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Advances in the Management of Hyperhidrosis

Skin Therapy Lett. 2026 Mar;31(2):4-7.

ABSTRACT

Hyperhidrosis (HH), a condition characterized by excessive sweating beyond thermoregulation, significantly impairs quality of life. Conventional medications to treat HH include aluminum chloride hexahydrate, systemic anticholinergics, and botulinum toxin injections. New treatments have emerged including glycopyrronium bromide, sofpironium bromide, targeted alkali thermolysis, and microwave devices. This paper reviews the mechanism of action, efficacy, safety, and practical considerations associated with these treatments.

PMID:41839170

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Prediction of compensatory hyperhidrosis severity after endoscopic thoracic sympathectomy in primary hyperhidrosis patients based on rough set analysis

J Thorac Dis. 2026 Feb 28;18(2):146. doi: 10.21037/jtd-2025-aw-2074. Epub 2026 Feb 25.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) remains the most prevalent postoperative adverse event following endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis (PH). Current predictive models lack reliability in estimating CH severity. This study introduces a novel predictive framework utilizing rough set theory to establish decision rules for CH stratification.

METHODS: In this single‑center retrospective cohort study, clinical data from 225 PH patients undergoing ETS were analyzed, including 37 predictive indicators. These variables were subjected to correlation analysis, regression analysis, and rough set analysis with CH severity.

RESULTS: There were 93.3% (210/225) of patients exhibiting CH following ETS, with 33.3% classified as grade III CH, and no grade IV CH was noted. Body mass index (BMI), the level of sympathectomy, and the temperature difference of the right hand after surgery and before anaesthesia were shown to be significantly correlated with CH on correlation analysis. However, no valid regression model was established with significant correlations involving indicators for further regression analysis. By switching to rough set analysis, four predictive rules for grade III CH were derived: (I) BMI >22 kg/m2 + initial onset age of PH >11 years, 84% accuracy; (II) BMI 19.5-22 kg/m2 + surgical age >28.5 years, 82% accuracy; (III) BMI 18.5-19.4 kg/m2 + postoperative right-hand temperature >36.6 ℃, 77% accuracy; (IV) BMI <18.5 kg/m2 + postoperative right-hand temperature <37.0 ℃ + initial PH onset age <10 years, 71% accuracy.

CONCLUSIONS: Rough set analysis provides a promising approach for exploring the patterns of CH severity following ETS in patients with PH, and thus which merits further investigation through multicenter, large-sample studies. The four preliminary decision rules for predicting grade III CH derived from rough set analysis show potential clinical relevance but remain tentative, as their utility requires validation in prospective cohorts prior to widespread clinical application.

PMID:41816421 | PMC:PMC12972784 | DOI:10.21037/jtd-2025-aw-2074

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Robotic ramicotomy for palmar and axillary hyperhidrosis

Multimed Man Cardiothorac Surg. 2026 Mar 4;2026. doi: 10.1510/mmcts.2025.150.

ABSTRACT

Ramicotomy is a surgical approach that focuses on dividing the rami communicantes of the sympathetic chain and has been introduced as a treatment for palmar and axillary hyperhidrosis with the goal of reducing the incidence of compensatory sweating. Evidence from recent randomized controlled studies and meta-analyses suggests that this technique effectively reduces localized excessive sweating while resulting in lower rates of compensatory hyperhidrosis and less postoperative hand dryness compared with traditional sympathetic chain interruption. Despite these advantages, ramicotomy has been linked to a greater likelihood of symptom recurrence, underscoring the importance of thorough patient selection and detailed preoperative counseling about potential long-term outcomes. Overall quality of life improvements and patient satisfaction appear similar between ramicotomy and conventional sympathicotomy, although ramicotomy may provide benefits in decreasing the severity or extent of compensatory sweating. In cases of axillary hyperhidrosis, combining ramicotomy with endoscopic sympathetic blockade does not seem to significantly change patient satisfaction or overall rates of compensatory sweating compared with blockade alone, though it may influence the pattern or distribution of compensatory symptoms. In summary, ramicotomy is a reasonable surgical option for carefully selected patients who prioritize a lower risk of compensatory hyperhidrosis, accepting the trade-off of a potentially higher recurrence rate.

