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Arun Prasad







Hyperhidrosis - Introduction

Hyperhidrosis is defined as sweating beyond the physiological need of the body. The condition causes great emotional distress and occupational disability for the patient, regardless of the form.

The commonest problem faced is inablitiy to shake hands as the person does not know when he/ she will start sweating. There is very little awareness of this problem and hence it leaves the patient totally baffled.


Parents, friends, teachers, colleagues and often doctors think that it is because the person is " nervous " and as time passes, the person also starts believing the same. It leads to lack of confidence, isolation, introversion, shyness, non-sporty personality etc. It is important to note that these behavioral changes are a result of the sweating and NOT the cause of it.




Sweating as a response to a rise in environmental temperature is a normal phenomenon experienced by all. It is the body’s method of dealing with the situation and leads to cooling of the skin once the sweat evaporates. This sweating occurs on the chest, back and central body of the individual.


Sweating as a response to stressful situation is also a natural phenomenon experienced by all when facing an interview, making a presentation, looking down standing on a high roof etc. This sweating occurs on the palms and sometimes soles and is accompanied by a queer feeling. The purpose of this sweating is not understood by people and we often wonder why nature has created this body response. The mechanism has been understood by scientists who attribute this to a sympathetic reaction of the body.


Sweating is a way by which the body regulates its temperature. Sweat is produced by sweat glands located in the skin in various parts of the body. These sweat glands have their highest concentrations in the palms of the hands. The activity of sweat glands is under the control of the sympathetic nervous system and is involuntary. Over activity of the sympathetic nervous system can cause excessive sweating.


Scientifically speaking, sweating is a central nervous system mediated physiological process, with thermo sensitive neurons in the pre-optic area of the hypothalamus playing an important role. Impulses pass from the hypothalamus, via the medulla, to the lateral horn of the spinal ganglia and then to the sympathetic ganglia and finally to the eccrine sweat glands, where acetylcholine is the principal terminal neurotransmitter. Patients with hyperhidrosis have over-functioning of the sympathetic nerve fibres and increased sympathetic outflow.


Sweating on the palms and soles is controlled solely by the cerebral cortex and is responsive to emotional stimuli rather than to temperature stimuli; therefore, palmoplantar hyperhidrosis, unlike generalized hyperhidrosis, does not occur during sleep or sedation.


This above phenomenon of sweating ( hydrosis ) is called HYPERHIDROSIS when the reaction is so severe that sweat starts dripping from the palms. The person suffering from this condition gets totally baffled by this phenomenon.




Men or women both can be affected by hyperhidrosis. It is difficult to give a ratio as patients who come for treatment are mainly men in India due to various social reasons that are a part of the culture. Hence it would be wrong to say that more men are affected as many women do not come forward with the complaints.


Medical textbooks have a paragraph or two written about this condition and those medical students who miss out on reading this para would perhaps never know about the condition. Maybe the socially trendy botox injections with its ties to the treatment of hyperhidrosis and the hi-tech endoscopic surgical treatment will elevate this disorder to a higher level?


Persons of all ages can be affected by hyperhidrosis. In our experience with palmar, axillary, or facial hyperhidrosis, 30% of patients reported that sweating began since before they could remember; 66%, since puberty; and 4%, during adulthood.





The author Dr Arun Prasad MS, FRCS .. has advised over 1500 patients suffering from hyperhidrosis.

He is a senior surgeon at Apollo Hospital, New Delhi and an expert in Minimal Access & Laparoscopic surgery, GI Surgery, VATS (Thoracoscopic) surgery. Also a teacher in Laparoscopic Surgery at Ethicon Institute of Surgical Education, Mumbai & Delhi.
Examiner for MRCS and tutor for Surgical Skills Course for the Royal College of Surgeons, Edinburgh & UK. He was a surgeon at Charing Cross Hospital and Medical School, London before returning to India. He belongs to the world's first generation of Laparoscopic Surgeons and is a pioneer in this field.

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