Excessive sweating (hyperhidrosis) – causes, treatment and sympathectomy

This article explains clearly why hyperhidrosis occurs, which treatment options are available and why a thoracoscopic sympathectomy – especially in uniportal VATS technique and even without intubation – can be an effective, final solution. Finally, we answer frequently asked questions (FAQ). Dr. Hamidreza Mahoozi (specialist in thoracic surgery, Berlin) provides an insight into this modern therapy, which can be outpatient can be carried out on an outpatient basis.

Causes and forms of hyperhidrosis

A distinction is made between primary (idiopathic) from secondary (symptomatic) Hyperhidrosis. With the primary hyperhidrosis there are no other underlying diseases – the sweat glands are healthy in themselves, but sweat regulation is overactive. The exact causes are not yet fully understood.

It is suspected that a hypersensitivity of the sympathetic nervous system is present, so that even slightest stimuli (such as stress, excitement or heat) trigger excessive sweating.

This form is often focaland therefore affects certain regions: e.g. palmar (palms), axillary (armpits), plantar (soles of the feet) or craniofacial (face/head). There is often a familial predispositionand the symptoms usually begin during puberty or in young adulthood.

In contrast, secondary hyperhidrosis occurs as a result of other illnesses or triggers. For example, hormonal disorders (e.g. hyperthyroidism, menopause), metabolic disorders (diabetes), infections, neurological diseases or certain medications can cause heavy sweating.

In such cases, treatment is directed at the underlying disease, as sweating is usually only a symptom. Generalized hyperhidrosis (affecting the whole body) also often has secondary causes, while Primary hyperhidrosis typically locally limited (e.g. only hands and armpits).

Effects on quality of life

Excessive sweating is not a danger to lifebut is an enormous burden on those affected in everyday life. The constant moisture on the hands or body leads to social insecurity – many avoid shaking hands, close physical contact or public situations for fear of embarrassing sweat stains.

At work Hyperhidrosis can also cause problems: Damp hands make it difficult to handle paper, instruments or electronic devices; some patients choose their profession based on where sweating is less of a hindrance.

Studies show that about 50 % of patients restrict their restrict their lifestyle and constantly have the feeling that the disease is “taking over”. Almost 70 % report chronic worry, anxiety or depression through sweating. Up to 48 % rate their quality of life as poor or very poor – comparable to severe chronic skin diseases.

The psychological stress can in turn create a vicious circle Stress and excitement increase sweating, which leads to further stress.

Many sufferers are reluctant to seek medical help out of shame or because they are not aware that Hyperhidrosis is treatable is. Today, there are effective therapies that can improve the quality of life. significantly improve – from simple local measures to the final operational solution, which we will discuss below.

Conservative treatment methods (without surgery)

Non-surgical therapies are always at the beginning of the treatment. They can often achieve good results for mild to moderate hyperhidrosis:

• Antiperspirants (aluminum chloride)Special antiperspirants deodorants, ointments or solutions with aluminum chloride are the first choice for e.g. axillary hyperhidrosis.
  They clog temporarily the ducts of the sweat glands. Regular use (especially at night) can significantly reduce sweat production. Disadvantage: Skin irritation and often not sufficiently effective for heavy sweating.  
• IontophoresisFor palmar or plantar hyperhidrosis the tap water iontophoresis as therapy standard. The hands or feet are immersed in conductive water and Light electrical currents is conducted through it. Over time, this leads to a Inhibition of sweat gland activity. Initially, the treatment must be carried out several times a week, later approx. once a week for maintenance. Many patients achieve a noticeable reduction in sweating, but the method requires a lot of Discipline and time commitment. 
• Botulinum toxin injections (Botox)Botulinum toxin A blocks the nerve impulses. nerve impulses at the sweat glands and can therefore almost completely stop sweat production locally.
  Especially for axillary hyperhidrosis This treatment is used successfully on the hands, but it can also work on the palms or forehead. The procedure needs to be repeated every few months, as the effect is on average 4-9 months lasts. Botox treatment is relatively uncomplicated and effective for the armpits; it is also effective on the palms of the hands, but painful due to the many injections (a local anaesthetic can help here). Botulinum toxin is a Proven method with highly effectivebut costly in the long term and limited in time. 
• Systemic medication: Anticholinergics (such as glycopyrronium bromide or oxybutynin) can reduce sweat secretion throughout the body. They block the neurotransmitter acetylcholinewhich activates the sweat glands.
  However, these drugs are often associated with side effects dry mouth, palpitations, visual disturbances or constipation – which limits their long-term use. Also herbal sedatives or sedatives have been tried, as stress increases sweating, but their effect is usually minimal. 
• Local surgical proceduresFor axillary hyperhidrosis there are procedures such as sweat gland curettage or liposuction (suction/scraping of the sweat glands in the armpits).
  These can significantly reduce the amount of sweat in the armpits, but are only considered once the above conservative methods have been exhausted. They are local interventions and avoid severing the nerve, but they only help in the armpit and not with sweating in the hands or other regions. 