PMID:41778845 | DOI:10.1510/mmcts.2025.150

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The role of acupuncture in managing hyperhidrosis and vasomotor sweating: evidence, mechanisms, and gaps

Complement Ther Med. 2026 Feb 27:103337. doi: 10.1016/j.ctim.2026.103337. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Hyperhidrosis and thermoregulatory disorders, including menopausal and treatment-induced hot flushes, can significantly impair quality of life. While acupuncture has been proposed as a potential non-pharmacological treatment for these conditions, the quality and consistency of available evidence remain unclear. This review aims to critically assess the current literature on acupuncture for various kinds of hyperhidrosis, evaluating its clinical efficacy, mechanisms of action, and limitations.

METHODS: A narrative review was conducted based on English-language, PubMed-indexed published clinical studies, randomised controlled trials (RCTs), and meta-analyses investigating acupuncture as a treatment for primary hyperhidrosis, emotional sweating, paraneoplastic sweating, and hot flushes in both menopausal and breast cancer populations. Particular attention was paid to study quality, intervention protocols, and outcome durability.

RESULTS: Evidence for the use of acupuncture in primary, emotional, and paraneoplastic hyperhidrosis is limited to small, often uncontrolled studies with significant methodological shortcomings. In contrast, acupuncture for menopausal and breast cancer-related hot flushes is supported by multiple RCTs and meta-analyses involving over 1,000 participants, demonstrating short-term improvements in frequency and severity of symptoms. However, effects on hot flushes generally diminish after three months post-treatment. Mechanistically, acupuncture is thought to act via modulation of the autonomic nervous system and neuropeptide regulation, though precise pathways remain to be fully elucidated.

CONCLUSION: Acupuncture may offer short-term benefits for hot flushes in menopausal and breast cancer populations, but current evidence for its effectiveness in other kinds of hyperhidrosis remains weak and inconclusive. High-quality, standardised clinical trials with long-term follow-up are needed to better define its role in the integrative management of thermoregulatory disorders.

PMID:41765151 | DOI:10.1016/j.ctim.2026.103337

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A multi-center, cross-sectional questionnaire survey in Japan (KOBE study) exploring factors associated with primary focal hyperhidrosis

Front Med (Lausanne). 2026 Feb 9;13:1739715. doi: 10.3389/fmed.2026.1739715. eCollection 2026.

ABSTRACT

BACKGROUND/AIM: Primary focal hyperhidrosis (PFH) is defined as a condition characterized by excessive sweating in localized areas, which causes patients to experience difficulties in daily life, regardless of temperature or psychological stress. Previous surveys in Japan have revealed that the majority of patients with PFH may not visit medical institutions. Identifying the factors potentially associated with PFH is useful for detecting unmedicated patients and providing appropriate medical interventions. In this study, we explored factors associated with PFH in a multi-center, cross-sectional questionnaire survey (KOBE study).

METHODS: This study enrolled patients aged 5-64 years who visited 1 of the 24 dermatological institutions in Japan between April and July 2024 and completed a questionnaire (registered at the Japan Registry of Clinical Trials: jRCT1050250083). A combination of univariate and multivariate logistic regression analyses was performed to explore the associated factors.

RESULTS: A total of 3,617 participants were included in the analysis. The prevalence of PFH was 15.0% (544 of 3,617 participants). Among the potential associated factors, the odds ratios (ORs) were higher in order of axillary osmidrosis (OR = 5.440), psoriasis (OR = 1.830), wet earwax (OR = 1.780), a definite Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score (OR = 1.780), a doubtful HADS-A score (OR = 1.460), and smoking (OR = 1.450). Receiver operating characteristic (ROC) curve analysis indicated that a HADS-A score of 6 was the optimal cutoff value for suspecting PFH.

CONCLUSION: These findings may aid in detecting unmedicated potential patients in routine clinical practice and promoting active intervention for the disease, ultimately improving the quality of life and well-being of patients with PFH.

PMID:41737399 | PMC:PMC12927475 | DOI:10.3389/fmed.2026.1739715

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Compensatory Hyperhidrosis After ETS: Temporal Evolution and Predictors

Thorac Cardiovasc Surg. 2026 Feb 24. doi: 10.1055/a-2819-1705. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.

METHODS: This multicentre retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 (n=60), R4 (n=72), R2-R4 (n=81), and asymmetric interruption (n=13). Compensatory hyperhidrosis severity was assessed at 6, 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of Compensatory hyperhidrosis, recurrence, and patient satisfaction.

RESULTS: Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels (p=0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR=2.18, p=0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis -was the main determinant of dissatisfaction (OR=2.48, p<0.001). Smoking history independently predicted recurrence (OR=2.09, p=0.042).

CONCLUSIONS: Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.

