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<title>Compensatory hyperhidrosis</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Compensatory hyperhidrosis</span></span>

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</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Compensatory hyperhidrosis</th></tr><tr><td colspan="2" class="infobox-full-data"></td></tr><tr><td colspan="2" class="infobox-full-data">Following <a href="Endoscopic_thoracic_sympathectomy" title="Endoscopic thoracic sympathectomy">Endoscopic thoracic sympathectomy</a> surgery for axillary (armpit), palmar (palm) hyperhidrosis and <a href="Blushing" title="Blushing">blushing</a>, the body may sweat excessively at untreated areas, most commonly the lower back and trunk, but can be spread over the total body surface below the level of the cut.</td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">

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<p><b>Compensatory hyperhidrosis</b> is a form of neuropathy. It is encountered in patients with <a href="Myelopathy" title="Myelopathy">myelopathy</a>, thoracic disease, <a href="Cerebrovascular_disease" title="Cerebrovascular disease">cerebrovascular disease</a>, nerve trauma or after surgeries. The exact mechanism of the phenomenon is poorly understood. It is attributed to the perception in the <a href="Hypothalamus" title="Hypothalamus">hypothalamus</a> (brain) that the <a href="Normal_human_body_temperature" class="mw-redirect" title="Normal human body temperature">body temperature</a> is too high. The sweating is induced to reduce body heat.

</p><p>Excessive sweating due to <a href="Anxiety" title="Anxiety">nervousness</a>, <a href="Anger" title="Anger">anger</a>, previous <a href="Psychological_trauma" title="Psychological trauma">trauma</a> or fear is called <a href="Hyperhidrosis" title="Hyperhidrosis">hyperhidrosis</a>.

</p><p>Compensatory hyperhidrosis is the most common side effect of <a href="Endoscopic_thoracic_sympathectomy" title="Endoscopic thoracic sympathectomy">endoscopic thoracic sympathectomy</a>, a surgery to treat severe <a href="Focal_hyperhidrosis" title="Focal hyperhidrosis">focal hyperhidrosis</a>, often affecting just one part of the body. It may also be called <i>rebound</i> or <i>reflex hyperhidrosis</i>. In a small number of individuals, compensatory hyperhidrosis following sympathectomy is disruptive, because affected individuals may have to change sweat-soaked clothing two or three times a day.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup>

According to Dr. Hooshmand, sympathectomy permanently damages the temperature regulatory system. The permanent destruction of thermoregulatory function of the <a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> causes latent complications, e.g., RSD in contralateral extremity.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

</p><p>Following surgery for axillary (armpit), palmar (palm) hyperhidrosis (see <a href="Focal_hyperhidrosis" title="Focal hyperhidrosis">focal hyperhidrosis</a>) and <a href="Blushing" title="Blushing">blushing</a>, the body may sweat excessively at untreated areas, most commonly the lower back and trunk, but can be spread over the total body surface below the level of the cut. The upper part of the body, above the sympathetic chain transection, the body becomes anhidrotic, where the patient is unable to sweat or cool down, which further compromises the body's <a href="Thermoregulation" title="Thermoregulation">thermoregulation</a> and can lead to elevated core <a href="Temperature" title="Temperature">temperature</a>, overheating and <a href="Hyperthermia" title="Hyperthermia">hyperthermia</a>. Below the level of the sympathetic chain interruption, body temperature is significantly lower, creating a stark contrast that can be observed on thermal images. The difference in temperatures between the sympathetically under- and overactive regions can be as high as 10 Celsius.

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<div class="mw-heading mw-heading2"><h2 id="Variations">Variations</h2></div>

<p>Gustatory sweating or <a href="Frey's_syndrome" title="Frey's syndrome">Frey's syndrome</a> is another presentation of <a href="Autonomic_neuropathy" title="Autonomic neuropathy">autonomic neuropathy</a>.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Gustatory sweating is brought on while eating, thinking or talking about food that produces a strong salivary stimulus. It is thought that ANS fibres to <a href="Salivary_glands" class="mw-redirect" title="Salivary glands">salivary glands</a> have become connected in error with the sweat glands<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> after <a href="Nerve_regeneration" class="mw-redirect" title="Nerve regeneration">nerve regeneration</a>. Apart from sweating in the anhidrotic area of the body, it can produce <a href="Flushing_(physiology)" title="Flushing (physiology)">flushing</a>, <a href="Goosebumps" title="Goosebumps">goosebumps</a>, drop of body temperature - <a href="Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> and <a href="Paresthesia" title="Paresthesia">paresthesia</a>. Aberrant gustatory sweating follows up to 73% of surgical sympathectomies<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> and is particularly common after bilateral procedures. Facial sweating during salivation has also been described in <a href="Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes mellitus</a>, <a href="Cluster_headache" title="Cluster headache">cluster headache</a>, following <a href="Chorda_tympani" title="Chorda tympani">chorda tympani</a> injury, and following facial <a href="Herpes_zoster" class="mw-redirect" title="Herpes zoster">herpes zoster</a>.

