1. What is hand sweating? Simply put, hand sweating is a symptom of excessive hand sweating, accounting for 0.6% to 1% of the total population. Sweating is a normal cooling response of the body, controlled by the sympathetic nerves in the vegetative nervous system. When the ambient temperature or body temperature exceeds the body’s own body temperature set point, in order to prevent the body temperature from rising further, the sympathetic nerve activity, dominating the body’s sweat gland secretion, through the evaporation of sweat to take away the heat to cool down. Sweating varies from person to person. In the same ambient temperature, some people sweat more, some people will sweat less. However, when the ambient temperature is not too high and sweating is not normally necessary to dissipate heat and cool down, it is called “hyperhidrosis”. Hyperhidrosis is divided into two categories: primary hyperhidrosis and secondary hyperhidrosis. Primary hyperhidrosis is a state of hypersecretion of the sweat glands with no apparent cause, and is actually an autonomic dysfunction in which the sweat glands overproduce. Secondary hyperhidrosis is caused by some neuroendocrine and other systemic diseases (e.g. hyperthyroidism, diabetes mellitus, hypoglycemia, poisoning, drug side effects, cardiovascular disease, respiratory failure, carcinoid syndrome, Hodgkin’s disease). According to the sweating parts, hyperhidrosis can be divided into generalized hyperhidrosis and localized hyperhidrosis. Generalized hyperhidrosis is mostly secondary hyperhidrosis, while localized hyperhidrosis is mostly primary hyperhidrosis. Hand sweating is actually a primary localized hyperhidrosis, which is known to be caused by excessive activity of the thoracic sympathetic nerves that innervate the secretory function of the sweat glands of the hands. After the hand sweating people’s family survey found that the symptom has a family, showing autosomal dominant inheritance characteristics, that is, it will be inherited to future generations. 2.What are the clinical manifestations of hand sweating? The main manifestation of primary hand sweating is not affected by the external temperature of the palms of both hands sweaty, mildly only the palm of the palm of the performance of wet, severe palm secretion of sweat beads visible to the naked eye, the serious will be dripping along the fingers. Sweating is often accompanied by cold palms, and only in a few cases do the fingers stay warm when sweating. In some cases, the sweating is combined with sweating of the feet or sweating of the head, face, or armpits. Sweating is highly correlated with emotional activity, and sweating is more frequent when the mind is stressed. The appearance of symptoms is characterized by suddenness and intermittency, with each episode lasting 5 to 30 minutes and the number of episodes per day being variable, but sweating is rare during sleep. Most patients have more severe symptoms in the summer and less severe symptoms in the winter. Individuals experience hand sweating as soon as they think about sweating, and the association with ambient temperature is much less than that with mental activity. Moreover, hand sweating often has the following manifestations: A, plantar sweating: hand sweating in 40% to 45% of people with plantar sweating at the same time, and foot sweat is more likely to accumulate, even if the frequent replacement of shoes and socks can not be removed in a timely manner sweat and its odor. Therefore, the soles of the feet are most likely to occur secondary skin lesions, such as dermatitis, athlete’s foot, skin keratosis, skin herpes. B. Sweaty armpits: 25%-30% of the sweaty hands are combined with sweaty armpits, and the sweat is easy to soak through the clothes, and the armpits are in the form of large sweat patches. Because the armpit area is hidden, it is also easy to cause bacterial or fungal infection of the skin there, and in serious cases, skin erosion occurs. C. Facial hyperhidrosis: the combined head and face hyperhidrosis accounts for 1%~5%. The part is mostly concentrated in the forehead, the sweat from the top downward flow, into the eye frame and neck, need to constantly wipe to keep the face dry, most of the patients are also accompanied by facial flushing, the heavy face is purple-red, presenting a kind of nervousness and anxiety of the embarrassing appearance. D, hands and feet prone to frostbite: sweaty hands and feet are sweaty hands and feet are mostly “wet and cold”, the temperature of hands and feet is only 33 ℃ or so, lower than the sweatless 2 ~ 3 ℃, and thus prone to frostbite in winter. Because the hands and feet are often in the sympathetic excitation of vascularization, hands and feet are often ischemic greenish gray. Hands and feet often immersed in sweat, also often appear “peeling” phenomenon, occasionally sweat herpes (sweaty hands and feet when the sweat duct mouth blockage caused by sweat storage in the skin of the palms and toes of a kind of eczema-like changes) appeared. In short, primary hand sweating symptoms typical, diagnosis is not difficult, but finally to the regular hospital to exclude secondary hyperhidrosis, symptomatic treatment. 