Despite these options, the final cure of primary hyperhidrosis is difficult. Many measures are only effective Temporary or incomplete. If a patient suffers from persistently severe, therapy-refractory sweating and their quality of life is severely restricted, the next step is to treat the condition. last option surgical intervention can be considered: the thoracoscopic sympathectomy.

This should only be done after all conservative options have been exhausted as – despite minimally invasive techniques – it is an invasive step with possible side effects. In the next section, we take a closer look at this operation.

Thoracic sympathectomy – the final solution

The thoracic sympathectomy (also known as Endoscopic thoracic sympathectomy – ETS – called) is currently the only methodto permanently cure primary focal hyperhidrosis permanently. Part of the sympathetic nervous system in the chest, which controls the overactive sweat glands, is cut or blocked. The aim of this procedure is to excessive nerve impulses to the sweat glands so that the affected areas (e.g. hands or armpits) are permanently dry. permanently dry remain dry.

How does it work? The sympathetic border cord runs along both sides of the spinal column within the thorax. It contains several Ganglia (nerve nodes)from which nerve fibers run to the sweat glands of the face, hands, armpits, etc. Depending on the area affected, the transection must be carried out at a certain level. height can take place.

For sweaty hands (palmar) typically the 3rd thoracic ganglion (T3) is cut; for sweating in the armpits (axillary) the 4th ganglion (T4). Often both areas are affected, in which case both corresponding points are interrupted. The transection can be performed using electrical coagulation (sclerotherapy), cutting (resection) or by clipping (application of a titanium clip to block the nerve).

Theoretically, the latter has the advantage of being able to be reversed if necessary – in practice, however, the differences between clipping and cutting are small, as even a removed or severed nerve can grow back together in rare cases.

Procedure of the operation: In the past, sympathectomy required a large opening of the chest (thoracotomy) with spreading of the ribs – an invasive procedure with a long hospital stay.

Today it is performed using minimally invasive technique usually performed as video-assisted thoracoscopic surgery (VATS). This means that Smallest cuts (approx. 5 mm)to insert a camera and fine instruments. Classically, each side two small cuts are made: one for the camera tube and one for a working instrument. The procedure is usually performed on both sides in one sessionto eliminate sweating on both the right and left side.

First of all, one lung is partially collapsed for a short time (by inducing CO₂ or adjusting ventilation) so that the surgeon has a view of the narrow chest cavity. The corresponding sympathetic nerve branches are identified and severed or obliterated under video guidance.

The procedure itself often only takes about 20-30 minutes; a total of about 1 hour Operation time for both sides. The lung is then unfolded again. In many cases on chest drains This is because there is only minimal air entry, which is quickly absorbed by itself. To be on the safe side, approx. 2 hours postoperatively a X-ray controlto rule out a significant pneumothorax (accumulation of air). If everything is normal, the hospital stay will be short.

Prospects of success: Immediately after sympathectomy, the target regions are dry in almost dry in almost 100 % of cases.

Patients wake up from anesthesia and immediately feel: their hands are warm and dry – an immediate effect. immediate effectwhich is often experienced as life-changing. In studies, the Success rate for the improvement of palmarpalmar hyperhidrosis at 96-100 % or a cure rate of around 90-95 %. With axillary hyperhidrosis, the success rate is somewhat lower (about 75-85 %), as sweating in the armpits can be more complex and additional glandular areas (T4/T5) sometimes play a role.

Overall, over 95 % of patients report initial satisfaction after a sympathectomy – the quality of life increases significantly in almost all cases.

Despite this high success rate, the downside must be considered: possible side effects and complications. Sympathectomy permanently interrupts part of the nervous system – this is not always without consequences. For this reason, careful consideration is given and the procedure is only entrusted to experienced thoracic surgeons.

In the next section, we look at the modern development of the surgical technique (uniportal, non-intubated VATS) before discussing the risks.

