Asian Skin Rejuvenation at a glance
- Best Results7 to 21 days
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- Back to WorkNA
Compensatory hyperhidrosis is a common event that occurs after ETS or endoscopic thoracic sympathectomy. This is a form of rebound sweating that can occur on parts of the body that were not affected from sweating like sweaty palms. This form of excessive sweating can occur on the trunk, underarms, limbs, face, & scalp. Once compensatory hyperhidrosis occurs, it often persists. Effective treatments are possible. Dermatologists use a combination of creams, tablets and in some cases anti-sweat injections to help reduce the inconvenience of compensatory sweating.
FactsFacts On Compensatory Hyperhidrosis
- This form of excessive sweating commonly occurs after endoscopic thoracic surgery
- Compensatory excessive hyperhidrosis is also called reflex or rebound sweating
- A combination of treatments including antiperspirants, tablets, & compounded creams can manage most cases of compensatory sweating
- Treatment for compensatory sweating often needs to be lifelong
What is compensatory hyperhidrosis?
Compensatory hyperhidrosis is also called reflex or rebound sweating and most commonly occurs after ETS surgery. ETS surgery or endoscopic thoracic sympathectomy is a type of surgery for excessive sweating of the hands, underarm sweating, or facial sweating. Compensatory sweating occurs in areas that were not affected by sweating before a procedure or event. Once sweating develops, it usually persists.
How common is compensatory sweating?
Compensatory hyperhidrosis is commonly seen after Endoscopic Thoracic Sympathectomy. Most patients undergo ETS for excessive sweating of the hands, or less commonly excessive underarm sweating, or facial sweating. Rebound or reflex sweating occurs several weeks or months after ETS surgery. The quoted incidence ranges from 20 to 70%.
Rare causes of compensatory hyperhidrosis include nerve trauma, brain disorders, myelopathy and thoracic disorders.
What areas are commonly affected by this pattern of sweating?
The most common areas involved in excessive rebound sweating is the back, chest, underarms and trunk, rarely compensatory hyperhidrosis can affect the neck & face. In extreme cases it can become generalised, and patients can sweat everywhere.
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What is the cause of compensatory sweating?
The exact cause of rebound sweating is poorly understood; however a theory is that the perception of a part of your brain called the hypothalamus, senses that your body temperature is too high. This stimulates nerves which in turn activates sweat glands in certain areas to sweat, which in turn reduces body heat.
What treatments are available to treat this pattern of rebound sweating?
Compensatory sweating is hard to treat. Treatments will depend on several factors including the location of sweating, the total area of excessive sweating, and previous treatment success and failures.
Patients should try a topical antiperspirant as first line treatment. Never occlude the antiperspirant, and where possible, apply to dry skin, always wipe the excess sweat on the area targeted before putting on an antiperspirant. I recommend aluminium chloride hexahydrate as the first step, 10-20% solution.
Failing antiperspirant use, your dermatologist can compound a variety of special anti-sweating creams to use on the area. DermDry pads containing 1% glycopyrrolate can be useful. Prescription tablets to control sweating may be helpful in some patients for short breaks from sweating.
If compensatory sweating occurs in a small area, the use of sweat stopping treatments injections can be helpful. Tiny injections are placed in the areas of excessive sweating. Injections can be successful in upto 80% of cases of compensatory hyperhidrosis and typically lasts up to 3-4 months. The limiting factor of sweat stopping treatments is the area involved, due to costing. These injections are subsidised by Medicare only if severe sweating occurs in the axillae or underarms.
Is it possible to predict who will get compensatory sweating after ETS surgery?
In short, no. Compensatory hyperhidrosis cannot be predicted. The pattern of excess sweating has no link to gender, age or location. Most cases of compensatory sweating occur on the lower back, and trunk, however rebound underarm sweating can occasionally occur. Patients should give careful consideration before undergoing Endoscopic Thoracic Sympathectomy and should try medical treatment before contemplating this procedure.
Davin’s Viewpoint on Compensatory Sweating
Compensatory or rebound sweating is commonly encountered by dermatologists. Most patients present secondary to ETS or endoscopic thoracic sympathectomy. The common story is that they have surgery for excessive and severe sweating of the hands, then a few weeks or months later, present with areas of excessive sweating elsewhere, most commonly on the back or trunk. Most patients do not regret having surgery in the first place, as excessive sweating on the hands is both more challenging to treat and has a higher impact on lifestyle than compensatory sweating elsewhere. The second most common presentation is that patients had ETS for facial sweating and blushing. Very rarely do patients have ETS for underarm sweating, now that effective treatments such as sweat stopping treatments are available under the PBS.
Compensatory excess sweating can be challenging to treat, however most patients respond with a combination of antiperspirants, prescription compounded creams, and tablets. Focal areas can also be injected with Botox treatments, especially if it involves small areas on the back/trunk, as well as the forehead and scalp area.
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