Category: Palmar

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Efficacy of Radiofrequency Combined with Chemical Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Cohort Study

J Vasc Interv Radiol. 2026 Oct 14:109135. doi: 10.1016/j.jvir.2026.109135. Online ahead of print.

ABSTRACT

PURPOSE: To investigate and compare the efficacy and safety of radiofrequency thermocoagulation (RFT) and combined with chemical sympatholysis (RFT-CS) for the treatment of primary palmar hyperhidrosis (PPH) (Hyperhidrosis Disease Severity Scale [HDSS] grade III or IV).

MATERIALS AND METHODS: Patients who underwent computed tomography-guided percutaneous thoracic sympathetic neurolysis (TSN) for PPH were retrospectively analyzed and divided into two treatment regimens: RFT (group RFT, N = 60, 120 sides) and RFT combined with CS (group RFT-CS, N = 58, 116 sides).

RESULTS: At 1, 3, 6, 12, and 24 months, the number of sides with HDSS III/IV in the RFT group was 29, 32, 41, 47, and 56, respectively; in the RFT-CS group, 25, 31, 36, 40, and 45, with no statistically significant intergroup differences at any time point (all P ≥ .05). Overall recurrence rates rose from 3.0% at 1 month to 19.5% at 24 months, with no significant differences between groups at any time point (all P ≥ .05). The RFT-CS group had significantly higher compensatory hyperhidrosis (CH) rates at 12 months (62.1% vs. 56.7%; P = .012) and 24 months (58.6% vs. 50.0%; P = .014), and a higher incidence of thoracic neuralgia at 1 month (P = .023) and 3 months (P = .011).

CONCLUSION: Both of the TSN treatment modes are effective for the treatment of severe PPH. Compared with RFT alone, RFT combined with CS does not seem to show better efficacy but increases the occurrence of CH and thoracic neuralgia.

PMID:42874704 | DOI:10.1016/j.jvir.2026.109135

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Robotic selective thoracic sympathectomy for hyperhidrosis: refined technique and anatomical variation

Multimed Man Cardiothorac Surg. 2026 Oct 14;2026. doi: 10.1510/mmcts.2026.094.

ABSTRACT

Primary hyperhidrosis substantially impairs quality of life. Conventional sympathectomy risks compensatory hyperhidrosis through trunk disruption, whilst selective sympathectomy preserves the trunk while dividing preganglionic and postganglionic fibres. We describe a technique refinement and a previously undescribed anatomical variant. A 23-year-old man had severe refractory palmar, axillary, plantar and gustatory hyperhidrosis (SSDS 4) profoundly affecting his confidence, social functioning and mental wellbeing, despite conservative management. He underwent staged bilateral robotic selective dorsal thoracic sympathectomy. Preganglionic and postganglionic fibres were divided from the top of T2 to T4 with trunk preservation. Refinements included resection from the top of the second rib, minimal diathermy with sharp dissection and non-touch technique using Maryland bipolar forceps. On the right, a postganglionic ramus ascending retrogradely from a displaced T3 ganglion into the third intercostal space was identified, previously undescribed in the literature, requiring dissection across the fourth rib to prevent hypothesized residual axillary hyperhidrosis. Both stages were completed 1 month apart, drain-free, with next-day discharge. There was complete symptom resolution, no Horner’s syndrome and no compensatory hyperhidrosis at follow-up.

PMID:42872462 | DOI:10.1510/mmcts.2026.094

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Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: ten-year clinical outcomes and a phenomenology-informed interpretation of body experience

Psychol Health Med. 2026 Oct 12:1-21. doi: 10.1080/13548506.2026.2746787. Online ahead of print.

