9 de julho de 2020 Author : Pedro Pinto Sousa Hyperhidrosis is an excessive sweat production beyond what is necessary to body temperature regulation. It is an uncomfortable situation that has an important emotional, social and professional impact . In primary or essential hyperhidrosis , excessive sweating is localized and affects mainly the palms, soles and armpits. It can also affect other body areas, such as the face, scalp, groin and infra-mammary region. The excessive sweat production of due to an alteration of the sympathetic nervous system that causes an excessive functioning of the skin sweat glands, which are responsible for the production of sweat. The incidence of hyperhidrosis in the population is about 3%. In general, it is assumed that a patient has primary or essential hyperhidrosis when there is a situation of visible, localized excess sweat, lasting at least six months and without an identifiable cause. Hyperhidrosis can also be secondary , that is, it may result from other diseases or be a side effect of some medications. When hyperhidrosis is not localized, it is more likely to be secondary hyperhidrosis. Before deciding which treatment is appropriate for a patient, it is necessary to exclude situations of secondary hyperhidrosis. The decision on the most appropriate treatment option for each patient with primary hyperhidrosis considers factors such as: The affected body region; The patient expectations and preferences; The characteristics of the disease; The safety and effectiveness of the treatment: The cost and availability of treatment. Currently available treatment modalities include, but are not limited to, antiperspirants, botulinum toxin treatments, microwave thermolysis, topical and oral medications and surgery. The treatment of hyperhidrosis by surgery - thoracoscopic sympathectomy - is not usually the first option considered, particularly in mild cases, but it is a definitive treatment solution for the disease, with a high success rate and immediate results. For example, in the case of axillary hyperhidrosis, patients usually start treatment with botulinum toxin injections. This treatment has a limited duration and it is necessary to periodically repeat the injections. Treatment with electromagnetic microwaves can also be carried out, which has been considered practically definitive. In axillary hyperhidrosis, surgical treatment is usually reserved for cases of failure of previous treatments. What is thoracoscopic sympathectomy? In thoracoscopic sympathectomy, electrocoagulation is used to caution the sympathetic trunk. The anatomical level at which the intervention is performed depends on the location of the problem. The surgery is minimally invasive , does not require a large incision, is it done through small holes in the skin. In general, patients with palmar hyperhidrosis (hands) benefit from intervention at the level of the third or four thoracic vertebra (T3 or T4), those with palmoplantar (hands and feet) and axillary hyperhidrosis benefit from intervention at the level of T3 and T4. When hyperhidrosis is only axillary, the intervention will be at the T4 level. The visible result of a sympathectomy is an anhidrosis , that is, no sweat. The areas previously affected, and which are treated, become dry and warm. In limited cases, it may be necessary to use a moisturizer. After surgery, the resumption daily living activities and professional activity can be done after two or three days, with only slight discomfort being noticeable at this time. Compensatory hyperhidrosis may occasionally occur, resulting from the change in sympathetic activity induced by cauteterization of the sympathetic trunk. The success rates of thoracoscopic sympathectomy are high: Palmar hyperhidrosis 96% -100% and residual recurrence rate; Axillary hyperhidrosis 63% -100%; Craniofacial hyperhidrosis 87% -100%. The high success rate of thoracoscopic sympathectomy translates into a considerable improvement in the quality of life of patients and a satisfaction rate of around 90% at 5 years after surgery. Meet the vascular surgery team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
