Category: Palmar

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Scar-concealed 2 + 3 mm dual-port thoracoscopic sympathectomy for palmar hyperhidrosis: single-center outcomes

Front Surg. 2025 Oct 24;12:1664901. doi: 10.3389/fsurg.2025.1664901. eCollection 2025.

ABSTRACT

OBJECTIVE: To minimize the trauma and incision of the operation for primary palmar hyperhidrosis (PPH), we have designed a inconspicuous scar thoracoscopic bilateral thoracic sympathetic chain transection via “2 + 3 mm” two-pinhole incisions (ISTTST). This study mainly retrospectively compares and analyzes the pros and cons of this surgical method vs. the conventional single-port thoracoscopic sympathetic nerve transection (CSTTST).

METHODS: Data of patients with moderate or severe PPH and underwent thoracic sympathetic chain transection were collected. Patients undergoing ISTTST and those receiving CSTTST were included in the two-pinhole group and the single-port group respectively. The baseline characteristics, intraoperative and postoperative conditions of the two groups were compared.

RESULTS: A total of 265 patients were enrolled, including 162 in the single-port group and 103 in the two-pinhole group. There were no statistically significant differences in baseline conditions such as gender, age, BMI, age of onset of PPH, hyperhidrosis sites, hyperhidrosis degree, and transection level of thoracic sympathetic chain between the two groups (P > 0.05). The two-pinhole group had shorter operation time (19.809 ± 3.356 min vs. 22.534 ± 4.541 min), lower postoperative incision pain score (1.563 ± 0.518 vs. 2.012 ± 0.788), and better incision satisfaction (9.437 ± 0.498 vs. 8.068 ± 1.424) (all P < 0.001). There were no statistically significant differences in postoperative conditions such as surgical effect, 24-h postoperative discharge rate, postoperative complication rate, postoperative compensatory hyperhidrosis, postoperative recurrence rate of PPH, and postoperative follow-up time between the two groups (P > 0.05).

CONCLUSION: The ISTTST is a more concealed-scar, minimally invasive, and convenient procedure, meeting the aesthetic needs. Compared with the CSTTST, it has certain advantages and deserves more attention and attempts.

PMID:41209064 | PMC:PMC12592174 | DOI:10.3389/fsurg.2025.1664901

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Altered Th17/Treg balance and therapeutic targeting of RORgamma in primary focal hyperhidrosis

Front Immunol. 2025 Oct 17;16:1656632. doi: 10.3389/fimmu.2025.1656632. eCollection 2025.

ABSTRACT

BACKGROUND: Primary focal hyperhidrosis (PFH) significantly impacts patients’ physical and mental health, yet its underlying mechanisms remain unclear.

METHODS: This study involved 80 healthy controls and 60 patients each with primary palmar (PPH), craniofacial (PCH), or axillary hyperhidrosis (PAH). Peripheral blood mononuclear cells (PBMCs) were analyzed via flow cytometry to assess Th17 and Treg cell populations. Cytokine levels were measured in patient serum using ELISA, while sweat gland tissue from PAH patients underwent gene expression analysis. A pilocarpine-induced mouse model of hyperhidrosis was used to test SR2211, a RORγ inverse agonist.

RESULTS: PFH patients exhibited a disrupted Th17/Treg balance, with increased Th17 and decreased Treg cells across all subtypes compared to controls. Elevated IL-17 and IL-6 and reduced IL-10 and TGF-β1 levels were observed in PFH serum. Sweat glands showed increased RORγt and decreased FOXP3 expression. In mice, SR2211 treatment reduced sweat secretion, secretory granules, and serum acetylcholine. It also lowered Th17 infiltration, serum IL-17/IL-6, and IL-17A expression in sweat glands.

DISCUSSION: PFH is associated with a Th17/Treg immune imbalance. SR2211 alleviated hyperhidrosis and Th17-related inflammation in mice, highlighting the potential of targeting the RORγ-Th17 axis as a therapeutic strategy for PFH.

