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Hyperhidrosis

Hyperhidrosis

Learn more about the Division of Pediatric General, Thoracic and Fetal Surgery

What is hyperhidrosis?

Hyperhidrosis is a condition characterized by excessive sweating in amounts greater than what is needed to regulate our body temperature. In most cases, the condition occurs for no apparent reason and is called primary hyperhidrosis. Primary hyperhidrosis usually affects only certain parts of the body, so it is also referred to as primary focal hyperhidrosis. The areas that are most commonly affected by primary focal hyperhidrosis are the palms of the hands, the axillae (armpits), and the feet. Primary focal hyperhidrosis affects 1 to 3 percent of the U.S. population. Males and females are affected equally, and in the majority of patients the condition starts during childhood or adolescence.

Hyperhidrosis can also occur as a result of several medical conditions, including hyperthyroidism and hypertension, in which case it is called secondary hyperhidrosis. Before starting any treatment for hyperhidrosis, all medical conditions that can lead to excessive sweating must be ruled out.

Signs and symptoms of hyperhidrosis

Patients with primary focal hyperhidrosis have constant excessive sweating in the affected areas, regardless of the environmental temperature and the emotional situation. Generally the excessive sweating only stops during sleeping hours and worsens in warm environments and stressful situations. In most patients, more than one area of the body is affected, hands and feet being the most common combination.

Most patients notice the excessive sweating for the first time when the moist palms begin to interfere with school and social activities. Excessive sweating in the hands can severely affect the ability to write, hold papers, use touch-screens, manipulate objects, and perform routine daily activities. It can also cause social embarrassment and impair the patient’s social interactions, which can lead to negative psychological and psychosocial consequences.

Testing and diagnosis of hyperhidrosis

After ruling out all potential causes of secondary hyperhidrosis, the diagnosis of primary focal hyperhidrosis is made by physical exam and a detailed evaluation of the patient’s signs and symptoms. No special diagnostic tests or imaging studies are required. The diagnosis is usually made by the patient’s pediatrician or dermatologist.

Treatment for hyperhidrosis

Hyperhidrosis can be treated non-surgically or with a surgical procedure. At Children’s Hospital of Philadelphia we are committed to treating the patient, not just the condition. Your child’s dermatologist, primary care physician and surgeon will work together to make sure that all hyperhidrosis treatment options are explored.

Patients who don’t have success with non-surgical options will be carefully screened through a comprehensive interview, a detailed self-assessment questionnaire, and a psychological evaluation to ensure that they are good candidates for surgery. Children (and their families) who are appropriate candidates for hyperhidrosis surgery will have an in-depth discussion with the surgeon about the risks and benefits of the operation. After the operation your child will be followed on a regular basis in the surgery clinic.

Non-surgical treatment of hyperhidrosis

Our expert pediatric dermatologists, led by Dr. Albert C. Yan, offer the full spectrum of non-surgical treatment options for hyperhidrosis.

  • Topical agents: Hyperhidrosis can be treated with the application of antiperspirants that prevent sweating by mechanically blocking the sweat glands. The topical agents most commonly used in the treatment of hyperhidrosis are Drysol® (20 percent aluminum chloride) and Xerac® (6.25 percent aluminum tetrachloride). These products are applied to the affected area once a day, usually at night.
  • Oral medications: The medications used to treat hyperhidrosis are called anticholinergic agents and work by blocking the innervation of the sweat glands. The most commonly used are Robinul® (glycopyrrolate) and Ditropan® (oxybutynin). These medications have a variety of side effects that include dry mouth, blurred vision and urinary retention.
  • Iontophoresis: This is a type of low-voltage electrical therapy. The affected areas are submerged in water to which an electrical current is applied. The electrolytes of the water accumulate on the surface of the skin, blocking the sweat glands. Iontophoresis is done on a daily basis, and each session is 20 to 30 minutes long. This treatment requires a significant time commitment.
  • Botox®: The botulinum toxin decreases the amount of sweating by inhibiting the release of acetylcholine from the nerves that stimulate the sweat glands. This treatment requires multiple skin injections to the affected areas and needs to be repeated every 3 to 9 months.

Other therapies such as lasers, herbal medicines, microwave energy, and high-intensity ultrasound are not standard options in pediatrics and their efficacy has not been scientifically proven. To learn more about the non-surgical options available to treat hyperhidrosis, contact the Dermatology Section.

When patients do not respond to non-surgical alternatives, we offer a surgical treatment option.

