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T2-sparing vs T2-including sympathectomy for hyperhidrosis: a meta-analysis on compensatory sweating

J Cardiothorac Surg. 2026 Jun 25;21(1):445. doi: 10.1186/s13019-026-04464-4.

ABSTRACT

BACKGROUND: Sympathectomy is the definitive treatment for primary hyperhidrosis, offering high success rates. However, compensatory sweating (CS) remains a frequent and distressing complication. The level of ganglionic resection, particularly the inclusion of T2, may influence CS incidence, but evidence remains inconsistent.

METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to July 2025, to identify studies comparing T2-sparing versus T2-including sympathectomy for primary hyperhidrosis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. For outcomes with significant heterogeneity, leave-one-out sensitivity analyses were performed.

RESULTS: Eleven studies involving 3,090 patients were included. Of these, 47.2% underwent T2-sparing sympathectomy and 52.8% underwent T2-including procedures. T2-sparing sympathectomy was associated with a significantly lower incidence of overall CS (OR 0.38; 95% CI 0.21-0.67; p = 0.0009; I2 = 65%) and severe CS (OR 0.43; 95% CI 0.28-0.64; p < 0.0001; I2 = 19%). Subgroup analyses confirmed consistent results across both randomized and non-randomized studies, as well as across short-term (≤ 12 months) and long-term (> 12 months) follow-up periods. Sensitivity analyses confirmed the robustness of the findings. No publication bias was detected.

CONCLUSIONS: T2-sparing sympathectomy was associated with a significantly lower incidence of CS. These findings support avoiding T2 when feasible to minimize postoperative morbidity. Further prospective studies are needed to confirm these results.

PMID:42351253 | DOI:10.1186/s13019-026-04464-4

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Self-Reported Prevalence and Awareness of Hyperhidrosis Among Medical Students at the Gulf Medical University, UAE

Cureus. 2026 May 21;18(5):e109385. doi: 10.7759/cureus.109385. eCollection 2026 May.

ABSTRACT

Introduction Hyperhidrosis is a condition characterized by excessive sweating that can negatively affect quality of life and psychosocial well-being. This study aimed to determine the self-reported prevalence of hyperhidrosis symptoms and the level of awareness among medical students at Gulf Medical University, Ajman, UAE. Methods A cross-sectional study was conducted over six months among students aged ≥18 years across six academic programs. Ethical approval was obtained, and a pilot study was conducted before data collection. A structured self-administered questionnaire developed from a literature review and reviewed by specialists was used to assess sociodemographic characteristics, self-reported excessive sweating symptoms suggestive of hyperhidrosis, awareness, and associated factors. Data were analyzed using descriptive and inferential statistics. Results Out of 600 eligible participants, 480 completed the questionnaire (response rate: 80%). The majority were female (75.4%) and aged 18-21 years. The prevalence of self-reported excessive sweating symptoms suggestive of hyperhidrosis was 36.8% (171/465; 95% CI: 32.4%-41.2%). Among participants reporting excessive sweating symptoms who responded to the relevant items, the axilla was the most commonly affected site, followed by the face and hands. Afternoon was the most frequently reported time of excessive sweating. Awareness of hyperhidrosis was low, with only 31.7% of participants reporting prior knowledge, most commonly through the internet and academic sources. A significantly higher prevalence of self-reported excessive sweating symptoms was observed among males compared to females (p<0.01). Smoking was also significantly associated with self-reported excessive sweating symptoms (p<0.05). No significant associations were observed with age group, body mass index, or diabetes status. A proportion of participants reported a positive family history of similar symptoms. Conclusion Self-reported excessive sweating symptoms suggestive of hyperhidrosis were relatively common among medical students, but awareness remained low. While associations with gender and smoking were observed, the findings should be interpreted cautiously, given the use of self-reported data rather than clinically validated diagnostic criteria. Increased awareness and further studies using validated diagnostic instruments are recommended.

PMID:42326313 | PMC:PMC13283055 | DOI:10.7759/cureus.109385

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Efficacy and safety of topical sofpironium bromide in treating primary axillary hyperhidrosis: systematic review and meta-analysis of randomized controlled trials

Dermatol Reports. 2026 Jun 16. doi: 10.4081/dr.2026.10853. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of topical sofpironium bromide in patients with primary axillary hyperhidrosis (PAH) in various published randomized controlled trials (RCTs). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Scopus, Web of Science, Embase, and Medline databases through April 30, 2025, using keywords related to sofpironium and PAH. The odds ratio (OR) or mean difference (MD) was calculated using a random effects model with 95% confidence interval (CI). Three RCTs of sofpironium were included in the meta-analysis, with 1,209 patients with PAH. Sofpironium, compared to the vehicle, showed statistically significant improvement in the Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) score (OR=2.35, 95% CI [1.82 to 3.04]), Hyperhidrosis Disease Severity Scale (HDSS) score (OR=2.02, [1.46 to 2.79]), Dermatology Life Quality Index (DLQI) score (MD=-2.75, [-3.58 to -1.92]), and gravimetric sweat production (MD=-26.39, [-44.65 to -8.12]). The incidences of anticholinergic adverse events (AEs) and application site AEs were statistically higher in patients treated with sofpironium. Sofpironium is an effective treatment for PAH associated with significant improvements in sweat reduction and QOL for patients, although the drug also has risks of anticholinergic or application-site AEs.