3, hand sweating on people have no harm? Hand sweating is just a relative excitement of the sympathetic nerves of the human body, and it is not harmful to the health. However, due to sweaty palms, soles and armpits, it often brings a lot of inconvenience to study, work, life, socializing and other activities. For example, the student exam due to sweaty hands easy to wet the test paper, operation of the computer sweat wet keyboard, engaged in electrician work wet easy to electrocution, social interaction due to the serious sweaty palms and do not dare to shake hands with others,……, and so on, indeed, to the work and life bring some trouble. 4.How is the diagnosis process of hand sweating? The diagnosis of hand sweating is relatively easy, the key is to distinguish primary hand sweating from secondary hyperhidrosis. A. Key points of history taking: (1) Determine the exact location of excessive sweating, and determine whether it is localized or generalized. (2) Frequency and duration of episodes of sweating. (3) The age of onset. (4) Family history. (5) Whether it is accompanied by systemic symptoms such as fever, night sweats, and weight loss. (6) Whether excessive sweating is associated with emotional activity. (7) How it affects socialization, occupation, and daily life. (8) Exclude other secondary hyperhidrosis symptoms. B. Physical examination: In cases of primary localized hyperhidrosis, only abnormal sweating manifestations and positive signs of secondary skin lesions are usually detected: e.g., palmar desquamation, herpes sweating, and frostbite. Attention is paid to the detection of positive signs that favor the differential diagnosis with generalized hyperhidrosis. Such as wasting may suggest chronic systemic wasting disease, acromegaly may be related to endocrine system diseases, accelerated heart rate should further exclude the possibility of hyperthyroidism, elevated blood pressure should be noted to exclude pheochromocytoma. C, auxiliary examination: hyperhidrosis diagnosis before the examination should also include routine blood and urine examination, as well as blood glucose, T3, T4 concentration measurement. In addition, X-ray chest radiograph or chest CT examination can exclude the presence of intra-thoracic tuberculosis and other lesions. Chest CT should be performed to exclude pleural hypertrophy and other lesions if the patient is to be treated surgically. For the suspected cases of systemic diseases, relevant items should be examined, such as the suspected pheochromocytoma should be measured by urinary catecholamine derivatives. 5.What are the treatments for hand sweating? There are various treatments for hand sweating, and the most common ones are six types of methods. ① topical lotion: topical lotion is mainly applied with astringent effect of alum, glutaraldehyde and other solutions soaked for tens of minutes, can have a certain effect in a few days, but there will be skin damage to the hands, wrinkles, cracking and other skin lesions, and the effect is not long-lasting. ② oral anticholinergic antiperspirant systemic anticholinergic drugs such as urotropin can inhibit sympathetic nerve activity to some extent, combined with a relative reduction in sweating, but stopping the drug that is recurrent, and the use of medication during the dry mouth, fast heartbeat and other complications often occur. ③ oral anxiolytics primary hand sweating episodes of sweating is often triggered by emotional activities, especially when the spirit of the nervousness, and after sleep sweating will not attack. For this reason, sedative anxiolytics can have a certain therapeutic effect. Commonly used drugs are tranquilizers: Valium tablets, Sulphasalazine tablets, Imipramine tablets, Sinequan tablets, anti-anxiety drugs Amitriptyline tablets, Prozac, Dailixin and so on. But sedative anti-anxiety drugs often cause mental depression, tiredness, fatigue, poor concentration. Drug dependence also occurs after prolonged use, so it is less used in the treatment of hand sweating. Local injection of carnitine: Carnitine palmar skin injection