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If you have had surgery or are contemplating it as an option to neutralize your excessive sweating condition, then you should know about compensatory hyperhidrosis.
Compensatory hyperhidrosis is a common and at times severe side effect of a surgical procedure called endoscopic thoracic sympathectomy (also known as ETS). Ironically, this surgical procedure is performed in efforts to eliminate excessive sweating in certain regions of the body (usually face, palms or underarms). The principal behind the procedure is based on specifically cutting off the nerve stimulation to sweat glands in a given area (without affecting any other nerves responsible for other bodily functions). These nerves emanate from a group of nerves called the sympathetic nervous system (thus the term 'sympathectomy'). Be sure to consult our Sweating Matters blog (May 2015) for pros and cons of cutting vs clamping nerves.
As the name implies, compensatory hyperhidrosis is the development of excessive sweating in other untreated areas. It is as though the involved areas of sweating have 'shifted' to another region. The regions are often the lower back, abdomen, buttocks, or groin. Having said this, some patients prefer to put up with sweating in these regions as opposed to perspiring from the underarms or palms. Keep in mind that compensatory sweating can be mild to severe. Unfortunately, it is impossible to determine in advance which individuals are more likely to develop the more severe forms of compensatory sweating. Click here for treating compensatory sweating with DryDerm gel.
Gustatory sweating can also be a troublesome side effect and has been reported to occur in up to half the patients having undergone ETS**.
How Common is Compensatory Sweating
Unfortunately, post-surgical compensatory hyperhidrosis is very common. In one study* involving 158 patients having undergone ETS, compensatory sweating occured in 89% of individuals. In 35% of patients, the compensatory sweating was so severe that they had to change their clothing during the day. Some patients (16%) indicated that they regretted having had the operation. Severity was significantly worse in the patient group that had the surgery for the axillary region (as opposed to face or palms).
Another study** (over 350 patients) also demonstrated that satisfaction rates were considerably higher in patients with palmar hyperhidrosis. The chart above summarizes these rates. In patients having had sympathectomy for their underarms, nearly half were partially satisfied. One fifth of these patients were dissatisfied with the outcomes of their surgery. The procedure appears to be significantly less successful in patients seeking help for axillary hyperhidrosis.
A more recent study*** confirms similar results. Although 70% of sympathectomy patients (32 of 46 participants) attained dryness of affected regions, almost all (93% or 43/46) experienced compensatory sweating. Of these, 27 had to change their clothes more than once a day. The resulting compensatory sweating was rated as severe in almost half (18/43) of individuals. Two individuals were graded with incapacitating compensatory sweating. Only 5 individuals noticed improvement of compensatory sweating over time. Only a little over half (56%) would recommend ETS to others with hyperhidrosis.
* 1. Licht PB, Pilegaard HK. Ann Thorac Surg 2004; 78: 427-31. ** 2. Zacherl J et.al. Eur J Surj 1998; (580): 43-6. ***3. Currie AC, et.al. Int J Surg 2011; 9(5): 437-9 **** Herbst F, et.al. Annals Surg 1994; 220(1): 86-90