Effects of Non-Pharmacological Sympathetic Sudomotor Denervation on Sweating in Humans with Essential Palmar Hyperhidrosis

Objectives: Quantitative sweat production and -ionic composition in Essential Hyperhidrosis (EH), and the effects of T2-T3 thoracoscopic sympathicolysis (TS) hereon, are unknown. Standardised pilocarpine iontophoresis sweat tests were performed before and after TS in order to study these issues. Design and Methods: Pilocarpine iontophoretic sweat tests measuring maximal sweat production (mg) and sweat Na+, K+ and Cl− concentrations (mMol/L) were performed on both forearms of 10 EH patients, before and six weeks after TS, and in normal volunteers. Results: As compared to normals, preoperative maximal sweat production was 30% higher (199.4 ± 68.8 (SD) vs. 150.6 ± 45.6 mg) in EH patients; due to type II error, however, statistical significance was not reached. Na+ and Cl− concentrations were similar, and K+ concentration was slightly lower in EH patients. After TS, sweat production had decreased to equal levels as in normals (149.1 ± 52.1 mg), whereas the Na+ (from 33.6 ± 6.9 to 51.0 ± 6.4 mMol/L), Cl− (from 21.5 ± 6.6 to 37.2 ± 7.1 mMol/L) and K+ (from 7.5 ± 1.3 to 8.6 ± 2.2 mMol/L) concentrations had increased. Conclusions: EH patients present 30% higher maximal sweat production at their forearms. This increase may be due to an increased activity of the adrenergic component of sweat gland innervation. The post-TS increase in Na+, Cl− and K+ concentrations suggests that the adrenergic component of sweat gland innervation in itself decreases sweat ion concentrations.