PMID:42299704 | DOI:10.4081/dr.2026.10853

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Sofpironium Bromide for the Treatment of Primary Axillary Hyperhidrosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cureus. 2026 May 9;18(5):e108570. doi: 10.7759/cureus.108570. eCollection 2026 May.

ABSTRACT

Sofpironium bromide is a recently approved topical anticholinergic agent for primary axillary hyperhidrosis, developed using a retrometabolic approach to limit systemic side effects. However, randomized evidence about its effects has not yet been quantitatively synthesized. This meta-analysis aimed to assess the efficacy and safety of topical sofpironium bromide compared with a vehicle in patients with primary axillary hyperhidrosis. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing topical sofpironium bromide with a vehicle. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models in Review Manager 7.2.0 (The Cochrane Collaboration, London, UK). Five RCTs, including 1,398 participants, were included, of whom 807 (57.7%) received topical sofpironium bromide. Compared with vehicle, sofpironium bromide significantly reduced gravimetric sweat production (GSP) at the end of treatment (MD -25.27 mg; 95% CI -40.15 to -10.40) and increased the likelihood of achieving at least a two-point improvement in the Hyperhidrosis Disease Severity Scale (HDSS) (RR 3.27; 95% CI 1.57-6.80). Discontinuation due to adverse events was more frequent in the sofpironium bromide group (RR 9.83; 95% CI 1.82-53.17). Adverse events occurred more frequently in the treatment group, including application-site dermatitis (RR 5.26; 95% CI 2.05-13.48), application-site pain (RR 4.63; 95% CI 2.08-10.28), pruritus (RR 5.97; 95% CI 1.98-18.02), and dry mouth (RR 15.45; 95% CI 5.35-44.62). No significant increase in serious adverse events was observed. Overall, this meta-analysis supports the efficacy of sofpironium bromide for primary axillary hyperhidrosis, while treatment decisions should be weighed against potential side effects.

PMID:42272574 | PMC:PMC13246317 | DOI:10.7759/cureus.108570

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Ultra-Minimally Invasive Medical Thoracoscopic Sympathectomy for Primary Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2026 Mar 13;4(2):733-736. doi: 10.1016/j.atssr.2025.12.024. eCollection 2026 Jun.

ABSTRACT

Endoscopic thoracic sympathectomy is an effective treatment of primary palmar hyperhidrosis. Currently, single-port thoracoscopy is the primary surgical approach. Ensuring efficacy and safety, reducing surgical obstacles, minimizing tissue damage, and enhancing cosmesis and aesthetics of the surgical incision are focal in clinical research on endoscopic thoracic sympathectomy. Herein, we report a simple and minimally invasive surgical technique that avoids collisions due to the telescope and endodissector crossing in single-port thoracoscopic surgery. This refers to the application of medical thoracoscopy combined with nonintubation anesthesia and perfusion index monitoring in the treatment of primary palmar hyperhidrosis.

PMID:42267010 | PMC:PMC13245509 | DOI:10.1016/j.atssr.2025.12.024

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Risk factors for compensatory hyperhidrosis following CT-guided percutaneous radiofrequency sympathectomy: A retrospective observational study

Medicine (Baltimore). 2026 May 22;105(21):e48976. doi: 10.1097/MD.0000000000048976.

ABSTRACT

Compensatory hyperhidrosis (CH) is a significant complication following surgery for primary hyperhidrosis, impairing patients’ postoperative experience and quality of life. Radiofrequency sympathectomy (RFS) is one of the main minimally invasive surgeries for hyperhidrosis, yet high-risk factors and patient experiences of postoperative CH are rarely reported. This retrospective observational study (Strengthening the Reporting of Observational Studies in Epidemiology compliant) aimed to identify significant risk factors for CH after RFS and to develop a dynamic nomogram for individualized risk prediction. A total of 410 primary hyperhidrosis patients who underwent RFS between January 2018 and March 2023 were enrolled. A CH database was established via systematic follow-up to track postoperative sweating patterns. Detailed clinical assessments included the Numeric Rating Scale (NRS), Hyperhidrosis Disease Severity Scale (HDSS), and Hospital Anxiety and Depression Scale (HADS). Advanced statistical techniques, including logistic regression analysis, were used to identify potential risk factors for CH. Of the 410 patients, 281 (68.5%) developed CH, with 105 (25.6%) reporting moderate-to-severe symptoms. Multivariate analysis revealed 4 significant predictors of CH: male gender (odds ratio [OR] = 1.69); higher NRS scores (OR = 1.16); lower immediate postoperative HDSS (OR = 0.48); higher preoperative HADS scores (OR = 1.11). A dynamic, web-based nomogram was also developed to provide personalized CH risk prediction. Male gender, higher intraoperative NRS scores, lower immediate postoperative HDSS, and higher preoperative HADS scores were identified as independent risk factors. The constructed dynamic nomogram enables individualized risk prediction and supports clinicians in providing personalized preoperative counseling and perioperative management for patients undergoing RFS.