Uniportals VATS – the one-port technology

In leading centers – including ours in Berlin – thoracoscopic sympathectomy is now often performed as uniportal VATS is often performed. Uniportal means that only one single mini-access per side of approx. 5-10 mm in length is required instead of two or three separate incisions. The camera and instruments are inserted through the same opening, so to speak.

This high-tech surgical technique reduces access routes to a minimum and offers several advantages:

• Less pain and better healing: Fewer incisions mean less trauma to muscles, nerves and tissue. In a comparative study, patients suffered less trauma after uniportal sympathectomy under significantly less pain than with the traditional two-port technique.
  The mean pain scores in hospital were around 0.8 (uniportal) vs. 1.2 (biportal) on a scale, and fewer patients also required painkillers in the weeks afterwards. Smaller wounds also heal more quickly and leave Barely visible scars (cosmetic advantage). 
• Shorter duration of surgery: Experienced surgeons can work more quickly with the single-port approach. In the study cited, the average operating time (bilateral) in the uniportal approach ~39 minutescompared to ~50 minutes with the biportal approach.
  This means that the procedure can be completed around 10 minutes faster, which shortens the duration of anesthesia. 
• Equivalent safety and effectiveness: It is important that the success rate of the sympathectomy is not impaired by the uniportal approach. In both techniques 100% of patients’ hands dry immediately. Also with regard to Patient satisfaction and side effects (e.g. compensatory sweating) there were no differences.
  There were no serious complications (such as Horner’s syndrome) in either the one-port or two-port group. 
• Outpatient application: Less postoperative pain and minimal access requirements support the goal of performing the procedure on an outpatient basis. outpatient procedure on an outpatient basis.
  If the procedure is uncomplicated, the patient can return home a few hours after the operation – this concept is particularly supported by the combination with the non-intubated technique (see below). 

In summary, the uniportal VATS sympathectomy has established itself as state-of-the-art. It is just as effective and safe as conventional endoscopic methods, but with the certain extra in protection for the patient.

For this reason, Dr. Mahoozi in Berlin prefers to use the one-port technique to enable our patients to recover as quickly as possible.

Sympathectomy without intubation (non-intubated VATS)

Another milestone in further development is the performance of sympathectomies without intubation anesthesiai.e. in spontaneous breathing. This procedure is called “Non-Intubated VATS (NiVATS)” designated.
This means that the patient not be artificially ventilated and is not given general anesthesia with a breathing tube; instead, the procedure is performed under under local anesthesia (local anesthetic nerve blocks) and a light sedation (twilight sleep).
The patient continues to breathe independently. Special anesthesia techniques – such as a interthoracic vagus blockwhich suppresses the cough stimulus – make it possible to operate calmly in the open chest cavity despite the patient being awake.

Why this seemingly complex procedure? Because it offers amazing advantages:

• Avoidance of general anesthesia risks: Intubation anesthesia puts a strain on the body and can lead to sore throat, nausea, vomiting and, rarely, even lung-specific complications (atelectasis, pneumonia).
  Studies show that patients undergoing non-intubated procedures experience fewer postoperative complaints such as nausea, vomiting and sore throat and the risk of ventilation-related lung damage is also reduced.
  The elimination of deep anesthesia means that the less strain on the circulatory systemThis is particularly well tolerated by young, healthy patients – as hyperhidrosis sufferers usually are. 
• Faster recovery: Without the “after-effects” of general anesthesia, patients are fit again more quickly. In one study, NiVATS was compared with classic VATS – the results showed a shorter recovery and anesthesia time and often shortened hospital stays. In procedures such as sympathectomy, which cause little tissue trauma, the benefits can be particularly exploited: It has been found that NiVATS sympathectomy can often be discharged on the same daybecause patients recover more quickly.
  In a Swiss study 90 % of the non-intubated sympathectomy patients were outpatient treated, compared to only 30% under conventional anesthesia. This saves time and costs.  
• Cost savings: Less medication, shorter surgery and hospitalization times lead to lower overall costs per procedure. This is particularly relevant in the healthcare system, but is also an advantage for patients (e.g. shorter absence from work).  
• High acceptance of the OP: Hyperhidrosis is not a life-threatening condition – many patients are reluctant to undergo surgery, partly because of the general anesthetic. The possibility of performing the procedure under Gentle anesthesia (without intubation) lowers the inhibition threshold. Internationally, it is reported that NiVATS contributes to the fact that an operation is perceived as “easier” to perceive and more sufferers dare to take the step towards a definitive cure.
  Surgeons even often use sympathectomy as an entry point to establish a NiVATS program in the hospital because the patients are young and healthy and the procedure is so well suited to it.

