A procedure can help those who suffer from excessive sweating, writes Dr Balaji Badmanaban
HIS handkerchief is drenched and his shirt is soaked at the armpits. But luckily for company managing director KK Tan (not his real name), his suit has shielded him from the embarrassment of his dishevelled look.
“I can’t mess this up,” he told himself, not with his company chairman and the VIPs standing behind to witness him ink an important agreement.
As the emcee announced the commencement of the signing ceremony, he slipped a dry handkerchief under his right palm after picking up the pen. He wrote his signature and in his haste, droplets of sweat dripped from his palm onto the paper.
Though he had taken the trouble to ensure it wouldn’t happen, the signature was smudged. His worst fear happened and that turned out to be yet another bad thing.
Tan’s excessive sweating has landed him in many embarrassing situations and taken a toll on his effectiveness in helming the management of the company.
EXCESSIVE SWEATINGM
Why is it that sweating — a natural bodily function needed for the regulation of body temperature — is different for Tan?
Why can’t his involuntary or autonomic nervous system effectively control the five million sweat glands throughout the body?
Why do two-thirds of these glands, located in the hands, cause him to have sweaty palms?
Tan suffers from a condition called hyperhidrosis. The nerves controlling sweat glands are over-stimulated and sweat is produced in a quantity far greater than needed to keep his body at a constant temperature.
Hyperhidrosis may be part of an underlying medical condition or may be of unknown cause (which is more common), and it affects one to two per cent of the population. It seems to be more prevalent in Asian countries.
Diseases or medical conditions causing secondary hyperhidrosis include hyperthyroidism, psychiatric disorders, obesity and menopause.
Hyperhidrosis may occur in one or several parts of the body. The hands and armpits (axillae) are the most common.
The condition usually starts during adolescence and is lifelong. Nervousness and anxiety can precipitate excessive sweating.
Excessive sweating interferes with routine activities such as securely grasping objects. Some sufferers avoid situations where they will come into physical contact with others, even a common handshake.
Some careers present challenges for hyperhidrosis sufferers. For example, careers that require the deft use of a knife may not be safely performed by people with excessive sweating of the hands.
Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands. Effectiveness in professions requiring a good, steady hand grip — pilots, doctors, especially surgeons, policemen, lawyers, labourers, teachers — will be compromised and may affect the lives of others.
Excessive sweatiness of the axilla (armpits) may result in bad odour, large visible stain marks on shirts, and a general reluctance to mix with others. Additionally, anxiety caused by being self-conscious of the sweating may aggravate the condition.
SILENT HANDICAP
These symptoms can severely affect the quality of life of an individual from a psychological, social and emotional perspective.
Referred to as the “silent handicap”, sufferers of the condition are embarrassed to discuss the issue and how it bothers them, even to close family members.
Unaddressed, it can have devastating emotional effects on one’s self-esteem, even leading to depression and other mood disorders in severe cases.
As the underlying issue in hyperhidrosis is the excessive stimulation of the involuntary nerves affecting the sweat glands, the potential treatment involves an interruption of this pathway.
The nerves controlling the sweat glands of the hands and axillae are located in the chest and therefore the, best access to these nerves is through the chest.
This procedure can be done by small 5mm incisions just below the armpits. Known as the keyhole/video-assisted thoracoscopic surgery (Vats), the appropriate nerve fibres are then interrupted either by clipping, cutting or cauterising (sympathectomy).
The procedure is done on one side first and then repeated on the other. The whole procedure takes approximately an hour and the patient is discharged the same day or the day after.
The results are immediate and the hands feel warm and dry at the end of the procedure.
Success rates are close to 98 per cent for sweaty palms and about 85 per cent for sweaty armpits.
Although other options are available such as medications, iontophoresis, deodorants and botox injections, most of these target the sweat glands, not the nerves supplying the sweat glands, and therefore are only temporary and will need to be repeated at varying intervals.
Dr Balaji Badmanaban is a cardiothoracic surgeon at Manipal Hospitals Klang.