ABSTRACT

Primary focal hyperhidrosis (PFH) is a chronic condition of excessive sweating disproportionate to thermoregulatory need, with substantial social and occupational burden. We evaluated outcomes of endoscopic thoracic sympathectomy (ETS)-symptom severity, quality of life, satisfaction, compensatory hyperhidrosis (CH), and recurrence-and interpreted dissatisfaction among patients who developed CH through a phenomenological lens. This retrospective single-centre cohort study included 72 patients who underwent ETS for PFH between January 2013 and December 2021, assessed preoperatively and at years one and five using the HDSS, DLQI, and Gillespie satisfaction scale. Sympathectomy level, technique, CH, recurrence, and psychosocial avoidance behaviours were recorded. Normality was rejected on Shapiro-Wilk testing; Wilcoxon signed-rank, Mann-Whitney U, chi-square, and Fisher’s exact tests were applied, with effect sizes as rank-biserial correlation (r) and Cramér’s V. The study received ethics approval (3 June 2026-39804) and adheres to the STROBE checklist. The cohort comprised 72 patients (44 male/28 female; mean age 22.8 ± 5.2 years; disease duration 7.3 ± 2.8 years). Palmar localisation predominated (63.9%); 90.3% avoided handshaking preoperatively. Mean HDSS declined from 3.29 ± 0.74 to 1.65 ± 0.96 at year five (p<0.001;r = 0.83); 61.5% reached HDSS = 1. Mean DLQI fell from 3.83 ± 0.67 to 1.94 ± 1.07 (p<0.001;r = 0.84); DLQI≥4 dropped from 68.1% to 7.7%. Five-year satisfaction was 76.6%. CH developed in 13 patients (18.1%), graded by level-T2 72.7%, T3 10.4%, T3-T4 0%(χ2 = 26.98;p<0.001; V = 0.61). Five-year DLQI was 3.23 ± 1.17 with CH versus 1.62 ± 0.77 without (p<0.001;r = 0.73); 84.6% of CH patients were undecided or regretful versus 7.8% without (p<0.001). Recurrence was 5.6%. ETS achieves durable symptom control and well-preserved long-term satisfaction in PFH. Marked dissatisfaction among patients who develop CH indicates that body-related awareness and social functioning are, for a meaningful subset, as decisive as physiological control. T2 sympathectomy should be reserved for clear anatomical indications, and informed consent should address the lived significance of CH beyond statistical risk disclosure.

PMID:42861922 | DOI:10.1080/13548506.2026.2746787

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Radiofrequency Ablation for Refractory Palmar and Plantar Hyperhidrosis: A Case Report

Anesth Pain Med. 2026 Feb 28;16(1):e172975. doi: 10.5812/aapm-172975. eCollection 2026 Feb 28.

ABSTRACT

INTRODUCTION: Palmar and plantar hyperhidrosis (PH) is characterized by sweat production that far exceeds thermoregulatory needs and often has substantial effects on daily functioning, social interaction, and mental health. The condition results from sympathetically mediated overstimulation of the eccrine glands, which are innervated by unmyelinated cholinergic C-type fibers. Radiofrequency ablation (RFA) offers a minimally invasive approach to symptom control in refractory PH through heat-mediated disruption of these sympathetic fibers. Reports describing staged upper- and lower-limb RFA for combined palmar and plantar disease in a single patient remain uncommon; this is the primary reason for presenting this case.

CASE PRESENTATION: A 21-year-old man (American Society of Anesthesiologists physical status I) presented with a 10-year history of progressive palmar and plantar hyperhidrosis that had not shown durable responses to conservative or prior interventional treatment. He used topical aluminum chloride for 2 months without meaningful benefit and subsequently underwent 2 sessions of palmar botulinum toxin injections 5 months apart, which reduced palmar sweating by an estimated 50 – 60% for approximately 2 months per session; the lower limbs were not treated. Eighteen months before the current admission, he underwent RFA of the right thoracic sympathetic chain at another center. This produced approximately 80% improvement in palmar sweating, although sweating persisted along the ulnar nerve distribution; the benefit lasted only approximately 4 months, after which symptoms recurred to baseline. During the present admission, staged RFA was performed bilaterally at L3, with different lower-limb protocols selected in advance based on the prior treatment response and the greater severity of plantar sweating on the left. Seven days later, bilateral RFA was performed at T3. At the 2-week, 1-month, and 7-month follow-up visits, the patient reported no compensatory sweating or change in cutaneous sensation. By his own assessment, overall sweating of the palms and soles was reduced by approximately 90% from baseline, with a satisfaction score of 9/10 and subjectively improved quality of life.

CONCLUSIONS: Staged RFA targeting both the thoracic and lumbar sympathetic chains appears to be a reasonably safe palliative option for patients with refractory combined palmar and plantar hyperhidrosis, with a more favorable complication profile than surgical sympathectomy. This case is considered reportable because it involves combined, staged treatment of both the upper and lower limbs in a single patient.

