Dr David Khoo Sin Keat
Consultant Cardiovascular and Thoracic Surgeon
Since 1920, surgical procedure remains the most effective and reliable approach towards treating wet hands
Sweating is a necessity for life, as is food and water. Everyday the human body uses perspiration to maintain constant internal body temperature. There are about five million sweat glands in the body, with approximately half located in the hands, and the process of perspiration is regulated by the Sympathetic Nervous System, a part of the Autonomic Nervous System. These sympathetic nerves are bundled up as chains which are located along both sides of the bodies of the vertebral column. Sweating in the right hand is controlled by branches of the right sympathetic chain that is located within the right chest cavity while sweating in the left is likewise controlled by the branches on the left side.
In all humans, sweating is an automatic process. The amount of sweat put out depends upon physical and emotional stimulation. During physical activities or being in surroundings that increase our body temperature, the human body would sweat more in order to aid in the process of cooling. During times of fear, stress and anxiety, sweating is a part of the “fight or flight” process, all regulated by the Autonomic Nervous System.
In some people, natural perspiration is excessive, a condition known as hyperhidrosis. The most common areas where the excessive sweating occurs are the hands, face, feet and axilla, causing sweaty palms, sweaty feet, sweaty armpits and a sweaty face. The prevalence of this condition is 0.6% to 1% in young adults. It often begins in adolescence but can occur in people of all ages. Its cause in unknown but is related to over-activity in the Sympathetic Nervous System and there seems to be a genetic tendency.
Palmar hyperhidrosis is a physical condition with uncontrollable excessive hand sweating. It may cause severe psychological, social and/or professional disability. Problems such as difficulties handling paper, pens, buttons, tools, electronic equipment as well as the need to avoid handshakes force many people to seek treatment.
The characteristics of palmar hyperhidrosis include:
Endocrine conditions such as hyperthyroidism
Systemic malignant disease
TREATMENT OF PALMAR HYPERHIDROSIS
There are many non-surgical approaches to controlling excessive sweating in palmar hyperhidrosis. Many of these treatments may be effective for short periods of time or for people with mild cases of hyperhidrosis. All treatment plans should be based on individual needs and be done under medical supervision.
Sedatives and anticholinergics (medications that block the substances responsible for nervous system activity) are the common medications used. These medications however were not developed specifically to treat hyperhidrosis and carry many side effects.
Antiperspirants and deodorants are used on a daily basis to reduce underarm wetness and fight odour. In people with excessive sweating, special antiperspirants containing aluminium chloride hexahydrate are often the first therapeutic measure recommended. These topical medications are easy to apply but some people experience skin irritation and the results are inconsistent. Topical agents are most effective for those with mild hyperhidrosis.
This treatment uses low-intensity current to disrupt the function of the sweat glands. The hands or feet are placed on a pad and low-intensity electric current is passed through the pad. This procedure is often time-consuming and must be repeated at regular intervals.
As used in treating wrinkles, botulinum toxin injections can be used to paralyse the sweat glands and the treatment is used especially to treat underarm hyperhidrosis. This procedure often needs to be repeated.
As none of the non-surgical treatments can offer permanent cure, surgical approaches have been developed to provide a better treatment option. Since 1920, sympathectomy (an operation to divde the sympathetic chain) has been a reliable method to abolish sweating. Unfortunately then, the only way a surgeon can gain access to the sympathetic chains is via a big incision in the chest or an incision in the neck. They all share the drawbacks of being major surgical procedures with considerable risk of complications and sizeable scars. There has therefore been an understandable reluctance of both doctors and patients to adopt this method in the treatment of hyperhidrosis, leading to the usual dismal results of treatment.
The introduction of thoracoscopy (a surgical method whereby a rodlike instrument with viewing openings at the end) to perform sympathectomy in 1942 led to hundreds surgeries being performed in the 1940s but for unknown reasons, this method fell into oblivion and was not adopted on a larger scale until 1980s with the introduction of a camera-mounted thoracoscope and video assisted thoracoscopy.