University of Maryland Rounds features clinical and research updates from the University of Maryland School of Medicine and the University of Maryland Medical Center.
Intended for physicians, Rounds contains contact information to learn more about the clinical and research advances featured in each issue. It is printed three times a year and distributed monthly via email.
A police officer who could not appropriately grip his weapon. A soldier too embarrassed to shake hands with superiors. A teenager whose golf club flew out of his hands at a driving range. A woman whose hands slipped off her steering wheel while driving.
All these people came to University of Maryland Medical Center (UMMC) with a chief complaint: Hands so sweaty that their quality of life — or indeed their safety — was impacted. The diagnosis was Hyperhidrosis, a condition causing excessive and unpredictable sweating, even when temperatures are cool and those affected are at rest.
Loosely translated as “excessive water,” Hyperhidrosis is believed to affect up to 3% of Americans, though the exact underlying cause remains unknown. At UMMC, this translates into a range of about 12 to 40 people each year who come here seeking help for treatment. “It’s a constant firing of the Sympathetic Nervous System that tells a certain production of sweat glands to liberate sweat without provocation and more commonly, at inopportune moments,” explains Whitney Burrows, M.D., a thoracic surgeon and an assistant professor of surgery at the University of Maryland School of Medicine. “The classic individual has sweaty palms in the middle of winter or while watching a movie in an air-conditioned theater with a loved one. They are not anxious or hot.”
Normal Perspiration Goes Awry
The body typically triggers sweating as an involuntary response to stress, overheating, or anxiety. But in those with hyperhidrosis, this normal sweat response goes haywire, typically affecting the palms, soles of the feet and armpits. In other cases, the face, groin, belly or small of the back becomes the site of profuse and unstoppable perspiration, explains Shamus Carr, M.D., a thoracic surgeon at UMMC and assistant professor of surgery at the University Of Maryland School Of Medicine.
Sweating can be linked to medical conditions, including thyroid problems, heart disease, menopause or cancer. However for patients with hyperhidrosis, this is typically their only medical issue. “Patients are generally very healthy outside of this condition that they consider a curse,” Dr. Burrows says. “It’s extremely debilitating and there’s something awry, but it’s not a disease and it won’t degenerate into a disease. Hyperhidrosis is a disorder that doesn’t have to be treated, but usually those who have this condition want therapy or treatment.”
Wide Variety of Treatments Includes Surgery
Treatments for hyperhidrosis span between a wide range of products, medications and procedures. They include:
Prescription-strength antiperspirants containing 10% to 20% aluminum chloride hexahydrate, which can block sweat glands under the arms
Medications, such as glycopyrrolate (brand name Robinul), which decrease secretions throughout the body, including from the sweat glands
Iontophoresis, a procedure using electric pulses to temporarily deactivate sweat glands in hands or feet
Botox, or botulinum toxin, injected to block the nerves stimulating sweating, typically under the arms
Endoscopic thoracic sympathectomy (ETS), a surgical technique that interrupts the Sympathetic Nerve chain at specific levels that are producing increased sweat-provoking signals.
Special training is required to perform ETS surgery, which is a “purely elective procedure,” Dr. Burrows notes. Side effects include so-called compensatory sweating, meaning patients develop excessive sweating in a body region previously unaffected. Life-threatening complications, while rare, can also result.
“I never consent a patient for surgery the day I meet them,” says Dr. Burrows, who, along with his colleagues, has performed hundreds of hyperhidrosis surgeries over the years. “I want them to think about everything we discuss. They don’t have to beg me for this procedure but I’m not going to convince them it needs to be done.”
When successful, which is typically the case, hyperhidrosis surgery “revolutionizes” patients’ lives, and Drs. Burrows and Carr often receive feedback from this greatly appreciative group.
The gratitude this subgroup of patients show is particularly robust. Dr. Burrows has received many a letter from patients who underwent surgical Sympathectomy intervention who report that this treatment has “changed their lives.”
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