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The comparative study of letibotulinum toxin A and onabotulinum toxin A in treatment of primary axillary hyperhidrosis

Arch Dermatol Res. 2025 Apr 1;317(1):661. doi: 10.1007/s00403-025-04069-2.

ABSTRACT

Primary axillary hyperhidrosis (PAH) is a challenging condition characterized by excessive underarm sweating. The U.S. Food and Drug Administration has approved onabotulinum toxin A (OnaBTX-A, Botox®, Allergan Inc, USA) as the only botulinum toxin treatment for severe axillary hyperhidrosis, and it has demonstrated positive results. Recently, the off-label use of letibotulinum toxin A (LetiBTX-A, Hugel®, Hugel Inc, Korea) has risen significantly for cosmetic purposes due to its effectiveness. For the treatment of primary axillary hyperhidrosis, the authors proposed that LetiBTX-A is at least as effective as OnaBTX-A. To evaluate the efficacy and safety of letibotulinum toxin A (LetiBTX-A) in comparison to onabotulinum toxin A (OnaBTX-A) for treating primary axillary hyperhidrosis (PAH). All participants with a diagnosis of moderate to severe primary axillary hyperhidrosis (Hyperhidrosis Disease Severity Scale (HDSS) score ≥ 2) received random injections of 50 U of LetiBTX-A in one armpit and 50 U of OnaBTX-A in the other site. HDSS score and hyperhidrosis area were measured by using the Minor’s iodine starch test. Participant satisfaction was evaluated at 1, 3, and 6 months following the injection. Onset of action and adverse events were also assessed. All 30 participants completed the study protocol, with the mean age was 34.44 ± 7.82 years and most of the participants were female. The mean age at onset was 20.47 ± 3.01 years and more than 50% of participants had a HDSS score of 3. There was no statistically significant difference observed in the reduction of HDSS scores, hyperhidrosis area, and participant satisfaction between the axillae treated with LetiBTX-A and those treated with OnaBTX-A at 1, 3 and 6 months after injections. The median onset of action of both LetiBTX-A and OnaBTX-A were 2 ± 1 day (p = 0.317). Procedure-related pain was comparable between 2 formulations (P = 0.876). No serious adverse event was observed. This study concluded that LetiBTX-A and OnaBTX-A demonstrate comparable efficacy and safety profiles in treating primary axillary hyperhidrosis (PAH).

PMID:40167830 | DOI:10.1007/s00403-025-04069-2

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Effectiveness of Sofpironium Bromide in Patients with Primary Axillary Hyperhidrosis Who Experienced Residual or Recurrence of Axillary Odor after Surgery for Axillary Osmidrosis

J Plast Reconstr Surg. 2024 Jul 5;4(1):13-19. doi: 10.53045/jprs.2023-0067. eCollection 2025 Jan 27.

ABSTRACT

OBJECTIVES: Sofpironium bromide is the first topical anticholinergic drug approved in Japan for the treatment of primary axillary hyperhidrosis. This study aimed to investigate the effectiveness of sofpironium bromide in patients with primary axillary hyperhidrosis who experienced residual axillary odor or recurrence of axillary odor after surgery with subdermal excision of apocrine glands by skin flap procedure for axillary osmidrosis.

METHODS: A total of 56 patients who underwent surgery for axillary osmidrosis at our hospital between January 2022 and April 2023 were included in this study. Axillary odor and sweat volume were evaluated with patient-reported visual analog scale in 56 patients who underwent surgery for axillary osmidrosis and 13 patients administered with sofpironium bromide after the surgery.

RESULTS: Surgery in patients with axillary osmidrosis significantly improved axillary odor and excessive sweating by approximately 90% and approximately 54%, respectively. Treatment with sofpironium bromide in patients with axillary hyperhidrosis after the surgery significantly improved axillary odor and excessive sweating by approximately 70% and approximately 63%, respectively.

