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T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2024 Dec 13;3(2):456-460. doi: 10.1016/j.atssr.2024.12.004. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for effectively treating palmar hyperhidrosis using the surgical technique of endoscopic thoracic sympathectomy (ETS). The variability in the location of T2 and T3 ganglia in relation to the ribs may contribute to inconsistent clinical outcomes after ETS.

METHODS: For the cadaver study, adult human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia by identifying their white rami communicantes. For the ETS group, T3 ganglionectomy ETS was performed. Surgical outcome and postoperative incidence of compensatory sweating were assessed.

RESULTS: A total of 74 pediatric patients underwent thoracoscopic T3 ganglionectomy. All patients were satisfied with the surgical outcomes. No patients complained of compensatory sweating. Forty cadavers were dissected: 25 adult female and 15 adult male. The findings showed that a high percentage of T2 ganglia are near the superior border of the third rib, while the T3 ganglion is near the fourth rib.

CONCLUSIONS: Because of the proximity of the T2 ganglion to the third rib, accidental thermal injury to the T2 ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be accomplished by using the white ramus communicans as a guide to accurately locate the T3 ganglion.

PMID:40525165 | PMC:PMC12167563 | DOI:10.1016/j.atssr.2024.12.004

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Seasonal Variation and Meteorological Correlates of Botulinum Toxin Injections for Axillary Hyperhidrosis in Japan: A Retrospective Analysis

Cureus. 2025 May 12;17(5):e83996. doi: 10.7759/cureus.83996. eCollection 2025 May.

ABSTRACT

BACKGROUND: Primary axillary hyperhidrosis, characterized by excessive underarm sweating without an underlying medical condition, significantly impairs quality of life. While various treatments exist, botulinum toxin type A injections are widely used in Japan, especially for severe cases. Although increased sweating is commonly observed during warmer months, the relationship between treatment demand and meteorological factors remains unclear. This study aims to determine whether there are seasonal differences in the number of axillary hyperhidrosis injections in Japan and to investigate their relationship with meteorological conditions.

METHODS: A retrospective, descriptive analysis was conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from fiscal years 2019 to 2022. Monthly injection data were correlated with meteorological variables (temperature, precipitation, solar radiation, wind speed, relative humidity, atmospheric pressure) obtained from the Japan Meteorological Agency. Seasonal differences were assessed using the Steel-Dwass test, and partial correlation analysis examined associations between meteorological factors and injection numbers.

RESULTS: The number of axillary hyperhidrosis injections peaked consistently in May and June each year, with significantly higher volumes in spring and summer compared to fall and winter (p<0.001). Partial correlation analysis revealed a strong positive correlation between all-day solar radiation and injection numbers (r=0.7193; p<0.0001), while temperature (r=-0.6052; p<0.0001) and wind speed (r=-0.441; p=0.0031) were negatively correlated. Relative humidity showed a moderate positive correlation (r=0.3626; p=0.0169). The seasonal peak preceded the hottest months, suggesting proactive treatment-seeking behavior.

CONCLUSIONS: Botulinum toxin injections for axillary hyperhidrosis in Japan display a reproducible seasonal pattern, with demand peaking in late spring and early summer. Solar radiation, rather than temperature alone, is most closely associated with treatment frequency, indicating that patients may seek care in anticipation of increased symptoms. These findings can inform healthcare resource planning and patient education to optimize the management of axillary hyperhidrosis.

PMID:40519391 | PMC:PMC12162388 | DOI:10.7759/cureus.83996

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Bibliometric Analysis in Hyperhidrosis: Recent Publication Trends from 2015 to 2025

Skin Appendage Disord. 2025 May 8:1-16. doi: 10.1159/000545767. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis is a chronic dermatologic condition that significantly impacts quality of life. While research has expanded in recent years, bibliometric analyses exploring publication trends remain limited. This study examined the 100 most-cited articles from 2015 to 2025 to assess research priorities.

METHODS: A Scopus search was conducted on January 2, 2025, using the terms “hyperhidrosis”, “primary hyperhidrosis”, “secondary hyperhidrosis”, and “excessive sweating”. Non-English, abstract-only, and non-hyperhidrosis focused articles were excluded. Two reviewers screened and identified the 100 most-cited publications. Data were analyzed for publication year, authorship, country, study design, journal, and topic focus. The Oxford Centre for Evidence-Based Medicine Level of Evidence (LoE) framework was used to assess study quality.

