When Ky Arena started driver’s education at age 15, her driving instructor noticed her hands were so slick with sweat that he worried about her safety. “He told my mom I couldn’t drive safely because my hands would slip on the wheel,” Ky said.
Her parents interpreted the sweaty hands as evidence Ky was experiencing extreme anxiety, but a psychologist determined she was not anxious at all.
Ky’s primary care physician suspected a skin condition and referred her to a pediatric dermatologist, who diagnosed her with hyperhidrosis, a condition that causes excessive sweating in certain areas of the body, usually the hands, feet, armpits, back or forehead. It effects about 3 percent of the population.
The official diagnosis was a relief.
“It’s not that my hands were a little clammy,” Ky said. “They were dripping with sweat.” She could barely hold a pencil. All that moisture made it impossible to use a laptop or any device with a touch screen, and she carried a rag in the car so she could wipe her hands repeatedly while driving. She avoided shaking hands, holding hands with loved ones and carrying babies.
“It made me insecure,” she said. “I didn’t want to touch people.”
A succession of nonsurgical options
With the guidance of her dermatologist, she began working her way through a series of remedies, including a prescription-strength antiperspirant she rubbed on her hands. It helped minimize the sweating but made her palms crack and peel, leaving them sore and prone to bleeding.
Next, Ky’s doctor recommended iontophoresis, a type of shock treatment she administered to her hands daily over many weeks. The treatment involved holding her hands underwater while sending an electric current through the water, which stopped the sweat glands from working. Once again, the treatment worked but left her with sore, sensitive hands.
Then, Ky’s doctor prescribed an oral medication known as oxybutynin, which reduces sweating. “The medication worked great,” Ky said. She used it daily for about six years, taking it in the morning and planning her day so she would, for example, use her phone before 8 or 9 p.m. when the medication typically wore off. Last year, when Ky was 23 years old, the medication suddenly stopped working. She tried another medicine, but it triggered severe side effects, including potentially serious kidney problems.
Running out of options, Ky’s dermatologist referred her to Mario Gasparri, MD, a thoracic surgeon in the Froedtert & the Medical College of Wisconsin health network and an MCW faculty member.
One of Dr. Gasparri’s specialties is the bilateral thoracoscopic sympathectomy, a newer surgery that stops excessive sweating.
Although Ky lives in the Chicago area, she eagerly drove to Froedtert & MCW Froedtert Hospital to see Dr. Gasparri in September 2018.
“I explained to Ky that she was a good candidate for the surgery, in part, because she had already tried the array of nonsurgical remedies,” Dr. Gasparri said.
In addition to the options Ky tried, some patients even undergo painful Botox® injections in their palms to paralyze the nerves that stimulate sweat glands. However, Dr. Gasparri said the injections last only four to six months.
Minimally Invasive Procedure
“The bilateral thoracoscopic sympathectomy is a minimally invasive surgery that involves two dime-sized incisions in each armpit,” Dr. Gasparri said. “Through those incisions, we remove a piece of the nerve, known as the sympathetic chain, which controls the sweat glands. In most cases, patients can go home the same day and then typically rest about a week while the incisions heal.”
Dr. Gasparri said a potential side effect is that some patients develop “compensatory sweating,” in which the excessive perspiration in their hands ceases, but they begin to sweat in another part of the body, such as the back.
“It was worth the risk to me,” Ky said. “People don’t touch my back every day.” She scheduled the surgery for two weeks after her appointment with Dr. Gasparri.
When she woke from the surgery, she was ecstatic to find that her hands were indeed dry, and it was particularly meaningful to shake the nurses’ hands after the procedure.
“My hands have not sweat since,” Ky said, and she has not experienced compensatory sweating.
As soon as she recovered from surgery, Ky began applying for new jobs. She had wanted to work in marketing, but the thought of job interviews and computer work had been too overwhelming given her dripping hands. Now the world was open to her, and she landed a job at an advertising agency shortly after her surgery.
Her follow-up appointment with Dr. Gasparri was emotional. “I was crying and thanking him,” Ky said. “I’m obviously really happy with the outcome.”