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Comparison of the effectiveness and safety between ramicotomy and sympathetic chain interruption in the treatment of primary hyperhidrosis: a meta-analysis

Clin Auton Res. 2025 Feb 5. doi: 10.1007/s10286-025-01115-x. Online ahead of print.

ABSTRACT

OBJECTIVE: This meta-analysis evaluates the effectiveness and safety of ramicotomy versus sympathetic chain interruption (SCI) in treating primary hyperhidrosis (PH).

METHODS: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Web of Science, Ovid, Cochrane Library, CNKI, and Wanfang, covering studies from their inception through October 2024. A total of 10 studies involving 970 patients were included, with 504 patients undergoing ramicotomy and 466 receiving SCI.

RESULTS: The analysis revealed that patients undergoing ramicotomy experienced significantly lower rates of compensatory hyperhidrosis (CH) [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.85, P = 0.02], severe CH (OR 0.17, 95% CI 0.06, 0.47, P < 0.001), and postoperative hand dryness (OR 0.10, 95% CI 0.01-0.72, P = 0.02), along with a higher recurrence rate (OR 4.03, 95% CI 2.38, 6.85, P < 0.001). No significant differences were observed in operative duration [mean difference (MD) = 0.19, 95% CI -18.23, 18.60, P = 0.98 > 0.05], length of hospital stay (MD = -0.08, 95% CI -0.19, 0.04, P = 0.20 > 0.05), total postoperative complications (OR 0.41, 95% CI 0.07, 2.34, P = 0.32 > 0.05), or surgical satisfaction (OR 0.93, 95% CI 0.45, 1.91, P = 0.83 > 0.05).

CONCLUSIONS: While ramicotomy results in lower incidences of CH and postoperative hand dryness, its higher recurrence rate suggests that its application should be cautious to manage PH effectively.

PMID:39907932 | DOI:10.1007/s10286-025-01115-x

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The Creation of the Arabic Version of the Hyperhidrosis Quality of Life Index (HidroQoL) with Validation and Cross-Cultural Adaptation

Clin Cosmet Investig Dermatol. 2025 Jan 25;18:251-263. doi: 10.2147/CCID.S498688. eCollection 2025.

ABSTRACT

PURPOSE: Hyperhidrosis (HH) is characterized by excessive sweating, which can significantly affect quality of life. The Hyperhidrosis Quality of Life Index (HidroQoL©) is the latest tool that has been developed and validated for assessing the quality of life of patients with HH. Because of the absence of an Arabic version of the HidroQoL©, this research aimed to create, validate, and adapt the HidroQoL© into Arabic.

PATIENTS AND METHODS: A quantitative, analytical, cross-sectional study was conducted with HH patients followed up in dermatology or thoracic surgery clinics. We assessed the results reliability through internal consistency and reproducibility by assessing test‒retest reliability. For validity, we conducted an exploratory factor analysis with an interitem correlation matrix and a rotated component matrix.

RESULTS: A total of 167 participants were enrolled in this study; 61.1% were males, and 92.8% were Saudi. All 18 items of the HidroQoL©, including the daily life activities domain, psychosocial life domain, and whole HidroQoL©, had Cronbach’s alpha values above 0.7. The test-retest reliability assessment demonstrated strong reproducibility. The correlations between each item and the other 17 items of the scale were positive, ranging between 0.2 and 0.6, and the results of the components analysis suggested that the questionnaire has three domains. The correlation between the test-retest results of the HidroQoL© revealed a significant strong positive correlation (r=0.9, P˂0.001).

CONCLUSION: Our findings revealed excellent psychometric properties of the Arabic HidroQoL© in terms of structural and construct validity, internal consistency, and reproducibility. Proper utilization of the Arabic HidroQoL© adequately assesses the quality of life of those affected by HH.

PMID:39881852 | PMC:PMC11776515 | DOI:10.2147/CCID.S498688

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Acute Hyperhidrosis: A Clue to Underlying Autonomic Dysfunction and a Rare Neurological Disorder

Cureus. 2024 Dec 25;16(12):e76387. doi: 10.7759/cureus.76387. eCollection 2024 Dec.

ABSTRACT

Acute hyperhidrosis is characterized by excessive sweating. In the absence of other symptoms, the symptoms of sweating alone are often benign and may be ignored by patients and clinicians. Rarely, hyperhidrosis may be a harbinger of an underlying severe disease. Autonomic nervous system dysfunction leading to hyperactivity of the sympathetic nervous system can result in excessive sweating. This case report is about a gentleman who presented with acute hyperhidrosis, a symptom of autonomic dysfunction, which turned out to be a relapse of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. This case adds to the existing literature on cases of anti-LGI-1 encephalitis, a rare form of autoimmune encephalitis, and its varied clinical manifestations. It serves as a reminder to consider a wide range of differentials in patients who present with a seemingly nonspecific complaint such as excessive sweating.

