Category: Hyperhidrosis

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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

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Systemic effect of sympathectomy in the treatment of localized hyperhidrosis

Updates Surg. 2025 Mar 10. doi: 10.1007/s13304-025-02163-8. Online ahead of print.

ABSTRACT

Hyperhidrosis is thought to result from excessive stimulation of sweat glands due to increased sympathetic activity; however, data on systemic responses following bilateral thoracic sympathectomy as the definitive treatment have not yet been sufficiently evaluated. This study, designed as a prospective cohort investigation, included 24 patients who underwent sympathectomy for palmar and axillary hyperhidrosis at our center in 2023, along with an age-matched control group of equal size. In the sympathectomy group, pupillometry measurements were performed 1 day before surgery and on the 7th postoperative day, while the control group underwent measurements at corresponding intervals. Data from the sympathectomy group were analyzed both preoperatively and postoperatively and compared with the control group. According to the Hyperhidrosis Disease Severity Scale, all patients had severe hyperhidrosis. Sympathectomy was performed at the T3 level in 9 patients and at both T3 and T4 levels in 15 patients. The postoperative satisfaction rate was recorded as 95.8%. No statistically significant differences were observed between preoperative pupillometry measurements of the sympathectomy group and those of the control group. However, when comparing preoperative and postoperative data within the sympathectomy group, significant differences favoring increased parasympathetic activity were noted in the latency of contractions and photopic low values (p = 0.016 and p = 0.038, respectively). Our study is one of the pioneering works to objectively demonstrate, through a quantitative method, that sympathectomy for hyperhidrosis enhances the parasympathetic system response in the ocular region.

PMID:40064815 | DOI:10.1007/s13304-025-02163-8

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Sofpironium topical gel, 12.45%, for the treatment of axillary hyperhidrosis: pooled efficacy and safety results from 2 phase 3 randomized, controlled, double-blind studies

J Am Acad Dermatol. 2025 Mar 5:S0190-9622(25)00393-7. doi: 10.1016/j.jaad.2025.02.086. Online ahead of print.

ABSTRACT

BACKGROUND: Current treatments for primary axillary hyperhidrosis are insufficient for some patients. Sofpironium topical gel is a retrometabolically-designed topical anticholinergic with rapid metabolism, which is associated with reduced side effects and targeted efficacy.

OBJECTIVE: To assess efficacy and safety of sofpironium topical gel for primary axillary hyperhidrosis.

METHODS: Cardigan I and Cardigan II were double-blind, randomized, controlled pivotal phase 3 studies of sofpironium topical gel, 12.45%, versus vehicle gel (1:1 randomization) for daily application to the axillae for 6 weeks.

RESULTS: The combined Phase 3 studies included 353 subjects in the treatment groups and 348 subjects in the control groups. For the co-primary endpoint of ≥2-point improvement from baseline to end of treatment on Hyperhidrosis Disease Severity Measure-Axillary-7, pooled analyses showed significantly better results for treatment versus control (p<0.0001). For the pooled co-primary endpoint of gravimetric sweat production at treatment end, the treatment group had greater reduction in sweat production (p=0.0002). Secondary endpoints also showed a statistically significant benefit for sofpironium topical gel versus control. Treatment was well-tolerated.

LIMITATIONS: Short treatment and follow-up periods.

CONCLUSION: Sofpironium topical gel, 12.45%, applied topically once daily before bedtime is effective and well-tolerated for treatment of primary axillary hyperhidrosis in patients ≥9 years old.

PMID:40054501 | DOI:10.1016/j.jaad.2025.02.086

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Hyperhidrosis: don’t sweat it

Intern Med J. 2025 Mar 7. doi: 10.1111/imj.70019. Online ahead of print.

ABSTRACT

Hyperhidrosis is an under-reported and under-treated condition that causes significant patient morbidity. Secondary causes require consideration, but the vast majority of cases are idiopathic. The condition is encountered by a range of clinicians, including neurologists, dermatologists and endocrinologists, and it pays to be familiar with the range of highly effective treatment options available for the treatment of both focal and generalised sweating disorders. We outline the treatment options and therapeutic approach to the most common hyperhidrosis phenotypes, with illustrative cases.