Surgery for hyperhidrosis

Illustration shows two incisions made in a hyperhidrosis surgery procedure called thoracoscopic sympathectomy
Illustration of thoracoscopic sympathectomy

Patients with primary hyperhidrosis have the option of undergoing a surgical procedure called thoracoscopic sympathectomy. The operation is also known as endoscopic thoracic sympathectomy or minimally invasive thoracic sympathectomy.

Dr. Pablo Laje, a pediatric general surgeon at The Children’s Hospital of Philadelphia, offers surgery to children and teenagers who have primary focal hyperhidrosis of the hands, alone or in combination with armpits and/or feet. Patients whose hands are not involved are not candidates for the operation. Learn more about surgery for hyperhidrosis.

Whether your child’s doctor has recommended surgery or you are seeking help, our team is available to answer any questions you may have about the procedure.

To learn more about surgery for hyperhidrosis or to refer a patient, contact the Division of Pediatric General, Thoracic and Fetal Surgery or email us with any questions.

If your child is undergoing a surgical procedure at The Children’s Hospital of Philadelphia, we have a variety of resources available that can help you and your family prepare for the experience. Check out our Guide to Your Child’s Surgery to learn more about having surgery at CHOP.

  • Hyperhidrosis Surgery for Children

    Daniel: It was terrible. I wanted to get rid of it so much.

    Carolina: Sometimes I just wanted to be away from people. I didn’t want to deal with it.

    Daniel: It was hard to like swing the bat with my sweaty hands. When I’d go to swing, the bat would sometimes fall out of my hands.

    Carolina: I used to play piano and that was really difficult for me because my hands would sweat way too much. They would drip in sweat, it would be all over the keys, and it was just really embarrassing.

    Sandra, Daniel’s Mother: At night, when I would tuck him in and everything was quiet, he’d always ask me why aren’t my hands like yours? When will it go away?  And I could never give him an answer.

    Pablo Laje, MD: So, primary hyperhidrosis is a condition of unknown origin in which the patients have excessive sweating in certain areas of their bodies, usually their hands, occasionally their underarms and their feet.

    Carolina: The hardest thing about hyperhidrosis by far, in my opinion, was socially with friends. I didn’t know why I had it and why I was different.

    Daniel: Writing was hard because when I would like write long stories, the paper would get wet and it would rip up.

    Sandra, Daniel’s Mother: The sweat would just pour off his hands on all the papers, puddles on the desk.

    Leanne Magee, PhD: Patients with hyperhidrosis can be very self-conscience about their sweating, which can lead them to withdraw from activities that draw attention to it.

    Carolina: Having my sweaty hands before was hard because my hands would be sweating and dripping everywhere. So, you could see it, you could see little drops of water coming out of my hands. Like it was really intense.

    Sandra, Daniel’s Mother: It did affect his school work. The teachers would write a note, “neater next time,” and it was very upsetting as a parent.

    Pablo Laje, MD: CHOP is different than other hospitals when it comes to primary hyperhidrosis in the fact that we take a look at these patients from multiple points of view.

    Mary Kate Klarich, MSN, CRNP: We get patients from all over. We’re one of the only centers that is multi-disciplinary for the hyperhidrosis that will perform surgery on children.

    Sandra, Daniel’s Mother: It was years of going to the pediatrician and bringing it up repeatedly. They would often say it’s normal. It should go away.

    Leanne Magee, PhD: Many of our families had no idea that this was a treatable condition before they came to CHOP and before they ended up here. And this is something that most of these kids live with for years and years.

    Mary Kate Klarich, MSN, CRNP: So, we offer them primarily surgical therapy, but we also like them to try medical therapy. So, there’s different things you can do before surgery.

    Kali Rhodes, MSN, CRNP: And we do often for the families that may come in and say, “I’m not quite sure if we’re at the point where we would like to discuss surgery.” We may say OK, well, would you like to try something topical on the hands, something you put on your hands, or do you want to try a medicine first? And we’re more than happy to kind of continue to follow them throughout other treatments too.

    Alexa: I am getting my surgery for my hyperhidrosis today.

    Alexa’s Mother: This has been an issue she’s been dealing with for her whole life really.

    Alexa: I’m feeling a little bit nervous. My hopes for today that my hands don’t sweat anymore. My surgeon is Dr. Laje, and I just can’t wait to have dry hands.

    Alexa’s Mother: Alexa had a lot of difficulty driving, and that’s when I really began to notice how much of a true issue it was. She would constantly take her hands off the steering wheel and wipe her hands on her shirt or her pants. And to me, it just became a huge safety issue.