PMID:41181099 | PMC:PMC12575253 | DOI:10.3389/fimmu.2025.1656632

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Food and Beverage Habits Among Individuals with Primary Hyperhidrosis: A Case-Control Survey in Sweden

Clin Cosmet Investig Dermatol. 2025 Oct 24;18:2769-2776. doi: 10.2147/CCID.S547497. eCollection 2025.

ABSTRACT

AIM: Excessive sweat production in primary hyperhidrosis (PH) can lead to water and mineral loss, yet data on patients’ dietary habits are limited.

PURPOSE: To explore associations between food and beverage consumption and severe PH.

PATIENTS AND METHODS: Participants with primary palmar and axillary hyperhidrosis (n=171) and without hyperhidrosis (n=165) completed a validated questionnaire on food and beverage habits at two hospitals in northern Sweden. Frequency and quantity of specific foods and beverages were compared between groups.

RESULTS: A total of 336 individuals participated in this study (men, n=109; women, n=218; unspecified sex, n=9). Individuals with PH were younger (18-29 years, n=104 vs n=66; p<0.001) and more frequently female compared to controls (n=75 vs 58; p<0.001). Total caffeine consumption was higher in PH (median score: 186.6 vs.151.0; p<0.001), and 57% of individuals with PH consumed energy drinks weekly compared with 39.5% of controls (p<0.001). Spicy foods, fatty foods, fast foods, and sweets were reported to trigger sweating. Women with PH more often reported difficulties replenishing water loss, and increased thirst was the most reported symptom in both men and women.

CONCLUSION: PH was associated with higher caffeine intake, distinct beverage consumption patterns, and self-reported fluid loss symptoms. These findings indicate potential associations between diet and PH and may inform patient education and future research, although causality cannot be inferred from this study.

PMID:41164747 | PMC:PMC12560645 | DOI:10.2147/CCID.S547497

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Development and validation of a model for predicting depression risk in primary palmar hyperhidrosis: a cross-sectional retrospective observational study

BMJ Open. 2025 Oct 10;15(10):e101212. doi: 10.1136/bmjopen-2025-101212.

ABSTRACT

OBJECTIVE: Primary palmar hyperhidrosis (PPH), characterised by excessive palm sweating, significantly impacts patients’ physiology, psychology, self-esteem, work, life and social interactions. The incidence of depression is higher among PPH patients. Timely detection of key predictive factors and the development of risk prediction models are crucial for effective intervention and treatment in this patient group.

DESIGN: We conducted an in-depth analysis of clinical data from 926 PPH patients treated at the Thoracic Surgery Department of Beijing Haidian Hospital between 2016 and 2021. We used the Boruta algorithm alongside the Backward Elimination strategy to select predictive factors and constructed five machine-learning models. By evaluating these models’ performance, we determined the optimal one. Additionally, we introduced the Shapley Additive exPlanations method to enhance the interpretability of this optimal model.

RESULTS: The Personality Diagnostic Questionnaire-4 score, Self-Rating Anxiety Scale score, family history, quality of life excluding PPH, onset age and the age when PPH begins to impact life (Impact age) are six predictive factors for depression in PPH patients. The support vector machine (SVM) model performs more comprehensively through model validation. In the validation set, the area under the curve is 0.798 (95% CI: 0.737 to 0.859), with a Brier score of 0.1451 (95% CI: 0.1233 to 0.1716), accuracy of 0.7184, sensitivity of 0.775, specificity of 0.699 and F1 score of 0.585.

CONCLUSIONS: These findings can enhance our understanding of depression in PPH patients, and the SVM model is a valuable screening tool for assessing the risk of depression in PPH patients.

PMID:41073115 | DOI:10.1136/bmjopen-2025-101212

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Pleural effusion following thoracoscopic sympathectomy in a patient with palmar hyperhidrosis

BMC Pulm Med. 2025 Oct 2;25(1):446. doi: 10.1186/s12890-025-03933-1.

