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Experts Weigh-in on Treating a Common Complication of ETS
(July/August 2005) One of the most common side effects of ETS surgery for hyperhidrosis is called "compensatory sweating." Compensatory sweating is excessive sweating that may occur on the back, chest, abdomen, legs, face, buttocks, or feet as a side effect of ETS surgery. Compensatory sweating is seen in 60% of people who undergo ETS or endoscopic thoracic sympathectomy. Severe compensatory sweating is experienced by up to 40% of those who undergo ETS.
This "new" sweating can be extreme enough to cause discomfort and distress equal to, or more intense than, that caused by the original hyperhidrosis problem. No one really understands why compensatory sweating occurs and it seems that the severity of compensatory sweating is unrelated to the severity of the original hyperhidrosis problem. It also seems that compensatory sweating is unrelated to the exact technique used to perform ETS. Thus, it is impossible to predict who, after surgery, will experience severe compensatory sweating, minor compensatory sweating, or no compensatory sweating.
If you are experiencing compensatory sweating or another complication after surgical treatment for hyperhidrosis, it is important to talk to your surgeon. Surgeons need to be aware of the complications that their patients experience -- even if they themselves cannot treat these complications. Ask your surgeon for a referral to a specialist, such as a dermatologist, who may be able to help you. Keep in mind, though, that our experts know of no studies that have analyzed how to best treat hyperhidrosis surgery complications, such as compensatory sweating. Treatment options are therefore limited and a trial-and-error system may be necessary.
Among the possible treatment options for compensatory sweating are systemic medications, topical treatments, and Botox injections.
Systemic medications are prescription medicines taken by mouth, such as anticholinergics, beta blockers, or Clonidine hydrochloride. Specifically, some of the systemic medications used to treat excessive sweating are Propantheline, Glycopyrronium bromide, Benztropine, diazepam, Diltiazem, Indomethacin, Oxybutynin, and Glycopyrrolate/Robinul. These medications can help prevent the stimulation of the sweat glands and thus limit sweating. Serious side effects such as dry mouth, impaired speech, blurred vision, constipation, urinary retention, and palpitations can occur and limit the long-term usefulness of these medications.
Topical treatments, such as antiperspirants, may also be tried. The most widely used ingredients in antiperspirants are metallic salts. Preparations containing aluminum chloride hexahydrate are among the most effective. For compensatory sweating, talk to a dermatologist about the right antiperspirant for the affected body area. Antiperspirants can irritate the skin and so must be used carefully on sensitive areas, such as on the buttocks or near the groin.
Botox injections may also be tried for the treatment of compensatory sweating. Whether Botox is a potential treatment option depends upon the size of the area affected by compensatory sweating. Because Botox is given by injection, it is best suited for rather small areas. Talk to a dermatologist about the practicality and potential cost of this option for your specific circumstances.
Finally, it may occasionally be possible to have a surgical procedure for hyperhidrosis reversed. There have been no studies to verify this, but some people believe that if a surgery is reversed, the complications could go away. The potential for reversal is rare and depends upon the type of surgery and surgical technique that has been used. Talk to your surgeon to find out whether reversal is a possible option.
If you cannot find relief from compensatory sweating through medical treatment, please try not to be too frustrated. It may help to remember that you are not alone. There are supportive groups on the Internet for people experiencing similar problems. If you find that your condition is making you depressed, talk to your physician. He or she may recommend that you seek assistance from a mental health expert who can help you learn to cope with your condition.
Here at the International Hyperhidrosis Society, we take compensatory sweating and other hyperhidrosis treatment complications very seriously. Whenever we hear of well-documented research in this area we will publish it in this newsletter.
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Find a doctor who treats excessive sweating. |
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