RESULTS: The majority (76%) of highly cited articles were published between 2015 and 2019. Randomized controlled trials (20%), cohort studies (18%), and case-control studies (16%) were the most common study types. Using LoE assessment, 33% of studies were level 1 (high-quality evidence). Research on treatments (55%) dominated, followed by quality of life (12%) and outcome measures (11%). The USA led in publication output.

CONCLUSION: This bibliometric analysis identifies evolving research priorities toward minimally invasive treatments and patient-centered outcomes, providing direction for future research and improvements in clinical practice.

PMID:40510941 | PMC:PMC12158438 | DOI:10.1159/000545767

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PAI1 regulating CHRNA1 contributes to primary focal hyperhidrosis: Clinical and experimental studies

Mol Ther Nucleic Acids. 2025 May 16;36(2):102566. doi: 10.1016/j.omtn.2025.102566. eCollection 2025 Jun 10.

ABSTRACT

Primary focal hyperhidrosis (PFH) is a debilitating condition characterized by localized excessive sweating, yet its underlying mechanisms remain poorly understood. In this study, sweat gland tissues from PFH patients (n = 204) and healthy controls (n = 60) were analyzed to assess the mRNA and protein levels of plasminogen activator inhibitor 1 (PAI-1) and nicotinic acetylcholine receptor alpha 1 subunit (CHRNA1) using RT-qPCR and western blotting. Primary sweat gland cells were isolated for in vitro experiments, and a pilocarpine-induced hyperhidrosis mouse model was established to evaluate the therapeutic effect of recombinant human PAI-1 (rhPAI-1). PFH patients showed significantly reduced PAI-1 expression and elevated CHRNA1 expression compared to controls (p < 0.01). Treatment with rhPAI-1 downregulated CHRNA1 and aquaporin 5 (AQP5) expression in sweat gland cells and decreased sweat secretion and serum acetylcholine levels in vivo. These results suggest that PAI-1 negatively regulates CHRNA1 and AQP5 expression, offering new insights into the molecular pathology of PFH and identifying PAI-1 as a potential therapeutic target for hyperhidrosis.

PMID:40503176 | PMC:PMC12155562 | DOI:10.1016/j.omtn.2025.102566

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Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review

Aesthetic Plast Surg. 2025 Jun 11. doi: 10.1007/s00266-025-04909-6. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical efficacy of botulinum toxin type A (BTX-A) injections for the treatment in primary axillary hyperhidrosis is a subject of ongoing debate. This study aims to consolidate and analyze the available evidence regarding the use of BTX-A as a therapeutic intervention for this conclusion.

METHOD: This study was conducted in accordance with PRISMA guidelines and registered with PROSPERO. We included RCTs on BTX-A injections for PAH, comparing it to placebo or other treatments. A comprehensive literature search was conducted in multiple databases up to May 2024. Out of identified articles, some underwent full-text review and were included in the qualitative and quantitative synthesis. Statistical analyses were done using RevMan5.4, and study quality was assessed with the Cochrane risk of bias tool. Subgroup and sensitivity analyses were also conducted.

RESULT: Twelve studies met our inclusion criteria (n = 904). BTX-A injection showed greater sweat reduction compared to placebo by gravimetric measurement (116.12 [92.68-139.57]; P < 0.05). BTX-A injection showed comparable sweat reduction to other treatments by gravimetric measurement (26.14 [- 26.8, 79.07]; P = 0.333) and HDSS (- 0.85 [- 1.20, 0.50], P = 0.413). The pain score of BTX-A injection is comparable to other treatments (- 0.41 [- 1.11, 0.29], P = 0.456). BTX-A injection exhibited fewer side effects compared to other treatments (0.18 [0.07, 0.43], P < 0.05).

CONCLUSION: In primary axillary hyperhidrosis, BTX-A injection significantly reduces sweat production compared with placebo, and there is no statistically significant difference compared with other treatments. BTX-A injection had less fewer side effects compared with other treatments.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40500510 | DOI:10.1007/s00266-025-04909-6

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Primary Hyperhidrosis in Children: Current Perspectives and Therapeutic Options

Pediatr Ann. 2025 Jun;54(6):e196-e202. doi: 10.3928/19382359-20250321-03. Epub 2025 Jun 1.