PMID:42175438 | DOI:10.1097/MD.0000000000048976

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Analysis of all video-assisted thoracic sympathectomy for hyperhidrosis over 9 years in Brazil: trends, costs and in-hospital mortality over 200 million inhabitants

Ann Vasc Surg. 2026 May 19:S0890-5096(26)00376-6. doi: 10.1016/j.avsg.2026.05.070. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (HH) causes substantial functional and psychosocial impairment. While anticholinergic therapy has become first-line treatment, video-assisted thoracic sympathectomy (VATS) remains the only definitive option for patients with refractory disease. Large-scale, real-world data on the safety and utilization of VATS for HH at a national level remain limited.

METHODS: We conducted a nationwide retrospective analysis including all patients who underwent VATS for HH in Brazil between 2015 and 2023. Data were obtained from publicly available governmental databases encompassing both public and private healthcare systems. Procedure volumes, demographic characteristics, regional distribution, reimbursement, in-hospital mortality, and healthcare-sector differences were analyzed.

RESULTS: A total of 26,980 VATS procedures for HH were performed during the study period. Most patients were female (64.5%) and aged 15-39 years (82.7%). Procedures were predominantly performed in the private healthcare system (75.3%), with marked regional concentration in the Southeast (48.3%) and South (29.5%) regions. Overall in-hospital mortality was extremely low (0.048%) and did not differ significantly between public and private sectors. Despite similar safety profiles, the mean cost per procedure in the private system was substantially higher, resulting in more than 90% of total national expenditures.

CONCLUSIONS: In this nationwide cohort of nearly 27,000 procedures, VATS sympathectomy for primary hyperhidrosis demonstrated an low mortality rate across both public and private healthcare systems, supporting its role as a safe definitive surgical therapy when appropriately indicated. The marked disparities in access and cost highlight important system-level differences but do not appear to compromise procedural safety.

PMID:42162859 | DOI:10.1016/j.avsg.2026.05.070

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Living Through Sweat: A Qualitative Study of the Pre-Surgical Decision-Making Trajectory in Patients with Palmar Hyperhidrosis

Patient Prefer Adherence. 2026 May 4;20:589191. doi: 10.2147/PPA.S589191. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to explore the dynamic and ambivalent pre-surgical decision-making process of patients with palmar hyperhidrosis (PH), focusing on the “anxiety-sweating” feedback loop and the psychological factors influencing their treatment choices, particularly the interplay between psychological distress and the decision to pursue surgery.

PATIENTS AND METHODS: We conducted a qualitative descriptive phenomenological study in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured in-depth interviews were conducted with 19 adults who had lived with PH for more than 10 years and were considering surgical treatment. All interviews were conducted before surgery. Data were analyzed using NVivo 11 software and Colaizzi’s seven-step phenomenological method.

RESULTS: Analysis revealed a four-stage pre-surgical journey. First, patients initially normalized excessive hand sweating as a personal difference or familial trait, but gradually developed disease awareness as symptoms persisted and intensified. Second, PH imposed a substantial psychosocial burden, including functional limitations in study, work, and daily life, as well as reduced self-confidence, anticipatory anxiety, and social avoidance. Many participants described a self-reinforcing “anxiety-sweating” vicious cycle. Third, dissatisfaction with conservative treatments and increasing access to treatment-related information prompted patients to move from temporary coping strategies toward consideration of more durable interventions. Fourth, surgical deliberation was characterized by ambivalence: patients hoped surgery would relieve symptoms and restore social confidence, while also expressing concerns regarding compensatory sweating, postoperative discomfort, and recovery.

CONCLUSION: The pathway toward surgical consideration in patients with palmar hyperhidrosis was a dynamic and ambivalent process shaped by symptom normalization, psychosocial burden, prior treatment experiences, and concerns about surgical risks. These findings highlight the importance of addressing psychological and social experiences alongside technical counseling and support the value of shared decision-making in pre-surgical care.

PMID:42109704 | PMC:PMC13155398 | DOI:10.2147/PPA.S589191