can make the injection site 1~3 months to stop or reduce sweating. However, this method has serious pain, requires multi-point injection, repeated injection, easy to cause palm surface infection and other complications, and the cost is high, each hand injection treatment requires nearly one thousand dollars, and can only be effective for 1~3 months. ⑤Surgical treatment: traditional open heart surgery to cut off the thoracic sympathetic chain for the treatment of hand sweating began in 1954, by Kux first open heart excision T2 to block the secretion of sweat glands has been successful, but due to the huge trauma of the open heart, the promotion of the difficulties (the traditional surgical method is to cut from the center of the back, to the two sides of the second, the third sympathetic ganglion excision, the method of the surgical time, the recovery time is longer, the risk of a large, post-operative there is a five to seven centimeters of the wound) since 1992, the television chest, the chest, the chest, the chest, the chest and the hands. Since 1992, when Endoscopic Thoracic Sympathectomy (ETS) was used for the treatment of hand sweating, it has become the “gold standard” for the surgical treatment of hand sweating: the incision is made in 1~3 small incisions in each axilla, each about 1~2 centimeters long, and each about 1~2 centimeters long. The incision is made in 1~3 small incisions in each armpit, each about 1~2 centimeters, through which the thoracoscope is put in, and then the thoracic sympathetic nerves innervating the secretion of sweat glands are cut off under the TV surveillance. The operation time and recovery period are shorter than that of the traditional open-heart surgery, and the pain is lighter than that of the traditional surgery, but general anesthesia is still required for the operation, and the cost is higher (more than RMB 10,000 yuan). At present, the operation is carried out more in China, and the technology is more mature, and the tertiary hospitals with thoracoscopy around the world can basically carry out the operation. 6.How does thoracoscopy treat hand sweating? Although the exact mechanism of primary hand sweating has not yet been fully clarified, it has been clarified that excessive activity of the thoracic sympathetic nerve is directly related to the occurrence of hand sweating. The effect of cutting off the thoracic sympathetic chain in the treatment of hand sweating has been clinically proven. Following conventional open heart surgery to sever the thoracic sympathetic nerve for the treatment of hand sweating, televised thoracoscopic thoracic sympathectomy (ETS) has become a classic procedure for the treatment of hand sweating. The anesthesiologist first administers general anesthesia to the patient with sweaty hands and inserts a double-lumen endotracheal tube to ensure that both lungs can be ventilated separately. The surgeon first makes one to three small incisions of about 1 cm in a relatively hidden place under the patient’s armpit, and the anesthesiologist controls the patient’s one-lung ventilation on the opposite side of the lung, while the lung on the operated side is completely atrophied, exposing the thoracic cavity completely, and the video of thoracic sympathetic nerve chain is displayed on the TV screen by a lens that extends into the chest cavity, and the operator looks at the TV screen, and the electrocautery knife, which extends into another incision, is applied at the position of the thoracic sympathetic nerve chain, T2-T4, to cut off these nerve chains and perform electrocautery. Electrocautery is performed to sever the sympathetic chain at these locations. Subsequently, the bleeding is stopped, the lens is removed, the anesthesiologist drums the lungs, a closed chest drain is placed, and the sympathetic chain in the contralateral thoracic cavity is then severed in the same manner. After the operation, the anesthesiologist stops the medication and removes the endotracheal tube when the anesthesia is fully awakened. The patient can speak after further resuscitation and can get out of bed one day later. Generally, the patient can be discharged from the hospital three days after the operation, and the incision sutures can be removed in 5-10 days. After cutting off the thoracic sympathetic sensory nerve chain, the phenomenon of hand sweating can disappear immediately, and can be lifelong without further episodes. However, some patients will have compensatory hyperhidrosis after the operation, that is, the sweat of the hands does not come out, but the chest, abdomen, waist, back and thighs and other places sweat more than before.