent maintenance of treatment is required.

"At the Barrow Neurological Institute in Phoenix, Dr. Curtis Dickman has performed over 350 procedures on adults and children to date, utilizing biportal thoracoscopic sympathectomy," said Dr. Wait. During this procedure, two tiny incisions are made in the chest wall just under the armpit on both sides. A miniature camera mounted on a surgical telescope is used to access the chest and divide the sympathetic nerves responsible for the excessive sweating. This minimally invasive approach results in virtually undetectable scars and patients can leave the hospital the same day the surgery is performed.

"We were very motivated to analyze the efficacy and outcome in adolescents, because this condition presents especially difficult emotional and psychological problems for this age group," stated Dr. Wait. Surgery was performed on 54 adolescent patients with hyperhidrosis (age range 10-17 years) over a period of 8 years. The following outcomes were achieved:

-- More than 98 percent of patients had complete resolution of palmar hyperhidrosis.

-- Over 96 percent of patients had improvement or resolution of axillary hyperhydrosis.

-- Plantar hyperhidrosis improved in 71 percent of patients.

-- One patient experienced a transient cardiac arrhythmia which completely resolved.

-- When asked whether they were satisfied with the surgery results, 98 percent of patients responded "yes."

"It is very satisfying to help adolescents who are struggling with an embarrassing condition to return to a normal way of life and be able to participate in the enjoyable activities of a typical teenager. In conclusion, biportal thoracoscopic sympathectomy is a safe and effective method of treating palmar and axillary hyperhydrosis in adolescents," concluded Dr. Wait.

The author reports no conflicts of interest.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,400 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.

Source: American Association of Neurological Surgeons

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