Sweating is a part of everyday life, but can be debilitating when it gets to be socially straining. Perspiration is a body temperature regulating function; it is a vitally important aspect for our bodies to inform us about what is happening on a very basic level. With over five million sweat glands in the human body, the mechanism is controlled by the sympathetic chain located in our chests. Hyperhydrosis is a condition in which excessive perspiration occurs in the body- more than normally allotted for physiologically. There is no definitive reason as to why this may happen, but it can happen at any of the many sites in which we normally perspire. Up to 1% of the population has this condition where the body works extremely diligently to cool down the internal body temperature.

Hyperhidrosis occurs in various locations in various ways - it can be a sudden onset, or a continuous issue, regardless of if the weather calls for it or not. One can have it occur in four primary areas - hands (palmer hyperhidrosis), armpits (axillary hyperhidrosis), feet (plantar hyperhidrosis), and face (facial hyperhidrosis).

This is a condition that may have an effect on one's social life- some people have reported it having such a profound effect on their lives that they actually must plan ahead of time to account for the possibility of having an outbreak. Sweaty hands may naturally happen when making a first impression, through nervousness or emotional stress. The simple action of rubbing hands together, rubbing lotion on, or brushing your hair can trigger an attack.

The psychological effect is vast- some patients have such severe hyperhidrosis that the sweat actually drips off the hands or other parts of the body. It can also manifest as a more simple cold and clamminess. Due to the close proximity social situations call for, many patients with hyperhidrosis lack self confidence and are self-conscious, which may cause them to avoid social situations. There may be reluctant to hold hands, handle delicate goods, or even cook. We will break down the different manifestations of the condition, and the various treatments.

• Axillary Hyperhidrosis, is simply, excessive sweating in the armpits.
• Plantar Hyperhidrosis is excessive sweating of the feet. With this type of hyperhidrosis, one can be more susceptible to foot odor, fungus and athlete's foot.
• Facial Hyperhidrosis is excessive sweating of the face, perhaps so excessive that it causes insecurity, appearing to be suspicious, anxious, even when this is not the reality.

There are many alternative treatments for hyperhidrosis- oral medication, BOTOX®, Drysol® and Drionic®, which are easily available, but the only lasting, effective treatment is with surgery. With surgery, one can stop the signal transmissions of the sympathetic nerve impulse to the sweat glands. This can be done on all locations in the body - the palms, face, armpits, and feet. The surgery is known as Endoscopic Thoracoscopic Sympathectomy (ETS).

A highly experience thoracic surgeon will be the ideal surgeon to perform the surgery. The operation is usually performed on an outpatient basis, while patient is under general anesthesia. Sympathetic nerves are located along the back, just beyond the ribs, and the surgeon will use a scope with magnification and illumination provided by the camera to view the sympathetic nerves. Your surgeon will clamp the sympathetic nerves of the ganglion through two small incisions (5 to 10 mm) just below the armpit area on both sides of your chest. These nerves are cut or clamped to reduce the body's necessity to produce sweat in the problem areas. The methods are slightly different in that the clamping method is achieved through metal clamps that are applied to the nerve to attempt to stop the sweating from a particular section of the nerve; the success rate for this method is low. The procedure can be performed bilaterally in the same session. After patients awake, they are moved to a recovery room, where they are monitored, before being discharged to go home. Patients may return to work or school within several days. The procedure is extremely effective for palmar and axillary hyperhidrosis. The endoscopic technique has been shown to be 98% effective in all patients that undergo the surgery.