Is the procedure safe? – Yes, in experienced hands, the NiVATS sympathectomy is is just as safe as under general anesthesia. The challenge lies in the coordination of the team: anesthesia and surgery work hand in hand to keep an awake patient stable. But numerous studies and reports show that Complications do not increase.

For example, no increased pneumothoraces or hemodynamic problems occurred in this setting either; if a cough or restlessness does occur, intubation can be switched to at any time.

In an Italian clinic in 2005, more than 30 patients were treated underwent bilateral sympathectomies sympathectomized – without serious incidents.

About 20% showed small (<30%) pneumothoraces that did not require treatment, and the long-term results (including quality of life) were equivalent to the general anesthesia group – with even better patient satisfaction and less effort. This and more recent data confirm: the Non-intubated thoracoscopic sympathectomy is feasible, safe and efficient.

Outpatient sympathectomy: Through the combination of minimally invasive uniportal-VATS and non-intubated anesthesia the procedure can nowadays in many cases be outpatient take place. The patient comes to the clinic in the morning on an empty stomach, is operated on under sedation and can go home again in the afternoon or evening after a monitoring phase and X-ray check.

At our Thorax Center Berlin, this is the usual procedure for suitable patients. Of course, each patient is assessed individually; if pre-existing conditions or fears speak against awake anesthesia, a safe general anesthetic can still be used. Nevertheless, experience shows that many patients appreciate the option, without “general anesthesia” and overnight stay to be treated. The inhibition threshold is lowered and the path to dry hands is shorter.

Prospects of success and risks of sympathectomy

The thoracic sympathectomy is considered a highly effective procedure for focal hyperhidrosis – but with possible side effects. It is therefore important to provide patients with comprehensive information in advance.

Effectiveness: As mentioned, the immediate prospects of success are excellent. For palmar sweating the success rate is ~95 % and for underarm perspiration ~75-80 % complete anhidrosis.

Recurrences (relapses) are rare – in experienced centers, renewed sweating in the treated areas is only reported in a few percent of cases. Should a recurrence nevertheless occur, this can be treated by nerve regeneration or incomplete transection; a repeat thoracoscopy for repair is then possible, but is rarely required.

Overall, long-term studies show that the satisfaction rate remains permanently high even though some patients live with side effects.

Main side effect: compensatory sweating. This refers to increased sweating in other parts of the body to compensation.

If, for example, the palms of the hands no longer sweat, the body can release more excess heat through the back, chest, stomach or legs.

How often does this occur? The figures vary: In the literature, rates of only ~3 % to almost 100 % – This enormous range is due to different definitions and survey periods. It is realistic to assume that in about half of the cases some degree of compensatory sweating occurs.

It usually manifests itself as slightly increased sweating of the trunk or legs during heat or exercise. Many patients experience this as little disturbing compared to the previously soaking wet hands.

However, around 5-10 % of those operated on report increased compensatory sweatingthat is perceived as unpleasant in everyday life. In a few cases, it can be so pronounced that it impairs satisfaction.

Important to know: Very heavy compensatory sweating (so that the patient regrets the operation) is rare – patients are usually happy despite a little more sweating on the body happy about dry hands.

In addition, there is often a attenuation of this side effect after a few months to years. Nevertheless before the operation be discussed in detail. There are Not a reliable methodpredict who will develop compensatory sweating. The Surgical technique (clip vs. incision, height T2 vs. T3 etc.), no clear scientific influence could be determined – for example, whether a particularly high or low incision is made does not clearly change the risk.

Some surgeons prefer not to operate too close to the stellate ganglion (T1) in order to avoid certain side effects; the standard procedure is to operate at the T3/T4 level anyway. It is important that the patient is aware of this possible consequence and weighs it up against the expected benefit (dry main problem area).

