Ian Loftus: Excessive Sweating (Hyperhidrosis) and Facial Flushing

While sweating is a normal phenomenon, some people suffer from excessive sweating such that it can affect there employment and social lives. Similarly, excessive facial flushing can be an embarrassing phenomenon.

Most excessive sweating can be controlled by conservative measures, including anti-perspirants, aluminium chloride and wearing light cotton clothing. When sweating is excessive and cannot be controlled, there are a number of treatment options including division of the nerves responsible.

There are a set of nerves in the body called ‘sympathetic nerves’, which control sweating and flushing. The sympathetic nerves lie in the chest, and are accessible with the use of a fibreoptic telescope. ‘Endoscopic Thoracic Sympathectomy’ is a keyhole surgery procedure which can reduce sweating and flushing on a permanent basis.

Under a general anaesthetic, the lung on one side is deflated and an endoscope passed through a very small incision in the side of the chest. When the sympathetic nerve chain is identified on the front of the spine, the nerves are carefully divided. The camera is removed and the lung reinflated. The effect is instantaneous and usually permanent.

[Picture shows: a sympathectomy has been performed on the patient’s left side, dramatically reducing sweating.]

The success rate depends upon the presenting problem. For hyperhidrosis of the hands and armpits, it is greater than 90% and 80% respectively.

For excessive facial flushing the success rates are nearer 70%. Complications are unusual and are discussed in detail prior to any surgery.