ABSTRACT

Thoracoscopic sympathectomy can be used to treat primary hyperhidrosis (PH). Nonetheless, there is a paucity of literature addressing the postoperative complications associated with this procedure. We report a case of a 21-year-old male patient who developed prolonged bilateral pleural effusion after undergoing thoracoscopic sympathectomy for PH. This case aims to raise awareness of this rare complication and discuss effective management strategies for it.

PMID:41039538 | DOI:10.1186/s12890-025-03933-1

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Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients

Thorac Cardiovasc Surg. 2025 Sep 11. doi: 10.1055/a-2699-8163. Online ahead of print.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a distressing condition that significantly impairs quality of life. Endoscopic thoracic sympathectomy (ETS) is an effective treatment, but compensatory hyperhidrosis (CH) remains a common and problematic complication. The optimal extent of surgical interruption, particularly the choice between unilateral and bilateral ganglionectomy, remains uncertain.

METHODS: We conducted a retrospective analysis of 118 patients who underwent unilateral (n=41) or bilateral (n=77) T3 ganglionectomy via video-assisted thoracoscopic surgery (VATS) between November 2023 and January 2025. Patient-reported outcomes, including CH and postoperative satisfaction, were assessed three months postoperatively using standardized questionnaires. Comparisons between the two groups were performed using t-tests and chi-square tests.

RESULTS: Baseline demographics were comparable between groups. The unilateral group reported significantly higher satisfaction, with 93% “very satisfied” compared to 61% in the bilateral group (p<0.001). CH was less prevalent in the unilateral group (20% vs. 48%, p=0.007), and when present, was generally mild and limited to a single body region. In contrast, bilateral ganglionectomy was associated with more frequent and multi-regional CH. Among unilateral ETS patients, only 22% later underwent contralateral surgery, indicating that unilateral intervention was sufficient in most cases.

CONCLUSIONS: Unilateral T3 ganglionectomy offers a favorable balance of efficacy and safety, yielding higher satisfaction and significantly reduced CH compared to bilateral procedures. These findings support the use of unilateral ETS as a first-line surgical strategy for PPH, particularly in patients sensitive to CH. A tailored, staged approach may enhance long-term outcomes and patient satisfaction.

PMID:40935159 | DOI:10.1055/a-2699-8163

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Efficacy and Safety of Treatments for Primary Palmar Hyperhidrosis: A Systematic Review Assessing Patient-Centric Outcomes

Dermatol Res Pract. 2025 Aug 20;2025:8867838. doi: 10.1155/drp/8867838. eCollection 2025.

ABSTRACT

Background: Primary palmar hyperhidrosis (PH) is a chronic condition characterized by excessive sweating in the palms, significantly affecting the quality of life (QOL) of affected individuals. Despite the availability of various treatment modalities, the long-term efficacy and safety of these interventions remain unclear, warranting a comprehensive evaluation. This systematic review aims to assess the efficacy, safety and patient-reported outcomes of treatments for PH. Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library from their inception until March 2024, adhering to PRISMA guidelines. Inclusion criteria focused on prospective and retrospective studies examining PH treatments published in English. Data from eligible studies were extracted, analysed qualitatively and reported based on outcomes, including efficacy, QOL improvements and adverse effects. Results: Fourteen studies, including 1733 patients aged 4-77 years, were included in the final review. The treatments assessed included oral and topical oxybutynin, iontophoresis, botulinum toxin A injections, photodynamic therapy (PDT) and endoscopic thoracic sympathectomy (ETS). Oral oxybutynin demonstrated symptomatic relief in 60%-97% of the patients although anticholinergic side effects were frequently reported. ETS, while providing the highest rates of complete sweat cessation, was associated with compensatory hyperhidrosis. Noninvasive treatments like iontophoresis showed moderate efficacy with minimal side effects but required ongoing sessions for maintenance. Conclusion: This review highlights the efficacy of several therapeutic approaches for PH though most treatments are hindered by significant adverse effects or practical limitations. Future research should prioritize long-term studies and standardized outcome measures to guide clinical decision-making more effectively.