PMID:41734813 | DOI:10.1055/a-2819-1705

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Early onset, genital, and axillary involvement are strongly associated with impaired quality of life in hyperhidrosis patients

Medicine (Baltimore). 2026 Feb 20;105(8):e47698. doi: 10.1097/MD.0000000000047698.

ABSTRACT

Hyperhidrosis is a chronic condition marked by excessive sweating that significantly affects patients’ quality of life (QoL). However, this issue is both underrecognized and undertreated, and its physical, emotional, and social burdens are often underestimated, particularly in Middle Eastern populations. A cross-sectional, analytical study was conducted across Saudi Arabia between May 2024 and April 2025. Participants were recruited through dermatology clinics and a Telegram support group. They completed an online self-administered Arabic questionnaire regarding demographics, medical history, the Arabic Hyperhidrosis Disease Severity Scale, and the Hyperhidrosis Quality of Life Index. A total of 276 Arabic-speaking adults with hyperhidrosis participated. The mean age was 27.3 years (SD ± 8.2), and 57.6% of the respondents were male. Most participants (82.9%) had severe hyperhidrosis (Hyperhidrosis Disease Severity Scale grades 3-4). The mean HidroQoL scores were 10.3 out of 14 for daily life and 16.6 out of 22 for psychosocial life, indicating moderate to severe burden. Disease severity showed the strongest association with QoL impairment (P = .001). Other factors significantly associated with daily functioning included lower education level, lower income, and sweating in the axillae and genital region, while genital involvement and low education were associated with psychosocial distress. Hyperhidrosis imposed a substantial QoL burden, especially in patients with severe symptoms and lower socioeconomic status. The findings supported the need for early detection and tailored treatment strategies and the use of culturally validated patient-reported outcome measures like the Arabic HidroQoL in clinical practice.

PMID:41731822 | DOI:10.1097/MD.0000000000047698

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Onset of Parkinson’s Disease Identified Through Hyperhidrosis: A Middle-Aged Woman Case Report

Reports (MDPI). 2026 Feb 2;9(1):50. doi: 10.3390/reports9010050.

ABSTRACT

Background and Clinical Significance: Parkinson’s disease (PD) is a neurodegenerative condition characterized by motor and non-motor symptoms, which significantly impact patients’ autonomy and quality of life levels. Basically, the PD diagnosis is clinical and, in some cases, can be challenging to diagnose due to the heterogeneity of the symptoms. Case Presentation: A 58-year-old woman who, during the COVID-19 lockdown, referred to experiences of slight tremor and stiffness in her left hand at rest, but without any other associated symptoms. Firstly, after consulting a general practitioner (GP), the patient was diagnosed with cervical radiculopathy (CR), presented as essential tremor and stiffness to the hand. Nevertheless, during the initial physiotherapy evaluation, the motor symptoms did not fully align with the diagnosis of CR. For this reason, the presence of non-motor symptoms was thoroughly investigated. Notably, hyperhidrosis was identified as a significant non-motor symptom, leading to the patient’s subsequent referral to a neurologist, who finally diagnosed PD. Conclusions: This case report highlights the essential role of physiotherapists in conducting independent assessments and comprehensive investigations of all patients’ symptoms, even when a medical diagnosis has already been established. This is particularly crucial when there is suspicion that musculoskeletal symptoms may be indicative of neurodegenerative diseases such as PD, which is well-known for its extensive array of non-motor symptoms. Especially in women with PD, non-motor symptoms tend to emerge earlier and in a more subtle manner than motor symptoms, making diagnosis challenging. Therefore, meticulous anamnestic data collection is essential, especially by physiotherapists working in direct-access settings.

PMID:41718300 | DOI:10.3390/reports9010050

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Aquagenic palmar keratoderma associated with palmoplantar hyperhidrosis: a case report

Oxf Med Case Reports. 2026 Feb 18;2026(2):omag001. doi: 10.1093/omcr/omag001. eCollection 2026 Feb.

ABSTRACT

Aquagenic palmoplantar keratoderma is a rare dermatological condition characterized by mild palmar thickening and burning pain upon exposure to water. A 31-year-old female with aquagenic keratoderma of the palms associated with palmoplantar hyperhidrosis presenting with wrinkling and hyperkeratosis within minutes of hand contact with water, resolving quickly after drying. While cystic fibrosis is a known association, most cases remain idiopathic. Treatment options such as 20% aluminum hydroxide, aluminum chloride (15%-20%), urea, salicylic acid, and botulinum toxin can be challenging, with the patient being evaluated after treatment with 16% aluminum chloride.

PMID:41716924 | PMC:PMC12916001 | DOI:10.1093/omcr/omag001