Hyperhidrosis is characterized by abnormal, excessive sweating that can occur in the hands, armpits and feet.  For some, the abundant sweating is localized to one area, such as the hands, while others may experience increased sweating in a combination of areas.

Hyperhidrosis is rare, affecting about 1 percent of the population.  However, for those affected, the condition often interferes with their daily activities and can be rather embarrassing in social situations.  Although the exact cause of this excessive sweating remains unknown, we do know that it is commonly controlled by the sympathetic nervous system, which normally responds strongly in situations of fear or stres.

Surgeons at UCSF Medical Center have significant experience treating patients with hyperhidrosis.  One option available to our patients is a minimally invasive procedure called endoscopic thoracic sympathectomy (ETS), where the sympathetic chain is cut or clamped to eliminate the excessive sympathetic nerve activity that causes the abundant sweating.

Signs and Symptoms     

Hyperhidrosis is characterized by abnormal, profuse sweating that can affect one or a combination of the following:     

  • Hands, called palmar hyperhidrosis    
  • Armpits, called axillary hyperhidrosis
  • Feet, called plantar hyperhidrosis      

The excessive sweating often interferes with daily activities, such as employment, personal relationships, and recreational activities, and may be a source of significant social embarrassment. 

For example, patients with palmar hyperhidrosis have wet, moist hands that sometimes interfere with shaking hands or grasping objects. Those with axillary hyperhidrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress. Plantar hyperhidrosis, excessive sweating of the feet, makes ones socks and shoes wet, which leads to increased foot odor.  

Symptoms of hyperhidrosis often become noticeable during childhood and adolescence.  In many cases, the sweating can be quite severe, affecting everyday life and causing social embarrassment.  The individual may feel uncomfortable, self-conscious and have an altered self-image due to the relentless, excessive sweating.  It is thought that the excessive sweating may be brought on by stress, emotions or exercise.  However, it also can occur spontaneously.     

The sympathetic nervous system controls sweating throughout the body. Often there is no identifiable cause, but excessive activity of the sympathetic nervous system is believed to be responsible in the majority of those affected.  The sympathetic nervous system normally responds strongly in situations of fear or stress.  It is not understood why individuals with hyperhidrosis appear to have constant increased activity of this system.  The involved nerves branch from the sympathetic chain within the chest cavity.      

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Hyperhidrosis is diagnosed by obtaining a thorough history and physical examination.  Your doctor will ask multiple questions related to the excessive sweating to get a sense of the extent of its severity and to get a sense of the extent of your condition. 

Some examples of the questions that may be asked are: How long you have been experiencing excessive sweating? What areas are affected (armpits, hands or feet)? How often do you experience the episodes of excessive sweating? What treatments have you tried to relieve the excessive sweating?  How effective were they?      


Many patients with hyperhidrosis try oral or topical medications, antiperspirants or herbal remedies to ease their condition, but these efforts have only temporary or no benefit at all.  The only treatment with proven long-term results involves surgical interruption of the sympathetic chain. These nerves primarily affect blood flow to the skin and the function of the sweat glands.  Interrupting the sympathetic nerves in the chest results in dilation of the veins and arteries in the arm and hand as well as the complete blockage of sweating.     

Endoscopic thoracic sympathectomy (ETS) is a minimally invasive procedure available to treat hyperhidrosis.  Using very small incisions, the sympathetic chain is cut or clamped to eliminate the excessive sympathetic nerve activity.  Using this approach, the procedure may be done on an outpatient basis with quicker recovery and less scarring than open surgery.  The procedure is highly effective in eliminating excessive sweating of the hands in over 98 percent of patients.  In addition, the risk of complications is very low.  ETS also can be applied in selected patients with axillary hyperhidrosis, or excessiving sweating of the armpits.   

About the Surgery  

Surgeons at UCSF Medical Center have can perform ETS on both sides of the body during a single operation, if needed.  The operation requires general anesthesia, and two 5 millimeter incisions on each side.  Most patients leave the hospital in under 24 hours and their recovery is generally complete within two weeks.   

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