Other possible side effects and complications:

• Horner’s syndrome: If during the operation the the uppermost thoracic ganglion (stellate ganglion, approximately at T1 level) would be damaged during surgery, a so-called Horner’s syndrome could occur.
  This leads to a slightly drooping upper eyelid, constricted pupil and slight eyeball retraction on the affected side. The probability of this is very low (approx. 1 % of cases or less), as this ganglion, when correctly performed sympathectomy above of the target area and is not severed. If it does occur, the symptoms often partially or completely disappear within weeks.  
• Neuropathic pain/intercostal neuralgia: Every thoracoscopy requires access between the ribs, which can irritate the nerves there. In most cases Postoperative pain low and subside within days. Very rarely, a persistent intercostal neuralgia (nerve pain) can occur.
  In studies, chronic nerve pain is only mentioned in a few percent (<2-3%). This can usually be treated well with painkillers and subsides over time.  
• Pneumothorax: As with any procedure in the chest cavity, there is the possibility of a small air leak into the pleural cavity. In fact, X-rays after sympathectomy sometimes show a minimal pneumothorax, especially if the lung did not fully unfold or tiny leaks developed in the lung surface.
  In over 95 % of cases this is so low that no drainage is necessary. If a larger pneumothorax does occur (very rare), a Pleural drainage is placed and the hospital stay is extended by 1-2 days. 
• Bleeding: Significant bleeding is rare, as only small vessels run through the area. The procedure is very safesevere bleeding or lung/heart injuries hardly ever occur in experienced hands. The general complication rate in larger series is estimated at by 1-3% (including all minor incidents). 

Overall, experience has shown that thoracoscopic sympathectomy – when performed correctly – is a very safe operation. very safe operation with low complication rate. The most common “side effect” remains compensatory sweatingthat you have to be aware of. The Most patients do not regret the procedure, but would recommend it recommend it to othersbecause the benefits (e.g. dry hands, new self-confidence) clearly outweigh the possible side effects.
It is important to obtain detailed advice from experienced specialists in order to set the right expectations.

Frequently asked questions (FAQ)

What exactly does “hyperhidrosis” mean?
Hyperhidrosis means excessive sweating. The body produces more sweat than is necessary to regulate temperature.

It typically occurs in certain areas (hands, armpits, feet, face) and begins in adolescence. It is a recognized medical condition that can be very distressing for those affected.

What are the causes of excessive sweating?
It is often a case of primary hyperhidrosiswhere there is no underlying disease. The autonomic nervous system is probably overactive in this case – often Genetics and stress also play a role.

However, sometimes there is something else behind it (secondary hyperhidrosis), e.g. hormonal disorders (thyroid gland), diabetes, infections or medication. The doctor will clarify this by taking a medical history and, if necessary, carrying out examinations.

What non-surgical treatments are available?
First of all you try simple measures: Special antiperspirant deodorants with aluminum chloride can reduce underarm perspiration. On hands and feet often helps Iontophoresis (weak current in a water bath).

Botox injections can shut down the sweat glands locally (effective for approx. 6 months). There are also tablets (anticholinergics), but these have side effects. Home remedies and relaxation techniques are also tried. These methods can reduce sweating, but sometimes have to be used repeatedly. They often reach their limits with very heavy sweating.

When should a sympathectomy be considered?
When all conservative therapies have been exhausted are exhausted and still high level of suffering exists. For example: you have tried various deodorants, medication, Botox etc. for years without sufficient success and the sweating continues to severely affect your professional and private life. In this case, a sympathectomy can be a last step be useful.

Of course, the possible side effects (e.g. compensatory sweating) must be weighed against the expected benefits. A discussion with an experienced thoracic surgeon is important here. For certain professional groups (e.g. surgeons with palmar hyperhidrosis), earlier surgery may be indicated, as dry hands are essential.

How does the sympathectomy actually work?
This is a minimally invasive procedure on the ribcage. Under general anesthesia (or in certain cases under sedation, see below), a tiny camera is inserted between the ribs, as well as a fine instrument.

The surgeon cuts the sympathetic nerve that controls sweating, e.g. in the hand, under visual control. This is done on both sides. The operation only takes about 1 hour in total. Afterwards, you wake up and immediately notice that your hands/armpits are dry. In most cases, no drainage remains in the chest. After a short period of monitoring, you can either go home the same day or stay overnight for safety reasons, depending on the clinic.

Is it true that the operation can be performed without general anesthesia?
Yes, in specialized centers, sympathectomy is also performed without intubation. without intubation carried out. You will then receive a Twilight sleep and local anesthesia. You are not fully conscious during the operation, but also not under deep anesthesia – comparable to a gastroscopy under sedation.

This method (non-intubated VATS) eliminates the need for a breathing tube and many anesthetic side effects. Not every patient is suitable for this (e.g. severe anxiety patients or certain lung diseases), but it works very well in young, healthy people. Your thoracic surgeon and anesthetist can assess whether this option is suitable for you.

