Category: Palmar

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Sustained efficacy of botulinum toxin in primary palmar hyperhidrosis: a systematic review of duration, quality of life, and satisfaction

Front Med (Lausanne). 2026 Mar 25;13:1795512. doi: 10.3389/fmed.2026.1795512. eCollection 2026.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a debilitating condition characterized by excessive sweating of the palms, significantly impairing patients’ quality of life (QoL). Botulinum toxin (BoNT) injections are a widely used treatment, but data on their sustained efficacy, impact on QoL, and patient satisfaction remain limited.

OBJECTIVE: This systematic review aimed to systematically evaluate the duration of BoNT efficacy, its effects on QoL, and patient-reported satisfaction and improvement in PPH.

METHODS: This systematic review followed PRISMA guidelines. PubMed, Cochrane Library, and Scopus databases were searched from 2005 to 2024. Studies included randomized controlled trials, observational studies, and clinical trials involving adults with PPH treated with BoNT injections. Outcomes included duration of efficacy, QoL measures (e.g., DLQI), and patient satisfaction.

RESULTS: Nineteen studies met inclusion criteria. The duration of BoNT efficacy ranged from 3 to 12 months, with BoNT-A demonstrating a mean efficacy of 4.9-9.5 months, while BoNT-B showed a shorter duration of 3.8-4.6 months. Higher doses and repeated injections were associated with prolonged symptom control. Disease severity influenced efficacy, with moderate cases experiencing longer relief compared to severe cases. QoL improvements were substantial, with Dermatology Life Quality Index (DLQI) scores showing significant reductions post-treatment. Patient satisfaction rates ranged from 65 to 100%, though this effect diminished over time.

CONCLUSION: BoNT is an effective and well-tolerated treatment for PPH, offering substantial symptom relief, improved QoL, and high patient satisfaction. Future research should focus on standardized protocols and long-term follow-up to optimize treatment strategies.

PMID:41958548 | PMC:PMC13056597 | DOI:10.3389/fmed.2026.1795512

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Robotic ramicotomy for palmar and axillary hyperhidrosis

Multimed Man Cardiothorac Surg. 2026 Mar 4;2026. doi: 10.1510/mmcts.2025.150.

ABSTRACT

Ramicotomy is a surgical approach that focuses on dividing the rami communicantes of the sympathetic chain and has been introduced as a treatment for palmar and axillary hyperhidrosis with the goal of reducing the incidence of compensatory sweating. Evidence from recent randomized controlled studies and meta-analyses suggests that this technique effectively reduces localized excessive sweating while resulting in lower rates of compensatory hyperhidrosis and less postoperative hand dryness compared with traditional sympathetic chain interruption. Despite these advantages, ramicotomy has been linked to a greater likelihood of symptom recurrence, underscoring the importance of thorough patient selection and detailed preoperative counseling about potential long-term outcomes. Overall quality of life improvements and patient satisfaction appear similar between ramicotomy and conventional sympathicotomy, although ramicotomy may provide benefits in decreasing the severity or extent of compensatory sweating. In cases of axillary hyperhidrosis, combining ramicotomy with endoscopic sympathetic blockade does not seem to significantly change patient satisfaction or overall rates of compensatory sweating compared with blockade alone, though it may influence the pattern or distribution of compensatory symptoms. In summary, ramicotomy is a reasonable surgical option for carefully selected patients who prioritize a lower risk of compensatory hyperhidrosis, accepting the trade-off of a potentially higher recurrence rate.

PMID:41778845 | DOI:10.1510/mmcts.2025.150

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Compensatory Hyperhidrosis After ETS: Temporal Evolution and Predictors

Thorac Cardiovasc Surg. 2026 Feb 24. doi: 10.1055/a-2819-1705. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.

METHODS: This multicentre retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 (n=60), R4 (n=72), R2-R4 (n=81), and asymmetric interruption (n=13). Compensatory hyperhidrosis severity was assessed at 6, 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of Compensatory hyperhidrosis, recurrence, and patient satisfaction.

RESULTS: Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels (p=0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR=2.18, p=0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis -was the main determinant of dissatisfaction (OR=2.48, p<0.001). Smoking history independently predicted recurrence (OR=2.09, p=0.042).

CONCLUSIONS: Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.

PMID:41734813 | DOI:10.1055/a-2819-1705

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Aquagenic palmar keratoderma associated with palmoplantar hyperhidrosis: a case report

Oxf Med Case Reports. 2026 Feb 18;2026(2):omag001. doi: 10.1093/omcr/omag001. eCollection 2026 Feb.

ABSTRACT

Aquagenic palmoplantar keratoderma is a rare dermatological condition characterized by mild palmar thickening and burning pain upon exposure to water. A 31-year-old female with aquagenic keratoderma of the palms associated with palmoplantar hyperhidrosis presenting with wrinkling and hyperkeratosis within minutes of hand contact with water, resolving quickly after drying. While cystic fibrosis is a known association, most cases remain idiopathic. Treatment options such as 20% aluminum hydroxide, aluminum chloride (15%-20%), urea, salicylic acid, and botulinum toxin can be challenging, with the patient being evaluated after treatment with 16% aluminum chloride.