    Pablo Laje, MD: Good morning.

    Alexa: Hi

    Pablo Laje, MD: How are you?  Hi Alexa, how are you?

    Alexa: I’m good.

    Pablo Laje, MD: Hi dad, how are you?  And mom?

    Alexa’s Mother: Hi

    Pablo Laje, MD: How is it going?

    Alexa: Good. I’m nervous.

    Pablo Laje, MD: I’m sure. You’ll find everything will be quick and easy. And so, in a few minutes we’ll be going to the operating room. Mom and dad, you’ll be taken to the waiting room. This will take roughly about an hour.

    We have developed a program here along with the dermatology team, the cardiology team, the psychology team, and a dedicated team of nurse practitioners, surgeons and operating room nurses. All patients interview with our pediatric psychologist and all patients are seen by a primary caretaker as well prior to the surgery.

    Primary hyperhidrosis occurs because the nerves that innervate and activate the sweat glands of the hands are constantly working and sending signals so that glands will sweat, regardless of the social situation, regardless of the temperature.

    So, the surgery that we’ll do is a minimally invasive procedure that is done through two tiny incisions on each underarm and consists in cutting a little nerve that we have along the spine.

    By cutting the nerve that we do for this operation, we do not affect any other innervation in a clinically relevant way. The operation is very safe and the incidence of surgical complications is extremely low, and the effectiveness of the surgery to cure the excessive sweating on the hands is just about 100 percent. The operation can have a potential side effect called compensatory sweating.

    Mary Kate Klarich, MSN, CRNP: Compensatory sweating is when your hands might be dry after surgery, but you start sweating somewhere else. And in our numbers, it’s between 2 and 5 percent. So, we haven’t had many cases.

    Alexa’s Mother: I’m really excited for her. I’m excited for her to move on to the next phase of her life and to not have to deal with this issue anymore.

    Pablo Laje, MD: Hi everybody, how are you?

    Alexa’s Dad: Good

    Pablo Laje, MD: Alright, we’re all done.

    Alexa’s Dad: Excellent

    Pablo Laje, MD: Everything went really well.

    The recovered time from the surgeries is extremely quick and the results are immediate. So, patients wake up from the anesthesia after the surgery with dry hands forever.

    Hello.

    Alexa: Like feel my hands.

    Pablo Laje, MD: Are they dry?

    Alexa: They’re dry.

    Alexa’s Mother: That’s all she keeps saying. Her hands are dry.

    Pablo Laje, MD: Oh, my God, this is awesome.

    Mary Kate Klarich, MSN, CRNP: So, when the children wake up after surgery, they wake, they look down at their hands, they feel them, they notice they’re dry, and then they look up at you with the biggest smile.

    Alexa’s Mother: Hi.

    Mary Kate Klarich, MSN, CRNP: Because it’s an immediate gratification. One of the best things to see.

    Daniel: I felt excited and happy.

    Sandra, Daniel’s Mother: He just kept telling us after the surgery, “My hands are dry, my hands are dry, feel my hands,” and he would start holding my hand, which he had never done before.

    Carolina: The results were immediate. I woke up and my hands were extremely dry.

    Pablo Laje, MD: Prior to the operation, they are very shy and then after the operation, it’s just amazing. They cannot believe the results and their entire life changes.

    Leanne Magee, PhD: They’re just feeling much more confident, much more at ease.

    Alexa: Right when I woke up, I notice that my hands were dry and I was telling everyone, I was like look, feel my hands, they’re dry.

    Carolina: The best thing after my operation was definitely being able to live in the moment, and I’m just doing what I want to do, when I want to do it.

    Sandra, Daniel’s Mother: I still can’t believe his hands are fixed and it was what I had always dreamed it would be.

    Alexa: Today was a ten for me.

Transcript Transcript

 

Close-up of surgical team with scrubs and masks on

Why choose CHOP for your child's surgery

If your child needs surgery, you want to know their care is in the hands of the best, most compassionate team. CHOP's world-class pediatric surgeons and experienced staff are here for you.

Doctor and patient smiling together

Preparing for surgery

Find tips to prepare for your preoperative visit with CHOP’s pediatric general surgeons, and resources to help prepare your child for surgery.

Resources to help

Hyperhidrosis Resources

Division of Pediatric General, Thoracic and Fetal Surgery Resources

We have created resources to help you find answers to your questions and feel confident with the care you are providing your child.

Reviewed by Pablo Laje, MD

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