PMID:40051370 | DOI:10.1111/imj.70019

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Hyperhidrosis, anticholinergics, and dementia

Actas Dermosifiliogr. 2025 Feb 28:S0001-7310(25)00110-3. doi: 10.1016/j.ad.2024.11.026. Online ahead of print.

ABSTRACT

In recent decades, the use of certain oral anticholinergics for the treatment of hyperhidrosis has become widespread, often off-label but supported by multiple studies, including clinical trials, demonstrating their effectiveness and an apparently good safety profile. Similarly, various studies published in recent years have associated the use of anticholinergics to the development of dementia, particularly in elderly patients. Additionally, other studies have suggested that hyperhidrosis itself may be an early symptom of developing dementia. However, to date, no research has specifically linked the use of oral anticholinergics for hyperhidrosis treatment with the development of dementia. We present the currently available data on this controversial topic.

PMID:40024600 | DOI:10.1016/j.ad.2024.11.026

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Topical oxybutynin deodorant for axillary hyperhidrosis: a topic or a systemic effect? Rationale and design of the phase II today trial

J Vasc Bras. 2025 Feb 21;24:e20240098. doi: 10.1590/1677-5449.202400982. eCollection 2025.

ABSTRACT

Anticholinergics have been shown to enhance quality of life and reduce sweat in patients with hyperhidrosis. However, it remains unclear whether topical application specifically exerts local or systemic effects. This study’s primary aim is to assess topical oxybutynin’s impact on axillary hyperhidrosis. Twenty patients will be randomized into three groups. Group A will receive 2.5 mg of oral oxybutynin from day 1 to day 35 (on a variable frequency regimen). Group B will be administered a topical placebo for 35 days and Group C will receive a 10% oxybutynin topical spray, to be used twice daily for 35 days. The primary efficacy outcome will be the evaluation of the effectiveness of topical oxybutynin spray in treating hyperhidrosis. The TODAY trial will generate high-quality evidence on the effects of topical oxybutynin, assessing whether its impact is local or systemic in patients with axillary hyperhidrosis.

PMID:40012967 | PMC:PMC11864779 | DOI:10.1590/1677-5449.202400982

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Arabic Translation, Cultural Adaptation, and Validation of the Hyperhidrosis Disease Severity Scale (Ar-HDSS)

Healthcare (Basel). 2025 Feb 12;13(4):397. doi: 10.3390/healthcare13040397.

ABSTRACT

Background: Hyperhidrosis (HH) is characterized by excessive sweating, which affects quality of life. The Hyperhidrosis Disease Severity Scale (HDSS) is a four-point scale used to evaluate HH severity by measuring how much excessive sweating disrupts daily activities. This study aimed to translate, validate, and adapt the HDSS tool into Arabic. Methods: A quantitative, analytical, cross-sectional study was carried out from May to June 2024 on patients clinically diagnosed with HH. The process of translating the HDSS into Arabic involved three independent forward translations, followed by a preliminary version created by a reviewer. Three additional independent translators conducted backward translations. All of the versions were then revised and merged to produce the final version. Reliability was evaluated through a test-retest reliability approach to ensure the reproducibility of the results. For validity, we used construct validity to compare the HDSS with the HidroQoL index. Results: A total of 167 patients were included, with a mean age of 29 ± 9.02 years, and over half of the patients were male (61%). The interrater agreement between the HDSS test and the retest results was substantial, with a kappa coefficient of 0.732. Significant positive correlations were observed between the HDSS score and daily life (r = 0.413, p < 0.001), the psychological domain (r = 0.374, p < 0.001), and HidroQOL (r = 0.425, p < 0.001). Conclusions: Our findings demonstrate that the Arabic HDSS has excellent psychometric properties, including construct validity and reproducibility. Proper use of the Arabic HDSS will allow the effective assessment of HH severity.

PMID:39997272 | DOI:10.3390/healthcare13040397