PMID:39867015 | PMC:PMC11762238 | DOI:10.7759/cureus.76387

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Predictors of Compensatory Sweating and Satisfaction Following Endoscopic Thoracic Sympathetic Chain Clipping for Palmar/Axillary Hyperhidrosis

J Clin Med. 2025 Jan 8;14(2):326. doi: 10.3390/jcm14020326.

ABSTRACT

Background: Endoscopic thoracic sympathetic chain clipping (ETSC) is a definitive treatment for primary palmar and/or axillary hyperhidrosis (PPAH); however, compensatory sweating (CS) remains a feared complication. The aims of this study were to investigate the factors associated with CS and satisfaction with the treatment and to evaluate the post-operative quality of life (QoL). Methods: From January 2011 to August 2023, 180 patients who had undergone two-stage ETSC were prospectively asked to complete pre- and post-operative questionnaires on satisfaction, CS, and QoL in several daily activities. Results: Seventy-nine patients (45.7%) were male, and fifty-two (30.1%) were active smokers, with a mean body max index (BMI) of 22.6 ± 3.14. The majority of the population (112 (62.2%)) was operated on for combined palmar and axillary primary hyperhidrosis (PH), whereas 56 (31.1%) patients had only palmar and 12 (6.7%) only axillar PH. Only 122 (67.8%) patients completed ETSC on both sides and the follow-up in the study period. CS was 50.8% (62 patients), and there was severe CS in 7 cases (5.7%); 9 (7.4%) patients developed a gustatory CS. The final effectiveness of ETSC was 95.9%, with a reported improvement in QoL in 95.3% of cases (mainly in manual work and socialization); 94.1% of patients were satisfied and would undertake ETSC again. At multivariable analysis, only older age (>24 years) was a predictor of CS (p = 0.007) and severe CS (p = 0.042). No predictor for satisfaction was found. Conclusions: ETS by clipping can improve QoL in cases of palmar/axillary hyperhidrosis. Older patients must be informed of a higher risk of CS.

PMID:39860332 | DOI:10.3390/jcm14020326

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Endoscopic thoracic sympathectomy for primary hyperhidrosis: an over a decade-long follow-up on efficacy, impact, and patient satisfaction

J Thorac Dis. 2024 Dec 31;16(12):8292-8299. doi: 10.21037/jtd-24-1407. Epub 2024 Dec 20.

ABSTRACT

BACKGROUND: Endoscopic thoracic sympathectomy is a well-known and effective treatment for palmar and axillary primary hyperhidrosis (PHH). Its most frequent drawback and the main complaint among patients who underwent surgery is the appearance of compensatory sweating (CS). To date, no long-term studies using internationally standardized tools have assessed the efficacy and impact of this surgery on patients. In this study we performed a very long-term follow-up of the patients using an internationally validated tool. The aim of this article is to assess the technique as a treatment for hyperhidrosis, focusing on its long-term efficacy, side effects (CS), and patient satisfaction with the procedure.

METHODS: A closed cohort study was performed conducting a review of the clinical records to identify 100 consecutive patients who underwent bilateral endoscopic thoracic surgery with a minimum follow-up period of 2 years. Patients with diagnoses other than primary palmar or axillary hyperhidrosis or those for whom follow-up was impossible were excluded. A structured telephone survey, including the International Hyperhidrosis Society “Hyperhidrosis Disease Severity Scale” (HDSS) was conducted for all patients. Data were summarized using median (1st and 3rd quartiles) for quantitative variables and relative and absolute frequencies for qualitative variables. To study the likelihood of a patient recommending the surgery, a Bayesian logistic regression model was used reporting results as odds ratio (OR).

RESULTS: A total of 91 patients were included in the follow-up. The median follow-up duration was 10.66 (5.68, 11.98) years. The most affected zone was the hands (29.67%), and the most common sympathectomy levels were R2 and R3 (68.13%). The overall surgical efficacy rate was of 94.50% and CS appeared in 36.26% of the patients, with 75.76% of these cases being mild and severe in only one patient. In total, 97.8% of patients improved their HDSS score after surgery. The OR of recommending the surgery for a lower HDSS index was 0.24 and 0.18 for the apparition of CS. Despite it, 91.21% of patients recommend the surgery, with an overall satisfaction rate of 93.95%.

CONCLUSIONS: Endoscopic thoracic sympathectomy is an effective and safe treatment for palmar and axillary PHH, with a relatively low rate of CS which, when present, is typically mild, making it a highly satisfactory treatment option for patients.

PMID:39831229 | PMC:PMC11740069 | DOI:10.21037/jtd-24-1407

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Botulinum Toxin-loaded Detachable Dissolvable Microneedles for Primary Axillary Hyperhidrosis: A Pilot Study on Efficacy and Safety

J Clin Aesthet Dermatol. 2025 Jan;18(1):E61-E66.

ABSTRACT

OBJECTIVE: Botulinum toxin injection is a well-established treatment for primary hyperhidrosis. The botulinum toxin-loaded detachable dissolvable microneedles (BoNT-MNs) were developed in a result of disadvantages of the intradermal procedure. This pilot study aims to evaluate the efficacy and safety of BoNT-MNs.