ABSTRACT

Primary hyperhidrosis is a common condition that often begins before age 18 years and frequently presents to the pediatric primary care provider. It can have significant negative impacts on a child’s quality of life (QOL) and emotional well-being. There are a variety of treatment options available that have been shown to decrease symptoms, as well as improve QOL. These treatments include over-the-counter antiperspirants, prescription antiperspirants, topical anticholinergics, iontophoresis, systemic anticholinergics, injectable botulinum toxin, and surgical sympathectomy. Treatment of this condition is lifelong and often nuanced. It is imperative for the pediatric practitioner to be well versed in the risks and benefits, as well as proper usage, of these various therapeutic modalities. With this knowledge, effective treatment plans can be crafted to improve both the physical and mental health of affected children. [Pediatr Ann. 2025;54(6):e196-e202.].

PMID:40489364 | DOI:10.3928/19382359-20250321-03

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Achieving high patient satisfaction after sympathectomy through preoperative thoracoscopic sympathetic nerve block in primary hyperhidrosis

J Thorac Dis. 2025 Apr 30;17(4):2050-2055. doi: 10.21037/jtd-2024-2145. Epub 2025 Apr 21.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a frequent complication following sympathectomy, influencing patient satisfaction. This study was established to evaluate the impact of bilateral thoracoscopic sympathetic nerve block (TSNB) on patient satisfaction after sympathectomy in the treatment of primary hyperhidrosis.

METHODS: From March 2021 to August 2023, 52 patients with primary palmar and craniofacial hyperhidrosis underwent TSNB at T3 using a 2-mm thoracoscope under local anesthesia. One week later, they decided whether to proceed with sympathectomy. Satisfaction was assessed using a 100-point scale, and patients were divided into two groups based on CH occurrence after sympathectomy. The groups were compared in terms of sex, age, hyperhidrosis site, and satisfaction scores.

RESULTS: Among 52 patients who underwent TSNB, 35 (67.31%) proceeded to sympathectomy, and CH occurred in 18 (51.43%) of these patients, while the remaining 17 patients (48.57%) did not develop CH. No significant differences were observed between the CH and no-CH groups regarding age (26.61±9.02 vs. 25.41±10.09 years, P=0.66), sex (61.11% vs. 52.94% male, P=0.88), or primary hyperhidrosis site (palmar: 77.78% vs. 88.24%, P=0.66). Satisfaction scores were comparable between the CH group (92.50±7.33) and the no-CH group (96.18±4.52), with no statistically significant difference (P=0.15).

CONCLUSIONS: Sympathectomy is associated with a high incidence of CH. Through TSNB, patients could preoperatively experience potential effects, including CH, enabling informed surgical decisions. Patients who developed CH reported high satisfaction levels comparable to those without CH, underscoring the utility of TSNB in improving patient-centered outcomes.

PMID:40400983 | PMC:PMC12090137 | DOI:10.21037/jtd-2024-2145

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A Comparative Study of Aluminum Chloride, Oxybutynin Chloride, and Botulinum Toxin in the Treatment of Primary Focal Hyperhidrosis

J Cutan Med Surg. 2025 May 21:12034754251336233. doi: 10.1177/12034754251336233. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (HH) is a common challenging problem. Different treatment modalities are present with no clear evidence favoring one modality over the others.

OBJECTIVES: To assess and compare the efficacy of aluminum chloride hexahydrate (ACH), oxybutynin chloride, and botulinum toxin type-A (BTX-A) in treating primary focal HH.

PATIENTS AND METHODS: Sixty-six patients of both sexes, with primary HH, were equally and randomly divided into 3 groups. Group (A) received a single session of intradermal (BTX-A), Group (B) received topical application of ACH lotion 25% once daily, and Group (C) received oral oxybutynin chloride 10 mg daily for 3 months. The clinical response was assessed using the Hyperhidrosis Severity Scale (HDSS) and the patients were followed up for 6 months.

RESULTS: The 3 modalities were effective and safe in the treatment of primary HH, but the clinical response was significantly higher in the BTX-A group (81.8% excellent response) compared to the other 2 modalities. The reduction of hyperhidrosis was also maintained for a longer period in the BTX-A group.

CONCLUSION: Among the 3 modalities, BTX-A was associated with a higher reduction of HDSS scores. A single session was sufficient; however, pain and high cost are limiting factors.

PMID:40396355 | DOI:10.1177/12034754251336233