CONCLUSIONS: These results suggest that sofpironium bromide is effective in patients with axillary hyperhidrosis after the surgery. Since this study was conducted with a small number of patients in a retrospective single-arm design, it is necessary to validate the results in a prospective controlled study with a large number of patients.

PMID:40160959 | PMC:PMC11950559 | DOI:10.53045/jprs.2023-0067

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Perioperative Hyperhidrosis: Case Reports of Two Patients and Literature Review

Cureus. 2025 Feb 20;17(2):e79370. doi: 10.7759/cureus.79370. eCollection 2025 Feb.

ABSTRACT

Perioperative hyperhidrosis (POH) can present as excessive sweating within hours after anesthetic induction and may persist up to 24 hours postoperatively following general anesthesia. While commonly a benign finding, excessive or persistent POH can be disconcerting for the patient and can occasionally signify an underlying infection, electrolyte disturbances, or autonomic dysregulation. A systematic approach to managing POH has not been published. We report the cases of two patients with excessive sweating under general anesthesia, highlighting their clinical presentation and management. We also propose a clinical algorithm to standardize the management of POH.

PMID:40125170 | PMC:PMC11929548 | DOI:10.7759/cureus.79370

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Which patients are more likely to experience compensatory hyperhidrosis after endoscopic thoracic sympathectomy: a meta-analysis and systematic review

PeerJ. 2025 Mar 18;13:e19097. doi: 10.7717/peerj.19097. eCollection 2025.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a common consequence of sympathectomy, which can adversely affect patients’ quality of life after surgery. Understanding the factors that influence the occurrence of CH and severe compensatory hyperhidrosis (SCH) is crucial for effective management and counseling of patients undergoing this procedure.

MATERIALS AND METHODS: We registered the protocol in International Prospective Register of Systematic Reviews (CRD42024592389) and following PRISMA guidelines. We searched PubMed, EMBASE, and Web of Science databases for studies published up to September 11, 2024. A systematic literature search identified a total of 10 studies involving 3,117 patients. The primary outcome was the number of CH or SCH. The secondary outcome was the weighted mean difference calculated based on identified related factors. When pooling results or conducting a meta-analysis was not feasible, the study findings were presented in a narrative descriptive format.

RESULTS: The overall incidence of CH was found to be 0.62 (95% confidence interval CI [0.51-0.72]), and four studies totaling 1,618 patients regarding the occurrence of severe compensatory hyperhidrosis, the overall incidence of CH was found to be 0.23 (95% CI [0.12-0.34]). Older age, higher body mass index (BMI) and smoking history correlated positively with CH incidence. In addition, higher BMI level is also associated with the occurrence of SCH (1.20 95% CI [1.01-1.39], p < 0.0001).

CONCLUSION: The findings of this meta-analysis highlight important demographic and lifestyle factors that contribute to the development of CH and SCH following sympathectomy. Older patients, smokers, and those with higher BMI may be at greater risk for these conditions.

PMID:40124609 | PMC:PMC11927556 | DOI:10.7717/peerj.19097

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Quality of life and compensatory hyperhidrosis following thoracoscopic sympathectomy: a retrospective cohort study

J Cardiothorac Surg. 2025 Mar 21;20(1):160. doi: 10.1186/s13019-025-03393-y.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis (PH), characterized by excessive palm sweating, significantly impacts quality of life (QOL) in affected individuals, particularly young adults. This study aimed to evaluate the efficacy of video-assisted thoracoscopic sympathectomy (VATS) in improving symptoms and QOL among 816 patients with PH.

METHODS: This retrospective study included 816 patients with PH, all of whom underwent VATS under general anaesthesia. One-year follow-up via phone surveys was used to assess symptom changes and side effects. Paired t tests were used to compare pre- and postoperative QOL scores, and linear regression was used to analyse the effects of various factors on QOL changes.