PMID:41716924 | PMC:PMC12916001 | DOI:10.1093/omcr/omag001

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A significant gap between inadequate pharmacotherapy and substantial unmet needs in palmar hyperhidrosis management in China: insights from a questionnaire-based survey among outpatients

Front Pharmacol. 2026 Jan 8;16:1715189. doi: 10.3389/fphar.2025.1715189. eCollection 2025.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis, characterized by excessive sweating primarily affecting the hands, significantly impairs quality of life and psychological well-being. Although topical agents, iontophoresis, microwave therapy, and sympathectomy are established interventions, real-world treatment patterns and pharmacotherapeutic adequacy among Chinese patients remain poorly delineated.

METHODS: An anonymous, questionnaire-based survey was conducted among consecutive patients at a tertiary thoracic surgery clinic in China between March 2023 and October 2024. A total of 363 valid responses were collected and analyzed using SPSS 27.0. Descriptive statistics and multivariable logistic regression were used to evaluate treatment patterns, patient preference, and predictors of treatment selection.

RESULTS: The study cohort was composed predominantly of individuals with severe disease (87.3% HDSS grade 3-4), and nearly all participants (97.8%) presented with palmar hyperhidrosis. Regarding treatment history, only 38.1% had previously received pharmacotherapy, while 32.6% had utilized Traditional Chinese Medicine (TCM) therapeutic approaches, including TCM, acupuncture, massage and manipulation therapies. Antiperspirants (28.6%) and TCM (25.0%) were the most frequently used prior pharmacotherapies, yet both were associated with limited therapeutic efficacy. According to our survey, owing to high symptom severity, 52.9% had a general knowledge of surgical intervention before the outpatient visit. Primary concerns regarding previous pharmacotherapy included insufficient efficacy and localized adverse effects, particularly skin irritation. Notably, 50.0% of participants remained receptive to future pharmacotherapy, showing a preference for topical formulations (29.3%) and reduced dosing frequency (31.6%). Gender and disease severity were identified as significant determinants of treatment choice. Importantly, prior negative experiences – such as inefficacy and side effects – did not significantly diminish willingness to consider future pharmacologic treatment.

CONCLUSION: Inadequate management and suboptimal treatment outcomes represent considerable challenges in the care of palmar hyperhidrosis in China. Existing pharmacotherapeutic options are constrained by limited availability, inadequate efficacy, and a narrow range of approved agents – a reality that highlights a critical disconnect with substantial patient demand. These findings underscore an urgent need to accelerate drug development and clinical translation in this field.

PMID:41585901 | PMC:PMC12823788 | DOI:10.3389/fphar.2025.1715189

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Hyperhidrosis: Prevalence, Diagnosis, and Stepwise Treatment

Dtsch Arztebl Int. 2026 May 1;(Forthcoming):arztebl.m2025.0229. doi: 10.3238/arztebl.m2025.0229. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2-5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects.

METHODS: This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term “hyperhidrosis” and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well.

RESULTS: The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60-70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively.

CONCLUSION: A variety of methods can be used to relieve hyperhidrosis and improve these patients’ quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

PMID:41572865 | DOI:10.3238/arztebl.m2025.0229

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A predictive model for postoperative compensatory hyperhidrosis in primary palmar hyperhidrosis: a retrospective cohort study

J Thorac Dis. 2025 Dec 31;17(12):11253-11261. doi: 10.21037/jtd-2025-1562. Epub 2025 Dec 26.

ABSTRACT

BACKGROUND: While sympathectomy remains the optimal surgical intervention for severe primary palmar hyperhidrosis (PPH), compensatory hyperhidrosis (CH) has emerged as the most significant factor contributing to postoperative patient regret. This retrospective study aimed to identify risk factors and develop a predictive model for moderate-to-severe compensatory hyperhidrosis (msCH) in patients with PPH.

METHODS: A total of 1,013 patients were retrieved from the institutional database between 2014 and 2024. Logistic regression modeling was utilized to identify risk factors for msCH. A nomogram for predicting msCH was developed accordingly.

RESULTS: Of the initial cohort, there were 903 patients included in the final analysis, among whom 182 (20.2%) developed msCH. The following factors were identified as independent risk factors for msCH: age >25 years [odds ratio (OR) 3.32, 95% confidence interval (CI): 2.23-4.95, P<0.01], smoking history (OR 6.46, 95% CI: 4.37-9.54, P<0.01), higher body mass index (BMI) (OR 1.68, 95% CI: 1.10-2.56, P=0.02), palmar-axillary hyperhidrosis (OR 2.37, 95% CI: 1.57-3.57, P<0.01), and T3 sympathectomy (OR 3.14, 95% CI: 2.03-4.85, P<0.01). A predictive nomogram for msCH was developed based on these factors. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.839, indicating good predictive performance.

