1, head and face sweating is what happened? The head and face sweating is commonly known as “steamer head”, that is, the image depicts the sweaty head like the steamer of steamed buns, water vapor bubbles incessantly. In fact, the so-called “steamer head” is just a manifestation of hyperhidrosis, and hand sweating is no different, both are local manifestations of hyperhidrosis. In general, sweating is a normal heat dissipation 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 further increases in body temperature, sympathetic nerve activity, the body’s sweat gland secretion, through the evaporation of sweat to take away heat cooling. Sweating varies from person to person. At the same ambient temperature, some people sweat more and some people sweat less. However, when the ambient temperature is not high and sweating is not normally needed to dissipate heat, but still sweating profusely, 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 a functional autonomic disorder in which the sweat glands are overproductive. Secondary hyperhidrosis is caused by a number of neuroendocrine and other systemic diseases (such as hyperthyroidism, diabetes mellitus, hypoglycemia, poisoning, drug side effects, cardiovascular disease, respiratory failure, carcinoid syndrome, Hodgkin’s disease) that cause excessive sweating. Hyperhidrosis can be divided into generalized hyperhidrosis and localized hyperhidrosis according to the location of sweating. Generalized hyperhidrosis is mostly secondary hyperhidrosis, while localized hyperhidrosis is mostly primary hyperhidrosis. The head and face hyperhidrosis is actually a primary localized hyperhidrosis, known to be caused by excessive cervical and thoracic sympathetic nerve activity that governs the secretory function of the head and face sweat glands, and generally has a family tendency. 2. What are the treatment options for cephalohidrosis? Unlike the treatment of hand sweating, the head and face are not suitable for topical lotions and local injections of carnitine because of the “face” involved, while oral anticholinergic antiperspirants and anti-anxiety medications have limited effect, so we can only hope for thoracoscopic thoracic sympathectomy or CT-guided thoracic sympathetic block. The thoracoscopic surgery for head sweating requires cutting the thoracic sympathetic nerve at T2, which has a significant surgical effect but is prone to severe compensatory hyperhidrosis; the CT-guided thoracic sympathetic block for head sweating has a puncture dosing gap between T2/3, because it does not cut the nerve but only inhibits its overactive function for a long time, and while effectively treating head sweating, severe compensatory hyperhidrosis rarely occurs, plus it only requires sticking two fine needles in the back. It is ideal for the treatment of head sweating because only two thin needles need to be pinned on the back, and the patient can get out of bed after the needles are removed, which is almost non-invasive. (For details, please refer to “Progress in the diagnosis and treatment of hand sweating”)