RESULTS: The cohort consisted of 359 males and 457 females, with a mean age of 24.98 ± 6.47 years. All patients underwent VATS, with a 91% success rate, and the mean operative time was 53.2 ± 24.7 min. Postoperative complications included 43 cases of incision infections, 194 cases of chest pain, and 82 cases of pneumothorax; compensatory hyperhidrosis (CH) occurred in 53.80% of the T3 group and 43.74% of the T4 group after one month, with significant differences noted at the 24-month follow-up. Furthermore, the QOL scores significantly improved from 38.25 ± 3.61 preoperatively to 69.07 ± 3.48 at one year postoperatively (P < 0.05).

CONCLUSIONS: VATS offers a reliable and effective treatment for severe PH, significantly enhancing patients’ overall QOL. Future research should focus on long-term outcomes and the applicability of this treatment across diverse populations to further advance the clinical management of PH.

PMID:40119450 | DOI:10.1186/s13019-025-03393-y

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Wearable Sensor Technology for Hyperhidrosis Management in Individuals With Prosthetic Limbs: A Narrative Review

Cureus. 2025 Feb 16;17(2):e79109. doi: 10.7759/cureus.79109. eCollection 2025 Feb.

ABSTRACT

Wearable sensor technologies offer a cutting-edge solution for managing hyperhidrosis in individuals with prosthetic limbs, directly addressing the complex challenges posed by excessive sweating at the prosthetic-skin interface. Excessive moisture can lead to skin breakdown, increased risk of infections, and compromised prosthetic fit, all of which reduce functionality and user comfort. Advanced biosensors embedded within the system continuously monitor moisture levels and skin temperature in real time, providing precise data on sweat production and skin conditions. This data is relayed to mobile health platforms, allowing users and clinicians to make informed, immediate adjustments, such as modifying prosthetic materials, adjusting fit, or activating integrated cooling mechanisms to mitigate complications. Integrating real-time feedback into the device’s function offers a personalized, noninvasive approach, enhancing both comfort and long-term prosthetic performance while surpassing traditional hyperhidrosis treatments like systemic medications, topical therapies, or invasive interventions such as botulinum toxin injections. However, limitations such as sensor calibration issues in fluctuating environmental conditions, sensor durability, and ensuring user compliance remain challenges. Future advancements may incorporate machine learning algorithms to predict and preempt hyperhidrosis episodes, offering even more precise control and adaptability. With the potential for seamless integration into telemedicine platforms, wearable sensor technologies have the potential to revolutionize the management of hyperhidrosis for prosthetic users, offering a personalized, real-time solution that addresses both medical and functional challenges.

PMID:40109775 | PMC:PMC11920845 | DOI:10.7759/cureus.79109

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CT-guided Percutaneous Ethanol Sympatholysis for Hyperhidrosis: How I Do It

Radiology. 2025 Mar;314(3):e241430. doi: 10.1148/radiol.241430.

ABSTRACT

Hyperhidrosis, excessive sweating from the eccrine sweat glands, is caused by overactivity of the sympathetic nerves. Facial, axillary, and/or palmar hyperhidrosis (excessive sweating of the face, armpits, and hands) has a reported prevalence of 1%-1.6%. This condition is initially treated conservatively using a combination of topical and pharmacologic treatments. Surgical sympathectomy or percutaneous sympatholysis are treatment options for severe hyperhidrosis (grade 3 or 4) that does not respond to conservative management. The aim of intervention is to permanently disrupt the sympathetic signal by targeting the thoracic vertebral levels T2, T3, and T4 of the paravertebral ganglia, located on the anterolateral surface of the vertebral body. This review presents the step-by-step technique for CT-guided percutaneous ethanol sympatholysis and discusses patient selection for the procedure, potential complications, and treatment outcomes. Although more than 90% of patients report complete resolution of hyperhidrosis immediately after sympatholysis, as many as 40% report symptom recurrence within 6 months. The probability of remaining hyperhidrosis-free long term (ie, more than 6 months) after CT-guided sympatholysis is 60%. Procedural risks include a 15% risk of compensatory hyperhidrosis elsewhere in the body, 8% risk of Horner syndrome (mostly self-limiting), 5% risk of pneumothorax, and 3% risk of severe intercostal neuralgia due to nontarget ethanol deposition. Despite the risks, this intervention can be life-altering for those with severe disease.

