Sweaty Hands and Armpits

Sweating is a normal response to a rise in body temperature. However in some people the sweating is excessive causing great embarrassment and affecting lifestyle. Sweaty hands make picking things up difficult, sometimes it causes great difficulty with writing and is often excessive, causing great embarrassment. Sweating armpits can be so severe as to stain clothing and seriously limit the activities a person is prepared to participate in. A number of effective treatments are now available, significantly reducing the impact of excessive sweating.

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Botox

Botox paralyses the sweat glands for 4-12 months. Botox is the firstline treatment of choice for axillary hyperhydrosis (sweaty armpits). It can also be used for some other areas. The effects of Botox last for 4-12 months and can be repeated.

Botox injections into the armpit take 10-15 minutes, and is mildly uncomfortable. Local anaesthetic cream can be used but is rarely nescessary. Botox takes effect over the next few days.

Botox can be injected in a number of different parts of the body to reduce local sweating. There are a number of alternative treatments for sweaty feet that exist, all of which have varying degrees of effectiveness.

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		Axillary Botox

Surgery (Endoscopic Thoracic Sympathectomy)

Minimally invasive ETS (endoscopic thoracoscopic sympathectomy) is the treatment of choice for palmar (hand) hyperhydrosis. ETS may be suitable for some patients with facial flushing.

ETS is usually performed as a day or 23 hour case. The surgery takes 15-25 minutes under a general anaesthetic. Once the patient is asleep two 3mm or 5mm access ports are carefully inserted into the chest cavity. The position of the port sites is carefully chosen to allow adequate access but also to minimize the scarring. The lung is collapsed allowing the sympathetic chain to be visualized (See diagrams). The nerve is usually cut at two levels. The lung is re-inflated and sometimes a small drain is inserted. A chest X-ray is taken to confirm the lung has returned to its normal position. The patient can go home either the same day or the next morning. Return to normal activities is rapid (2-8 days). The other side can be operated on a few weeks later.

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Port insertion		Sympathetic chain
		Patient after sympathectomy on one side

Side Effects: A number of side effects can occur after the procedure. Commonly patients describe dry hands that may require the use of moisturising cream. Compensatory hyperhydrosis (increased sweating often in the small of the back) is common. Very rarely there are problems of a droopy eye (Horners Syndrome) or lung collapse.

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