</p><p>Phantom sweating is another form of autonomic neuropathy. It can be observed in patients with nerve damage (following accidents), <a href="Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes mellitus</a> and as a result of sympathectomy. Phantom sweating is a sensation that one is sweating, while the skin remains dry. Affected people can not distinguish whether it is real sweating or just a sensation. The phenomenon is experienced in the anhidrotic, denervated area of the body, presenting an abnormal sympathetic nervous system function.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup>

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<div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2></div>

<p>The term 'compensatory' is largely misleading, as it indicates that there is a compensatory mechanism that takes effect after sympathectomy, in which the body 'redirects' the sweating from the palms or face to other areas of the body. Sweating after sympathetic surgery is a reflex cycle between the sympathetic system and the anterior portion of the hypothalamus. Reflex sweating will not happen if hand sweating can be stopped without interrupting sympathetic tone to the human <a href="Brain" title="Brain">brain</a>.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup>

</p><p>Compensatory hyperhidrosis is aberrant <a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> functioning. The only study evaluating the total body sweat prior and shortly after sympathectomy concluded that patients produce more sweat after the surgery, just not so much in the areas treated by the surgery.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup>

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<div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2></div>

<p>Of people that have a sympathectomy, it is impossible to predict who will end up with a more severe version of this disorder, as there is no link to gender, age or weight. There is no test or screening process that would enable doctors to predict who is more susceptible.

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<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</style><cite id="CITEREFStolman_LP2008" class="citation journal cs1">Stolman LP (2008). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2344132">"Hyperhidrosis: medical and surgical treatment"</a>. <i>ePlasty</i>. <b>8</b>: e22. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2344132">2344132</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18488053">18488053</a>.</cite></span>

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<li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://rsdrx.com/sympathectomy_failure.htm">Sympathectomy failure</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20090105160320/http://rsdrx.com/sympathectomy_failure.htm">Archived</a> 2009-01-05 at the <a href="Wayback_Machine" title="Wayback Machine">Wayback Machine</a></span>

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<li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><cite id="CITEREFLichtPilegaard2006" class="citation journal cs1">Licht PB, Pilegaard HK (March 2006). "Gustatory side effects after thoracoscopic sympathectomy". <i>Ann. Thorac. Surg</i>. <b>81</b> (3): <span class="nowrap">1043–</span>7. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.athoracsur.2005.09.044">10.1016/j.athoracsur.2005.09.044</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16488719">16488719</a>.</cite></span>

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<li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><i><a rel="nofollow" class="external text" href="http://www.whonamedit.com/synd.cfm/390.html">Frey's syndrome</a></i> at <a href="Whonamedit%3F" title="Whonamedit?">Whonamedit?</a></span>

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<li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://journal.medscape.com/viewarticle/473206_2">Disorders of Sweating: Hyperhidrosis</a></span>

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<li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://drmony.co.il/hyperhidrosis-treatment/">"טיפול בהזעת יתר"</a>.</cite> Wednesday, 21 August 2019</span>

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<li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text">Chien-Chih Lin and Timo Telaranta at the 4th Symposium on Sympathetic Surgery in Vienna.</span>

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<li id="cite_note-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-8">^</a></b></span> <span class="reference-text"><cite id="CITEREFKopelmanAssaliaEhrenreichBen-Amnon2000" class="citation journal cs1">Kopelman D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M (2000). "The effect of upper dorsal thoracoscopic sympathectomy on the total amount of body perspiration". <i>Surg. Today</i>. <b>30</b> (12): <span class="nowrap">1089–</span>92. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs005950070006">10.1007/s005950070006</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11193740">11193740</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:23980585">23980585</a>.</cite></span>

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<li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><cite id="CITEREFLyra_RdeCamposKangLoureiro_Mde2008" class="citation journal cs1">Lyra Rde M, Campos JR, Kang DW, Loureiro Mde P, Furian MB, Costa MG, Coelho Mde S, Sociedade Brasileira de Cirurgia Torácica (Nov 2008). <a rel="nofollow" class="external text" href="https://doi.org/10.1590%2Fs1806-37132008001100013">"Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis"</a>. <i>J Bras Pneumol</i>. <b>34</b> (11): <span class="nowrap">967–</span>77. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1590%2Fs1806-37132008001100013">10.1590/s1806-37132008001100013</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19099105">19099105</a>.</cite></span>

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