METHODS: This within-subject study included ten adults (N=10; 100% female) with mild primary axillary hyperhidrosis. BoNT-MNs patches were prepared and each microneedle patch contained 15 units of onabotulinum toxin. BoNT-MNs and placebo patches were randomly applied to different sides of axilla. Iodine-starch test, dermatologists’ and patients’ satisfaction scores were assessed at baseline and Weeks 1, 2, 3, 4, 8, 12, 16, 20, and 24.

RESULTS: All ten female subjects completed the trial. Notably, on the BoNT-MNs side, iodine starch scores exhibited an onset at Week 2, with a 57.14-percent reduction at Week 12, returning to baseline after Week 20. Dermatologists’ and patients’ satisfaction scores were consistently superior to the placebo side from Week 2 and Week 1, respectively, until Week 16, with statistical significance (p<0.05) observed at Week 12 and Week 2.

LIMITATIONS: This study involved a limited number of female participants and administered a single, small dosage of botulinum toxin in the BoNT-MNs.

CONCLUSIONS: Botulinum toxin-loaded detachable dissolvable microneedles patches offer a safe and effective method for reducing axillary sweating.

CLINICAL TRIAL: This study was approved by the Institutional Review Board of Faculty of Medicine, Chulalongkorn University with IRB number 567/63, and registered in the Thai Clinical Trials Registry (Thaiclinicaltrials.org) under registration number TCTR20201230002.

PMID:39830825 | PMC:PMC11741174

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Comparative study between fractional laser assisted drug delivery of botulinum toxin versus botulinum toxin injection in primary palmar and axillary hyperhidrosis

Arch Dermatol Res. 2025 Jan 13;317(1):241. doi: 10.1007/s00403-024-03715-5.

ABSTRACT

Palmar hyperhidrosis is common condition that is challenging to treat. Nonsurgical treatments include topical antiperspirants, iontophoresis, anticholinergic drugs and botulinum toxin injections. To evaluate the safety and efficacy of ablative fractional laser therapy, combined with topically applied botulinum toxin versus its injection for the treatment of hyperhidrosis. This study included 40 patients with pimary hyperhydrosis divided into two groups. Group A (n = 20) diagnosed with primary axillary hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right axilla and botulinum toxin injection in left axilla. Group B (n = 20) diagnosed with primary palmer hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right palm and botulinum toxin injection in left palm. There was a statistically significant decrease in the hyperhidrosis disease severity scale (HDSS) in all subgroups after treatment as compared to before treatment. Following 3 months of treatment, the amount of sweat as detected by transepidermal water loss (TEWL) was statistically significantly lower in the injection subgroup in both the axillary group (p = 0.075) and the palmer group (p < 0.001). The use of both botulinum toxin injection and laser assisted botulinum toxin drug delivery were associated with significant improvement in the manifestation, disease severity and quality of life in the cases with both axillary and palmer hyperhidrosis. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A.

PMID:39804494 | DOI:10.1007/s00403-024-03715-5

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Validation of new items for diagnosing primary hyperhidrosis and the prevalence of primary hyperhidrosis

Clin Exp Dermatol. 2025 Jan 10:llaf013. doi: 10.1093/ced/llaf013. Online ahead of print.

ABSTRACT

BACKGROUND: The Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis developed evidence-based consensus criteria for diagnosing primary hyperhidrosis.

OBJECTIVES: To validate new questionnaire items for self-reported classification of primary hyperhidrosis based on the consensus criteria and to estimate the prevalence of primary hyperhidrosis.

METHODS: This is a cross-sectional diagnostic accuracy study. Questionnaires containing the index tests and reference tests were distributed to blood donors at blood centers between June and December of 2021 in Region Zealand, Denmark. The index tests were the two questions ‘Have you had troublesome sweating?’ and ‘Have you ever had troublesome sweating?’, which were used to create six single-item algorithms for classifying primary hyperhidrosis. The reference test was the consensus criteria.

RESULTS: Overall, 1,071 (95.9%) of 1,083 eligible blood donors completed the index tests. The reference test classified 59 participants as having primary hyperhidrosis and 980 as not having primary hyperhidrosis, generating a prevalence of 5.7% (95% confidence interval 4.4-7.3%). The algorithms with the highest combined sensitivity and specificity were algorithm 2 with a sensitivity of 0.94 (95% confidence interval 0.77-0.99) and a specificity of 0.94 (confidence interval 0.92-0.95), and algorithm 5 with a sensitivity of 0.94 (95% confidence interval 0.80-0.99) and a specificity of 0.92 (confidence interval 0.90-0.94).

CONCLUSIONS: With high diagnostic accuracy, these items allow for the identification of individuals with and without primary hyperhidrosis, which may prove useful in epidemiological research. Validation in the general population is warranted.

PMID:39790068 | DOI:10.1093/ced/llaf013