PMID:42763681 | PMC:PMC13589454 | DOI:10.5812/aapm-172975

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Efficacy and safety of rib-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation at two different targets for primary palmar hyperhidrosis: a randomized controlled trial

Ann Med. 2026 Dec;58(1):2717461. doi: 10.1080/07853890.2026.2717461. Epub 2026 Aug 26.

ABSTRACT

OBJECTIVES: To compare the efficacy and safety of computed tomography-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation (RFT) targeting the upper versus lateral margin of the fourth rib head for severe primary palmar hyperhidrosis (PPH).

METHODS: Patients with severe PPH were randomly divided into Group U (upper margin target) and Group L (lateral margin target). Outcome measures included 1-year recurrence rate, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI), palm skin temperature, finger perfusion index (PI), compensatory hyperhidrosis and patient satisfaction.

RESULTS: Both groups (n = 55 each, 110 sides) successfully underwent RFT. No preprocedural PI differences were found (p > 0.05). Immediately post-RFT, PI in Group L was significantly higher than in Group U (left p = 0.025, right p = 0.013). No significant differences in HDSS grades were observed between groups before and at 1 day, 2 weeks, 1 month and 3 months post-procedure. However, at 6 and 12 months, Group L showed significantly lower HDSS grades (left p = 0.033 and 0.016; right p = 0.039 and 0.025) and lower DLQI scores (p = 0.037 and 0.024) than Group U. Patient satisfaction did not differ within 6 months, but Group L had significantly higher satisfaction at 12 months (p = 0.036).

CONCLUSIONS: Targeting the lateral margin of the fourth rib head for RFT achieved greater efficacy, better quality of life and higher patient satisfaction compared to the upper margin target.

PMID:42647852 | DOI:10.1080/07853890.2026.2717461

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A retrospective study comparing T3 ganglionectomy and R4 sympathicotomy for reducing compensatory hyperhidrosis in primary palmar hyperhidrosis

J Thorac Dis. 2026 Jun 30;18(6):592. doi: 10.21037/jtd-2026-0904. Epub 2026 Jun 26.

ABSTRACT

BACKGROUND: Despite the high surgical success rate, postoperative compensatory hyperhidrosis (CH) remains a persistent concern in the treatment of primary palmar hyperhidrosis using endoscopic thoracic sympathectomy (ETS). This study aims to compare the early clinical outcomes of two surgical techniques-T3 ganglionectomy and R4 sympathicotomy-to determine which approach minimizes CH occurrence and enhances patient satisfaction.

METHODS: A retrospective analysis of medical records was conducted on patients who underwent either T3 ganglionectomy or R4 sympathicotomy for primary palmar hyperhidrosis at Gangnam Severance Hospital from January 2023 to December 2023. Demographic data and postoperative outcomes were evaluated. CH and degree of satisfaction were assessed during outpatient visits at 3 weeks and 3 months after surgery.

RESULTS: In this study, 44 patients underwent T3 ganglionectomy and 225 patients underwent R4 sympathicotomy. There were no statistically significant differences in baseline characteristics (age, sex, body mass index, smoking history, and family history) or operative complications between the two groups. However, CH at 3 weeks and 3 months after surgery was significantly lower in T3 ganglionectomy group [4 (9.1%) vs. 143 (63.6%); P<0.001, 5 (11.4%) vs. 150 (66.7%); P<0.001]. Additionally, patient satisfaction was significantly higher in the T3 ganglionectomy group compared to the R4 sympathicotomy group (P<0.001).

CONCLUSIONS: T3 ganglionectomy exhibited superior surgical outcomes in terms of both CH and patient satisfaction for primary palmar hyperhidrosis when compared to R4 sympathicotomy. Nonetheless, a larger prospective study with long-term follow-up is necessary to validate these findings.

PMID:42444879 | PMC:PMC13358477 | DOI:10.21037/jtd-2026-0904

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Clinical Characteristics and Treatment Patterns of Hyperhidrosis in Northern Hokkaido: A Single-Center Retrospective Descriptive Study

J Dermatol. 2026 Jul 1. doi: 10.1111/1346-8138.70373. Online ahead of print.

