Say goodbye to "sailors": revealing the solution to hyperhidrosis of hands

Author: Liu Yanguo, Chief Physician, Peking University People's Hospital

Reviewer: Shi Wenzai, attending physician at Peking University International Hospital

Sweating, as a natural physiological regulation mechanism of the human body, is essential for maintaining a constant body temperature. However, for some people, excessive sweating of the palms has become a problem, seriously affecting their daily quality of life. We call this condition "hyperhidrosis of the palms".

1. Causes and characteristics of hyperhidrosis of hands

Hyperhidrosis of the hands, as the name suggests, refers to the phenomenon of abnormal sweating of the hands. The palms of the patient will sweat frequently and profusely when they are emotionally tense or in a hot environment. In severe cases, water droplets may form, which will affect basic activities such as writing, using electronic devices, and social handshakes, causing great trouble to the patient's life. The results of epidemiological surveys in my country show that the prevalence rate is about 2%.

Figure 1 Original copyright image, no permission to reprint

Hyperhidrosis of the hands is mainly a congenital disease, and its pathogenesis is closely related to genetic factors. Patients usually have symptoms of excessive sweating in the palms since childhood. It is worth noting that although hyperhidrosis of the hands has a certain genetic tendency, it is not a hereditary disease, and its inheritance probability is about 30%. In addition, the diagnosis of hyperhidrosis of the hands is mainly based on subjective feelings, that is, the pain caused to the patient by continuous and heavy sweating of the palms, and the patient's willingness to actively seek treatment, rather than specific objective indicators.

Environmental factors can also have a certain impact on the clinical manifestations of hyperhidrosis. For example, when patients are nervous, hot, or engaged in physical or mental activities, the amount of sweating will increase significantly. When patients with hyperhidrosis sleep at night, their palms are usually dry; and in a calm state during the day, sweating may also decrease or disappear.

Treatment of hyperhidrosis of hands

Traditional treatments for hyperhidrosis include oral medications, topical astringents or corrosives, and botulinum toxin injections, but the therapeutic effects of these methods are often limited and short-lived. Currently, thoracic sympathectomy under thoracoscopic surgery is considered to be the most effective method for treating hyperhidrosis. This surgery reduces palmar sweating by cutting off the sympathetic nerve branches that innervate the sweat glands in the palms.

Specifically, the operation will make a small incision of about 5-10 mm in the patient's armpit, use a thoracoscope to enter the chest cavity, and accurately cut the target nerve. If everything goes well, the single-sided operation time is about 5-10 minutes, and the total duration of bilateral surgery is no more than 20 minutes. The patient is under general anesthesia during the operation, so he will not feel any discomfort.

Figure 2 Original copyright image, no permission to reprint

However, surgical treatment is not suitable for all patients. Surgery for hyperhidrosis is usually suitable for patients with moderate to severe hand sweating, that is, people whose hand sweating seriously affects their daily life. This type of surgery is not recommended for patients who have had pleurisy, tuberculosis or severe pneumonia that has caused pleural adhesions, and for patients with significant bradycardia, because these conditions increase the risk of surgery.

3. Postoperative Condition

The effectiveness of surgery for hyperhidrosis of the hands can reach 95%-100%. Patients may experience a short period of pain after surgery, especially in the wound and back area, but this pain can usually be relieved by appropriate analgesics and gradually decreases until it disappears within a week. A common side effect that may occur after surgery is increased sweating in other parts of the body, such as the chest and back, and the extent of this phenomenon varies from person to person.

Depending on the specific method of surgery, that is, the different parts of the sympathetic nerves that are cut (T3 or T4), the postoperative effects will also be different. T3 cutting will lead to drier palms, but its side effects are relatively large; T4 cutting has milder side effects, but some patients still have sweaty palms after surgery. Patients can make personalized choices based on doctor's advice and personal preferences.