Effects of non-pharmacological sympathetic sudomotor denervation on sweating in humans with essential palmar hyperhidrosis

Abstract Objectives: Quantitative sweat production and -ionic composition in Essential Hyperhidrosis (EH), and the effects of T2T3 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.