PMID:40100019 | DOI:10.1148/radiol.241430

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Compensatory sweating after thoracoscopic sympathectomy for primary focal hyperhidrosis: a series of 820 cases

Interdiscip Cardiovasc Thorac Surg. 2025 Mar 13:ivaf063. doi: 10.1093/icvts/ivaf063. Online ahead of print.

ABSTRACT

OBJECTIVES: Primary hyperhidrosis is a functionally and socially limiting condition. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis. However, post-sympathectomy compensatory sweating remains a challenge in clinical practice.

METHODS: Record analysis of patients who underwent thoracoscopic sympathectomy between 2002 and 2020. Emphasis was given to demographic data, site of complaint, functional and social impairment, procedure performed, postoperative results, and compensatory sweating.

RESULTS: A total of 820 patients were included (age 23.8 [7.3] years, body mass index-BMI 22.3 [3.0] kg/m2, 66.3% female). The palmoplantar (44.3%) and palmoplantar-axillary (41.6%) sites were the most affected, followed by the axillary (12.3%) and craniofacial sites (1.8%). On a 0 to 4 scale, functional impairment was significantly greater in the palmoplantar group (p < 0.001) and social impairment in the axillary, palmoplantar-axillary, and craniofacial groups (p < 0.001). The degree of compensatory sweating after surgery was minimal in groups palmoplantar (74.9%), palmoplantar-axillary (70.4%), axillary (63.4%), and mild in the craniofacial group (66.7%). The bivariate analyses showed significant differences in the compensatory sweating variable for age, sex, BMI, and site. The multiple analysis by logistic regression showed BMI, sex, and the palmoplantar-axillary, axillary, and craniofacial variables to be significant for compensatory sweating.

CONCLUSIONS: Thoracoscopic sympathectomy was an effective procedure for controlling primary focal hyperhidrosis, with tolerable compensatory sweating in the patients analyzed in this study.

PMID:40080705 | DOI:10.1093/icvts/ivaf063

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Impact of primary hyperhidrosis on patients’ quality of life in Damietta governorates

Arch Dermatol Res. 2025 Mar 12;317(1):551. doi: 10.1007/s00403-025-04034-z.

ABSTRACT

Primary hyperhidrosis (PH) is the presence of increased sweating in the absence of a physiological trigger or underlying identifiable pathological cause. The aim of this study was to assess the impact of primary hyperhidrosis on patients’ quality of life in Damietta; one of Egypt’s governorates. This cross sectional study included 302 patients aged between 8 and 35 years and fulfilling diagnostic criteria of primary hyperhidrosis. Data were collected using a hyperhidrosis quality of life index (HidroQoL) questionnaire and to assess the severity of hyperhidrosis (HH), we used the hyperhidrosis Disease Severity Scale (HDSS). The majority of the participants had experienced some emotional sequelae as a result of the hyperhidrosis, and these were the most prevalent psychosocial domains of hyperhidrosis quality of life index. Patients were often very much embarrassed (57.6%) and were often nervous (51%) about sweat breaking out at any moment and very much frustrated (46.7%). Hyperhidrosis has a profound psycho-social impact on patients. Results demonstrated a significantly impactful and distressing illness that warrants equal attention as other more well-known skin conditions. Further multicenter large-scale and adequately powered randomized controlled trials are needed to provide an integrated approach for tackling the psychosocial impairment associated with hyperhidrosis.

PMID:40072576 | DOI:10.1007/s00403-025-04034-z