CONCLUSIONS: Age >25 years, smoking history, higher BMI, palmar-axillary hyperhidrosis, and T3 sympathectomy were independent risk factors for msCH. Based on these factors, a predictive model for msCH was developed and showed high predictive accuracy.

PMID:41522169 | PMC:PMC12780405 | DOI:10.21037/jtd-2025-1562

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Beyond the Axilla: The Evolving Role of Botulinum Toxin in the Treatment of Facial, Scalp, and Focal Hyperhidrosis

Clin Dermatol. 2025 Dec 27:S0738-081X(25)00336-0. doi: 10.1016/j.clindermatol.2025.12.003. Online ahead of print.

ABSTRACT

Botulinum toxin type A (BoNTA) is an established treatment for focal hyperhidrosis of the axillae and palms, but its use has recently expanded to include craniofacial, facial, and scalp hyperhidrosis. This systematic review with narrative synthesis evaluates the clinical use of BoNTA for focal hyperhidrosis across multiple anatomical sites. A structured search of PubMed/MEDLINE, Embase, and Scopus was conducted for English-language human studies published between 2000 and 2025. Original clinical studies reporting outcomes related to sweat reduction, disease severity, quality of life, duration of effect, or adverse events were included, while reviews and non-original publications were used only for background and citation tracking. A total of 33 original clinical studies met inclusion criteria. Evidence was strongest for axillary hyperhidrosis, where randomized controlled trials consistently demonstrated substantial reductions in sweating and sustained patient-reported benefit. Palmar hyperhidrosis showed reliable efficacy, although treatment was limited by injection discomfort and transient weakness. Evidence for craniofacial, facial, and scalp hyperhidrosis consisted primarily of small cohorts and case series, which nevertheless reported meaningful symptom improvement and acceptable safety profiles despite heterogeneity in dosing and injection techniques. Overall, BoNTA remains a cornerstone therapy for focal hyperhidrosis, and while evidence beyond the axillae is less robust, available data support its use in selected patients and underscore the need for larger, standardized studies in craniofacial and scalp hyperhidrosis.

PMID:41461243 | DOI:10.1016/j.clindermatol.2025.12.003

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Compensatory hyperhidrosis following endoscopic thoracic sympathectomy: a 5-year follow-up study of risk factors and symptom progression

J Cardiothorac Surg. 2025 Dec 8. doi: 10.1186/s13019-025-03720-3. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study aimed to evaluate the risk factors and progression of CH during a 5-year follow-up period.

METHODS: This study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients received bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with the development and progression of CH.

RESULTS: A total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores gradually increased over the 5-year postoperative period, indicating symptom worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR = 4.28, 95% CI: 1.27-15.60, P = 0.021) while having three or more affected areas was identified as a protective factor (OR = 0.19, 95% CI: 0.05-0.63, P = 0.008).

CONCLUSION: This study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for symptom progression.

PMID:41361439 | DOI:10.1186/s13019-025-03720-3

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Is There a Risk of Recurrence That Would Discourage Sympathicotomy for Hyperhidrosis in Minors?

J Clin Med. 2025 Nov 19;14(22):8194. doi: 10.3390/jcm14228194.

ABSTRACT

Background/Objectives: Primary palmar hyperhidrosis (PPH) is a socially debilitating condition that often begins in adolescence. Although sympathicotomy is a low-risk procedure, there are conflicting opinions about the optimal time for surgery: some recommend it at onset in adolescence, while others are cautious because of the risk of recurrence associated with juvenile neuroplasticity. The primary objective was to assess the recurrence rate; secondary objectives included the management of hyperhidrosis, compensatory sweating onset, and satisfaction. Methods: This retrospective cohort study included sympathicotomy procedures for palmar hyperhidrosis performed between 2004 and 2024 in patients younger than 18 years with a preoperative Hyperhidrosis Disease Severity Scale (HDSS) class of 4. Quantitative data are presented as medians and interquartile ranges, while categorical data are presented as numbers and percentages. Results: 28 patients were included, of whom 4 underwent single-stage surgery and 24 two-stage surgery. The median age was 17.30 years, with no gender predominance. At a median follow-up of 75 months, the recurrence rate was 10.71%. Twenty-two patients experienced compensatory sweating, with the majority (60.7%) reporting mild symptoms and the remainder reporting moderate. The median patient satisfaction score was 9.34 (range 9-10). Conclusions: Even though PPH typically begins during adolescence, there is no consensus on the appropriateness of sympathicotomy for younger patients, primarily due to concerns about recurrence. Our data, characterized by long-term follow-up and large numbers of minors, are consistent with those observed in adults’ cohorts in terms of hyperhidrosis management, compensatory sweating rates, and, particularly, recurrence rates, supporting the surgical approach even at a young age.

PMID:41303230 | DOI:10.3390/jcm14228194