by RAHIMI YUNUS 

The National Heart Institute (IJN) provides treatment to cure excessive sweating disorder and allow people to have a better quality of life. 

Excessive sweating, or hyperhidrosis in medical terms, is a condition that could affect the sufferers socially and psychologically in their daily life. 

IJN head of department and senior consultant cardiothoracic surgeon, Datuk Seri Dr Jeffrey Jeswant Dillon (picture) defines hyperhidrosis as a condition characterised by abnormal and chronic sweating, more than what is required to regulate body temperature. 

Dr Jeswant said hyperhidrosis is divided into two classifications — one that is due to underlying health condition, or another which had no apparent cause. 

“Primary hyperhidrosis is idiopathic with no identifiable cause, while secondary hyperhidrosis may be associated with medical conditions such as hyperthyroidism, diabetes or tuberculosis,” he said. 

Excessive sweating most commonly affects hands (palmar hyperhidrosis) and feet (plantar hyperhidrosis) — whereby it is usually in combination due to the high concentration of sweat glands. 

Other affected areas include underarms (axillary hyperhidrosis) as well as face and scalp which is known as craniofacial hyperhidrosis. 

“Some people, such as military personnel and electricians, could not perform their duties as it is dangerous to handle firearms or electrical appliances with a sweaty palm,” Dr Jeswant said. 

He said people living with hyperhidrosis often possess a lack of confidence, occupational hazards, difficulties in social and intimate relationships, and are more prone to bacterial and fungal infections. 

In South-East Asia, he said hyperhidrosis affects about 3% of the population, slightly higher than the 2.8% rate in the US. 

Hyperhidrosis affects men and women equally with higher prevalence among those between the ages of 20 and 50. 

There are non-surgical and surgical options to treat the disorder. 

Dr Jeswant said people with less severe hyperhidrosis are best to opt for non-surgical methods. 

Antiperspirants, anticholinergic agents, Iontophoresis and Botulinum Toxin, also known as Botox are among treatments available in Malaysia.  

“I usually prescribe antiperspirant to the patients for one to three months before assessing the result,” he said, adding that antiperspirant is a method to control the symptoms but not for cure. 

An oral anticholinergic substance is used for managing excessive sweating, although it often comes with severe side effects such as dry eyes and throat. 

Iontophoresis is a method where patients put their hands and feet into a basin of water before delivering a dose of electricity to desensitise the nerve endings. 

Dr Jeswant said patients must repeat the process two times a week for six months, which comes with a high relapse rate due to its intense nature, and upon completion of the therapy. 

He does not recommend Botox injection because the effect only lasts for three to four months and requires repeated injections, which may be costly and painful. 

He added that the procedure is painful when injected into the palm or feet due to tight tissues in the areas. 

When all the existing non-surgical treatment options fail as they are far from ideal, Dr Jeswant said surgery could be the next option. 

The minimally invasive surgical treatment to cure hyperhidrosis is called endoscopic thoracic sympathectomy (ETS) which involves cutting a small portion of the sympathetic nerves that control the sweat glands. 

Dr Jeswant said the ETS is a safe and straightforward procedure with minimal bleeding and complications. 

The procedure has a success rate of 99% for sweaty palms, 90% for sweaty underarms and 50% to 60% for sweaty feet, with less trauma, minimum pain, faster recovery time (one-day post-operative stay) and better cosmetic result resulted from the operation. 

He said, however, the procedure may have side effects such as compensatory sweating. 

“Compensatory sweating is like a trade-off, where the sweat from the palm and the feet may migrate to the chest and back, which is not seen in every patient.” 

“It usually occurs at its peak in the second week of post-operative but it will gradually improve after 14th week and the majority of patients do not experience long-lasting effects,” he added. 

Another side effect of the ETS is Horner’s syndrome, in which patients have a dry face and droopy, although it is an uncommon side effect. 

Nevertheless, Dr Jeswant said surgery is always the last resort despite having minimum operation risks and complications. 

“It should be considered only if the condition is severe, interrupts the patient’s daily life, and when all other non-surgical treatments are ineffective,” he said. 

Equipped with the latest and most advanced facilities, IJN is ranked among the best medical centres for cardiovascular and thoracic care in the region.