How long do I have to stay in hospital?
As a rule, the stay is very short. Many clinics perform the procedure outpatient This means that you can return home on the day of the operation. Otherwise you usually only stay One night of observation and is discharged the next day. It is important that X-rays and examinations are carried out beforehand to ensure that there is no significant pneumothorax. If everything is ok and you feel well, there is nothing to prevent you from being discharged.

How quickly will I be fit again?
Surprisingly fast: as only small incisions are made, most patients experience hardly any pain. hardly any pain – possibly a slight feeling of pressure in the chest for a few days. This is easily manageable with painkillers. After a few days you can usually normal everyday activities again take up. Heavy physical exertion or sport should be avoided for about 1-2 weeks so that everything can heal internally. Office work is often possible again after just a few days. Your doctor will give you precise instructions on this. Overall, the recovery time is very short compared to major operations.

What is compensatory sweating? Will I get it?
This is the compensatory sweating in other parts of the body after the operation. It is the most common side effect of sympathectomy. For example, you notice that your back or legs sweat a little more than before, especially in the heat.

Whether and to what extent that occurs varies from person to person. Statistically, around half of patients experience some form of compensatory sweating, but it is often so mild that it hardly bothers them. Only a small minority (5-10%) have it to such an extent that it is perceived as problematic.

Unfortunately, it is not possible to predict who will be affected. It has nothing to do with the skill of the surgeon or your body type. The important thing is that you should be aware of the possibility. In most cases, however, the relief of dry hands/underarms clearly outweighs the discomfort. The compensatory sweating can also improve again over time. If it is extremely bothersome, there are individual options such as medication or (rarely) removing clips – but these are exceptional cases. Discuss your concerns with your doctor; he or she will honestly assess whether the operation makes sense for you.

What other risks does the operation entail?
Serious complications are very rare. As with any operation, there is a risk of anesthesia (with general anesthesia) and a minimal risk of infection or bleeding, but this is in the low percentage range. A small air leak in the lungs could cause a Pneumothorax If it is larger, a drain would be placed, which would extend the stay by 1-2 days. However, this hardly ever happens as the camera accesses are tiny.

Injuries to important organs (heart, large vessels) are practically not to be expected in the position of the sympathetic chain as long as an experienced thoracic surgeon operates. The Horner syndrome (see above) is very rare (~1 %). In short: the procedure is very safe and the risks are low. Nevertheless, everything is done to further minimize even these small risks – for example through state-of-the-art imaging technology, monitoring and the experience of the surgical team.

Will the result last forever? Can the sweating come back?
As a rule, the result is permanent. The severed nerve endings do not normally regenerate to the extent that the sweating function returns. In studies, the relapse rate is around 5-10% depending on the observation period – this means that a small number of patients notice increased sweating in the areas originally treated after months or years.

However, this is often far less pronounced than before the operation. If a relevant relapse does occur, a new thoracoscopy can be performed to check whether there are, for example second nerve tracts or whether the first intervention was incomplete. This can then be corrected retrospectively. However, the vast majority of patients (over 90 %) remain in the affected zones permanently anhidrotic (dry) and happy with the result of the operation.

Does the health insurance company cover the costs?
As sympathectomy for hyperhidrosis is an established therapeutic procedure, the costs are generally covered by statutory and private health insurance companies covered – provided thatit is a case of pathological hyperhidrosis and conservative treatments have been tried without success.

Your doctor will document which therapies have already taken place before you apply for cost coverage.

In Germany, endoscopic thoracic sympathectomy for primary hyperhidrosis is listed in guidelines as a therapy pillar, so there are usually no problems with cost coverage. If in doubt, clarify in advance with your health insurance company whether cost approval is necessary. In many cases, the clinics carrying out the treatment will also take care of the approval.

Your specialists for hyperhidrosis in Berlin and the surrounding area

If you suffer from severe sweating and are looking for a definitive solution, we are at your disposal at the Knowledge Center Thoracic Surgery Berlin under the direction of Dr. Hamidreza Mahoozi will be happy to help you.

As experienced thoracic surgeons, we offer the modern uniportal VATS sympathectomy – for suitable patients also non-intubated and outpatient – to. In our consultation hours we advise those affected from Berlin, Brandenburg as well as nationwide e.g. from Leipzig, Dresden or Hanover about the possibilities of hyperhidrosis treatment. Make an appointment to discuss your questions in person. We will help you escape the vicious circle of sweat and avoidance – for a a dry, self-confident life without hyperhidrosis.

Sources

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