Both hyperhidrosis and erythrophobia have their origin in a malfunction of the sympathetic nervous system. This nerve, which is defined as the sympathetic gangliated cord, passes along the thoracic spine directly below the pleura and is thus accessible by thoracoscopy.
Increased sweating is defined as hyperhidrosis. Affected persons produce more sweat than they would need for regulating their body temperature.
Erythrophobia is the definition for the fear of blushing whereas the distinct blushing in the face is increasing the unease in this situation even more. In most cases not the blushing itself but the fear of uncontrolled occurrence is the problem.
The increased production of sweat in hyperhidrosis patients might affect the entire body or only certain body parts. Typically hands, armpits or feet are affected the most. Many patients believe that they need to accept increased sweating as they don't know that there are treatment options, but they are heavily impaired by it.
Although it is possible to quantify the severity level of sweating compared to the entire population (iode starch test, gravimetry etc.) the disease is generally clinically diagnosed and basing on the patient's suffering. Laboratory diagnostic in cases of increased sweating is made if other diseases shall be excluded, such as thyroid diseases or hormonal disorders.
Besides various local treatment options such as deodorants, aluminium hydroxide cremes or iontophoresis for sweating at hands and feet also the medical therapy (anticholinergic drugs, beta blockers, neuroleptics) is possible.
Another option of treatment is the local injection of botulinum toxin. However this treatment needs to be repeated if the effect is deteriorating (in most cases after 3 to 6 months). The price is individually defined and basing on the effort and consumption. The therapy costs are often not covered by health insurances.
A definite solution offers the thoracoscopic sympathectomy. Thereby a defined part of the sympathetic trunk, which regulates the sweating in the respective area, is cut or extracted. This procedure is performed minimally invasively performed with the so-called keyhole surgery. The surgery takes place under general anesthetic and requires a one-day hospital stay.
With this surgery the hands of the patients are absolutely dry in 95 to 100 percent of the cases. After surgeries often (in about 50%) mildly increased sweating occurs at another body part (compensatory hyperhidrosis), what is not impairing them very much according to the operated patients. In 1.5 to 2 percent of the cases the patients are however very impaired by the compensated sweating and even more than they have been with the initial extent of hyperhidrosis. Some of them are heavily impaired in daily life.
Extremely rarely after the surgery a so-called Horner's syndrome occurs. This means that the upper lid is slightly hanging and the pupil is narrowed. But this has no influence on the visual performance. In experienced hands this can be avoided.
Partial removal of the sympathetic trunk for treatment of hyperhidrosis
With erythrophobia the uncontrollable blushing of face skin is paired with a sensation of heat in the head region or certain facial parts.
The diagnosis is also made clinically. The sudden, situational erythema formation is proving.
The therapy consists mainly in a behavioral therapy. The aim of the therapy is that patients are learning that blushing is no disaster and that it is an annoying but not a dangerous reaction of their bodies. Before the surgery takes place a psychological examination is required to make use of all non-surgical treatment options.
If the conservative therapy is not showing the desired results the same operation as described above for hyperhidrosis can be considered. The potential complications are the same, whereas the risk for a Horner's syndrome is higher due to the localization of the sympathetic trunk part, which needs to be cut, and the success rate is lower by a few percent.