Excessive Sweating / Hyperhidrosis frequently asked questions

Excessive Sweating Resource

Answers to common Hyperhidrosis questions:

Is excessive sweating / hyperhidrosis inherited?

In about 40% of the cases there is a family history of hyperhidrosis. This means that it is likely a genetic disorder, though not everyone knows of a family member who suffers from this ailment. If there is no family history then the patient might be the first one to carry the genes for hyperhidrosis.

There are some medical ailments that can cause excessive sweating. Thyroid, menopause, and anxiety can cause excessive sweating, but this perspiration will appear on the majority of the body, whereas hyperhidrosis is limited to certain areas such as the hands or face. Night sweating can be a presentation of some malignant diseases or infections such as tuberculosis.

Will hyperhidrosis last my entire life?

Hyperhidrosis usually lasts a lifetime. There are some patients who claim that their mother or father had it and it disappeared later in their life. This does not mean that the patient will have a similar experience. From the genetic point of view it seems to be that in those patients that have a family history the chances the hyperhidrosis will disappear over time is even less possible most likely due to a simple genetic strengthening with time. As always it is recommended that you discuss this complicated topic with your surgeon.

Will hyperhidrosis shorten my lifespan?

Hyperhidrosis is a benign disease and has no affect on longevity. It does not result in increased medical risks for the patient.

What does the future hold for hyperhidrosis sufferers?

Currently, sympathectomy offers the best long term solution for those who suffer from severe hyperhidrosis. In the future we hope gene manipulation or new and better medications will also be options.

Do the treatments last for life?

The effects of non-surgical treatments for hyperhidrosis such as lotions, pills, and iontophoresis are generally short lived. Sympathectomy offers a life-long solution for most, though a recurrence rate of about 1.5% was recorded. The exact reason for recurrence in some patients is not yet known. It may represent regrowth of the nerve or other pathways of nerve conduction.

My doctor isn't familiar with this condition. Are there specialists?

Yes. There are several doctors across the U.S who specialize in procedures to end excessive sweating. Frequent advances are being made, adding to the effectiveness of treatments.

Since hyperhidrosis is not a life-threatening condition, there is a
lack of understanding among physicians and laypersons alike with regard
to this problem. In the past the operations were quite extensive, often with side effects, and thus many physicians were reluctant to recommend these procedures. Now, due to technological advances and the availability of endoscopic surgery, operations are more common and more effective.

Why is there compensatory sweating associated with the ETS procedure?

There is no definite answer why compensatory sweating occurs. Everyone gets some sort of compensatory sweating, the majority being mild to moderate. About 5% of the patients will develop severe compensatory sweating. If there was only one cause of compensatory sweating to happen then every patient should develop the same symptoms, but this is not the case. The most common explanation for compensatory sweating is the fact that the upper body is the devoid of sympathetic inervation which in turn changes the temperature regulation.

With the clamping method, there may be options for those who suffer from severe compensatory sweating to reverse that side affect, for example applying the clamps on a lower level may help. For more details talk to your surgeon about this.

Is there a risk of dehydration after sympathectomy?

No. The body will have enough areas supplied with sweat glands to help with your bodies normal sweating mechanisms. Patients can return to normal life within few days after the operation.

Is facial blushing a psychological or a physiological condition?

Facial blushing also known as social phobia or erythrophobia is another manifestation of hypersympathetic activity. The best candidates are those with short bursts of facial redness which appear on the mild social situations. Some patients will describe also a feeling of warmth going to their face but this is a very subjective issue. The belief among ETS surgeons is that those who suffer from physiological blushing are good candidates for sympathectomy as long as other medical ailments were ruled out. It should be stressed again that there is a controversy with regard to ETS as a treatment modality for facial blushing.Doctor Rafael Reisfeld of Los Angeles has lead the way in recommending that ETS not be done for facial blushing.

What are the differences between the cutting and clamping ETS methods?
Is one better?


With the cutting method, the nerve is cut. This can be done various ways, such as with electric cautery, or harmonic scalpel which is an ultrasonic device. In the clamping method, titanium clips are applied to the nerve, which stops the function of that particular nerve segment.

Both methods result in compensatory sweating. In about 5% of cases, the compensatory sweating is severe enough to make the patient dissatisfied. With the clamping method, patients wishing to remove the clips may do so, and return back to his or her condition prior to the operation. This option is not available if the nerve was cut or destroyed by any other means. A nerve graft reversal may be possible for these patients, but it is much more difficult and results are unpredictable.

Where does the operation take place?
Most of the time with the refinement of the surgical techniques, improvement of anesthetic methods, the endoscopic thoracic sympathectomy can be done on an outpatient basis. Either hospital based outpatient surgery or in a free standing outpatient facility. The lumbar sympathectomy, which is now performed for severe foot sweating (plantar) this operation used to be carried out at a hospital with a very short post-operative stay. As more cases were done and experience gained the operation is now offered on an outpatient basis as well. Recovery is short and within a few days the patient can go back to their normal activity.

What is the difference between sympathectomy vs. sympathotomy?

Both are medical terminologies which in essence describe the same end result of the operation. In sympathectomy the function of the sympathetic chain segment affecting the un-physiological sweat production in the hands is stopped by excision of that segment of the sympathetic chain. In sympathotomy that function is stopped by the application of clamps on the sympathetic chain. The end result is the same. The same applies to lumbar sympathetcomy vs. lumbar sympathotomy.