ABSTRACT

Hyperhidrosis is a common condition associated with a substantial negative impact on the quality of life. Several studies have described the clinical characteristics and disease burden of patients with hyperhidrosis in Japan. However, comparable real-world clinical data on hyperhidrosis from Hokkaido remain limited. We therefore evaluated real-world clinical practice patterns at our institution before and after the establishment of a specialized outpatient clinic for hyperhidrosis. In this retrospective study, we analyzed the data of 144 patients who presented with hyperhidrosis between November 2013 and March 2025. Patient characteristics, pathways to care, treatment modalities, and treatment continuation were evaluated using data from electronic medical records. The sex distribution, age at presentation, and subtype distribution of hyperhidrosis in our cohort were largely consistent with those reported in a prior nationwide survey. Primary axillary and/or palmar hyperhidrosis accounted for 87.5% of all cases. After launching a specialized clinic in April 2023, we observed a substantial increase in the number of patients who consulted for hyperhidrosis during visits for other dermatologic conditions; this finding may suggest the presence of previously unrecognized patients. However, changes in hospital access policies may also have influenced consultation patterns. The treatment continuation rates for axillary and palmar hyperhidrosis were both approximately 40%. Among the treatments for axillary hyperhidrosis, sofpironium bromide gel was prescribed most frequently, whereas glycopyrronium tosylate hydrate wipes showed a higher treatment continuation rate. In conclusion, the presence of a specialized outpatient clinic may improve access to care for patients with primary focal hyperhidrosis and facilitate the identification of previously unrecognized patients. However, treatment continuation remained suboptimal, highlighting the importance of improving continuity of care in hyperhidrosis management at our institution.

PMID:42385158 | DOI:10.1111/1346-8138.70373

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Ultra-Minimally Invasive Medical Thoracoscopic Sympathectomy for Primary Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2026 Mar 13;4(2):733-736. doi: 10.1016/j.atssr.2025.12.024. eCollection 2026 Jun.

ABSTRACT

Endoscopic thoracic sympathectomy is an effective treatment of primary palmar hyperhidrosis. Currently, single-port thoracoscopy is the primary surgical approach. Ensuring efficacy and safety, reducing surgical obstacles, minimizing tissue damage, and enhancing cosmesis and aesthetics of the surgical incision are focal in clinical research on endoscopic thoracic sympathectomy. Herein, we report a simple and minimally invasive surgical technique that avoids collisions due to the telescope and endodissector crossing in single-port thoracoscopic surgery. This refers to the application of medical thoracoscopy combined with nonintubation anesthesia and perfusion index monitoring in the treatment of primary palmar hyperhidrosis.

PMID:42267010 | PMC:PMC13245509 | DOI:10.1016/j.atssr.2025.12.024

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Living Through Sweat: A Qualitative Study of the Pre-Surgical Decision-Making Trajectory in Patients with Palmar Hyperhidrosis

Patient Prefer Adherence. 2026 May 4;20:589191. doi: 10.2147/PPA.S589191. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to explore the dynamic and ambivalent pre-surgical decision-making process of patients with palmar hyperhidrosis (PH), focusing on the “anxiety-sweating” feedback loop and the psychological factors influencing their treatment choices, particularly the interplay between psychological distress and the decision to pursue surgery.

PATIENTS AND METHODS: We conducted a qualitative descriptive phenomenological study in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured in-depth interviews were conducted with 19 adults who had lived with PH for more than 10 years and were considering surgical treatment. All interviews were conducted before surgery. Data were analyzed using NVivo 11 software and Colaizzi’s seven-step phenomenological method.

RESULTS: Analysis revealed a four-stage pre-surgical journey. First, patients initially normalized excessive hand sweating as a personal difference or familial trait, but gradually developed disease awareness as symptoms persisted and intensified. Second, PH imposed a substantial psychosocial burden, including functional limitations in study, work, and daily life, as well as reduced self-confidence, anticipatory anxiety, and social avoidance. Many participants described a self-reinforcing “anxiety-sweating” vicious cycle. Third, dissatisfaction with conservative treatments and increasing access to treatment-related information prompted patients to move from temporary coping strategies toward consideration of more durable interventions. Fourth, surgical deliberation was characterized by ambivalence: patients hoped surgery would relieve symptoms and restore social confidence, while also expressing concerns regarding compensatory sweating, postoperative discomfort, and recovery.

CONCLUSION: The pathway toward surgical consideration in patients with palmar hyperhidrosis was a dynamic and ambivalent process shaped by symptom normalization, psychosocial burden, prior treatment experiences, and concerns about surgical risks. These findings highlight the importance of addressing psychological and social experiences alongside technical counseling and support the value of shared decision-making in pre-surgical care.

PMID:42109704 | PMC:PMC13155398 | DOI:10.2147/PPA.S589191