Last updated: January 2024
Also known as: Rebound Sweating, Post Endoscopic Thoracic Sympathectomy (ETS) Sweating, Paradoxical Sweating, Reflex Sweating
What is compensatory hyperhidrosis?
Compensatory hyperhidrosis is a common, post-surgical complication of endoscopic thoracic sympathectomy (ETS surgery).
The condition occurs mainly on the trunk and can affect large areas of the body.
Who gets compensatory hyperhidrosis?
Most cases of compensatory hyperhidrosis occur in individuals who have undergone ETS surgery. Other rare causes may include:
- diabetes
- brain injury
- spinal cord disease
- limb amputation
What causes compensatory hyperhidrosis?
Compensatory hyperhidrosis most often occurs after ETS surgery.
Compensatory hyperhidrosis can also occur because of nerve damage in conditions such as diabetes, brain injury and syringomyelia. It is sometimes called “phantom sweating” in nerve damage following accidents and amputation surgery.
Compensatory hyperhidrosis has also been reported following botox (botulinum toxin A) injections for axillary hyperhidrosis. However, it is extremely rare and usually resolves within 4 to 6 months.
What does compensatory hyperhidrosis look like?
The areas affected can be small or large. The most frequently affected areas include the chest, flanks, abdomen and back. The lower limb and buttock areas can also be involved.
How is compensatory hyperhidrosis diagnosed?
The diagnosis is made when there is a clear history of ETS surgery prior to the presentation of sweating.
How is compensatory hyperhidrosis treated?
Treatment options will vary depending on the individual and their needs.
Compensatory hyperhidrosis can be difficult to treat. The chosen method of treatment will depend on how localised and severe the sweating is, and may include:
- Topical treatments, such as aluminium chloride hexahydrate (Driclor), anticholinergic creams, lotions and sprays (i.e., glycopyrrolate (0.5-3%).
- Botulinum toxin type A injections
- Oral medication, such as anticholinergic tablets (i.e., oxybutynin, propantheline bromide), propranolol, clonazepam, gabapentin.
What is the likely outcome of compensatory hyperhidrosis?
Compensatory hyperhidrosis will often need ongoing and persistent treatment. However, some individuals may notice that the amount of sweating decreases as they get older.
| Dr Davin Lim | January 2024 |
| Dr Davin Lim | February 2020 |