Hyperhidrosis Treatment

The Hyperhidrosis Center at North Shore University Hospital, part of the renowned Cushing Neuroscience Institute, uses sophisticated medical and surgical techniques for the treatment of hyperhidrosis.

Our center provides several medical and surgical treatment options for hyperhidrosis. Our specialists work with patients to find the least invasive treatment option that relieves the problem. Surgery, as a hyperhidrosis treatment option, is reserved for patients with severe symptoms who do not find relief from other treatments. Surgical procedures are performed by a collaborative team of experienced senior surgeons from the neurosurgical and thoracic surgery departments.

  • Antiperspirants – Strong antiperspirants such as Drysol, containing 10% to 19% aluminum chloride hexahydrate, may be used to control sweating. Some patients may be prescribed an anti-perspirant containing up to 25% of aluminum chloride, which is applied nightly onto the affected areas. Deodorants do not prevent sweating, but are helpful in reducing body odor.
  • Medications – Anticholinergic drugs, such as glycopyrrolate (Robinul®) and oxybutynin (Ditropan®) help to reduce the production of sweat. Effective for some patients, these drugs haven't been well studied even though they've been used for years. Many patients discontinue use due to side effects such as dry mouth, blurry vision, bloated feeling, constipation, decreased milk production; dizziness, drowsiness, enlarged pupils, headache, loss of taste, nausea, nervousness, sleeplessness and weakness. Other systemic agents have been used for hyperhidrosis treatment including:
    • amitriptyline, clonazepam, beta blockers and calcium channel blockers
    • indomethacin and clonidine for the treatment of cranio facial and generalized hyperhidrosis
  • Iontophoresis – This procedure uses electricity to temporarily turn off the sweat glands and has been used for several decades for palmar (sweaty palms) and plantar hyperhidrosis (sweaty feet). The mechanism of action is not entirely clear. The hands or feet are placed into water and a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-30 minutes and requires several sessions a week. This device may not be very effective and is time-consuming. Although serious side-effects are uncommon, the patient may suffer from skin irritation. There are several iontophoresis devices on the market including Dridonic, Fischer, Hidrex and Idromed. It may be possible to rent a unit on a weekly basis to assess its efficacy.
  • BOTOX® – Botulinum toxin type A, known as BOTOX® may be used for the treatment of severe underarm sweating. Small doses of purified botulinum toxin are injected into the underarm to temporarily block the nerves that stimulate sweating. This agent has also been used for the palms and feet. Its main drawbacks are that the effect is temporary, the injections can be painful and it is expensive.
  • Endoscopic thoracic sympathectomy (ETS) – In severe cases of palmar hyperhidrosis (sweaty palms) when patients have not responded to medical treatment for hyperhidrosis, this minimally-invasive surgical procedure may be recommended and has a high success rate in properly selected cases. As a result, patients can look forward to enjoying many years of freedom from this distressing condition.

Endoscopic thoracic sympathectomy surgery for sweaty palms is performed by a collaborative, senior surgical team of neurosurgeon Dr. Raj K. Narayan and thoracic surgeon Dr. Lawrence R. Glassman. Both surgeons are highly experienced in hyperhidrosis surgery. The objective is to eliminate the signal telling the body to sweat excessively.

Since the sweat glands are stimulated by nerves from the sympathetic nervous system, the excessive sweating can be stopped or significantly reduced by surgically clamping these small nerves. The ETS procedure involves making two very small incisions (about half an inch) below each arm pit. One port is used to introduce a thin long tube that transmits a strong light (endoscope) while the sympathetic chain is clamped via the second port. The entire procedure takes about an hour.

Patients may be discharged on the same day or stay in the hospital overnight. They are able to resume work and regular social activities within a couple of days. The endoscopic thoracic sympathectomy procedure is considered safe, and post-surgical complications are rare. The incisions, once healed, are usually barely visible. Recurrence of excessive sweating following the procedure is uncommon.

The EST surgical procedure has also been used for abnormal sweating of the axillae (armpits), feet and face. 
 


Make an appointment at our Hyperhidrosis Center
Cushing Neuroscience Institute’s Hyperhidrosis Center makes it easy for you to take the first steps in ensuring the best neurological care for yourself and your family. Simply click on our Request an Appointment form, email us at neuro@nshs.edu, or call us at (516) 562-3816.