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There’s help for the devastating condition of excessive sweating

September 12, 2019 | UCI Health
woman shaking hands after hyperhidrosis treatment

One of the primary ways we interact with the world is through our hands. We open a door, handle money or tap on a keyboard. We clap a friend on the back, smooth an upset child’s hair or shake a prospective employer’s hand.

Most of us take these everyday activities for granted. But for a small segment of the population — about 2% of us — excessive sweating transforms those interactions into frightening situations.

It’s a condition called hyperhidrosis, says UCI Health thoracic surgeon Dr. Ali Mahtabifard, who also is an associate professor of surgery at the UCI School of Medicine.

Although doctors don’t know the cause, they believe hyperhidrosis has a genetic component.

Hands, feet affected most

It most often affects the palms of the hands, the feet and the armpits. More rarely, excessive sweating occurs on the face and other areas of the body.

Mahtabifard says that while the condition is most likely present at birth, hyperhidrosis becomes really noticeable and problematic at puberty, when children start texting and touching. It affects both boys and girls evenly, and they do not outgrow it. The trouble is, it can be devastating.

“It often comes to light during the teen years,” he says.

“There’s a stigma to having hands so sweaty that they’re as wrinkly as if you’d been sitting in a bathtub for a long time. When you’re 15 or 16, you just don’t have the social wherewithal to deal with it.”

Simple surgery stops severe sweating

For some people experiencing severe sweating of the palms, Mahtabifard says a simple surgical procedure to snip the sympathetic chain nerve on both sides of the chest stops the sweating immediately.

In a minimally invasive outpatient procedure that takes less than an hour, he makes small, five-millimeter incisions to enter and snip the nerve.

“The patient comes in in the morning and goes home at night,” he says. “They’re back to normal in a couple of days.”

Removing the stigma

Mahtabifard has performed the operation successfully on kids who were so stigmatized that homeschooling seemed the only option.

He has attended some former patients’ high school graduations. He also was invited to the wedding of one patient whose problems with sweating had convinced him that he’d never be able to get a date.

Other patients with dry palms include a police officer who’d feared he wouldn’t be able to hang onto his gun and a bus driver whose hands slipped dangerously over the steering wheel.

Surgery isn’t for everyone

Although the surgery is successful nearly 100% of the time, it works only for excessive sweating of the palms. It doesn’t work for sweaty feet, armpits, faces or other body areas.

And there’s a downside: The patient almost always experiences compensatory sweating in another area, such as the back or groin.

For patients with severe cases of hyperhidrosis, the tradeoff is often worth it, but Mahtabifard doesn’t recommend surgery for mild or moderate cases.

Alternative approaches

Other treatments to help excessive sweating include:

  • Prescription-strength antiperspirants
  • Botox injections, which are expensive and may be painful
  • Iontophoresis machine treatments performed at home up to seven days a week

“A lot of times patients who come to me have already tried these things,” Mahtabifard says. “I want people to know that it’s a real disease. If you have really bad hand sweating, come to your thoracic surgeon.”

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