PMID:40881604 | PMC:PMC12390518 | DOI:10.1155/drp/8867838

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Effect of Radiofrequency Ablation and Comparison With Surgical Sympathectomy in Palmar Hyperhidrosis

Cureus. 2025 Jul 22;17(7):e88543. doi: 10.7759/cureus.88543. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis is a distressing condition characterized by excessive palm sweating that significantly impacts patients’ quality of life (QoL). Radiofrequency ablation (RFA) and surgical sympathectomy are effective treatment modalities. This study aims to evaluate and compare the effectiveness, patient satisfaction, and safety profiles of RFA and surgical sympathectomy in managing palmar hyperhidrosis.

METHODS: This retrospective study included 91 patients diagnosed with primary palmar hyperhidrosis who underwent either RFA or surgical sympathectomy. The primary outcome was the reduction in sweating severity. Statistical analyses were performed to compare treatment outcomes between the two groups.

RESULTS: Both RFA and surgical sympathectomy significantly reduced Hyperhidrosis Disease Severity Scale scores; however, surgical sympathectomy demonstrated greater symptom reduction at six months (p = 0.01) and 12 months (p = 0.002). Patients in the sympathectomy group reported a longer symptom relief duration (11.8 ± 3.1 vs. 9.2 ± 2.5 months, p = 0.003) and greater improvement in QoL scores at 12 months (p = 0.02). The incidence of compensatory sweating was higher in the sympathectomy group (34.0%, n = 16 vs. 18.2%, n = 8, p = 0.08), whereas recurrence of hyperhidrosis was more frequent in the RFA group (27.3%, n = 12 vs. 10.6%, n = 5, p = 0.03).

CONCLUSION: Both RFA and surgical sympathectomy effectively reduce sweating severity in patients with palmar hyperhidrosis. While sympathectomy provides longer-lasting symptom relief and greater QoL improvement, it is associated with a higher incidence of compensatory sweating.

PMID:40851706 | PMC:PMC12370239 | DOI:10.7759/cureus.88543

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20-Year Efficacy of Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis: A Cohort Study

J Clin Med. 2025 Jul 8;14(14):4831. doi: 10.3390/jcm14144831.

ABSTRACT

Background: Primary focal hyperhidrosis, characterized by excessive sweating primarily affecting the hands and axillae, can significantly impact quality of life. Bilateral thoracic sympathectomy is the gold standard treatment, providing permanent resolution of palmar hyperhidrosis. Most studies evaluating outcomes and patient satisfaction after sympathectomy focus on short- to medium-term follow-up, typically up to 5 years. This study aimed to assess anxiety, satisfaction, and sweat redistribution 20 years after bilateral endoscopic thoracic sympathectomy. Methods: Between January 2002 and December 2003, 106 patients with primary hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy targeting ganglia T2-T3 at our center. The patients were contacted via telephone in 2023 and asked to complete the same survey they had filled out preoperatively and 12 months postoperatively. The survey evaluated sweat redistribution, anxiety, hyperhidrosis-related symptoms, and satisfaction. Anxiety, satisfaction, and perceived sweating were rated using a 5-point visual analog scale (VAS) ranging from 0 (unsatisfied/no symptoms) to 4 (very satisfied/severe symptoms). Results: Of the 106 eligible patients, 24 (22.6%) completed the survey. Most reported persistent anhidrosis (palmar or palmar-axillary) 20 years post-surgery. The survey results remained consistent with those at the 1-year follow-up. Significant sweat redistribution to the abdomen and back was observed. Patient satisfaction remained high, with no significant differences between the 1-year and 20-year assessments. Anxiety significantly decreased compared to preoperative levels (p < 0.001). Conclusions: Bilateral endoscopic thoracic sympathectomy is an effective long-term treatment for reducing excessive sweating. Patient satisfaction remains high over time, despite the persistence of compensatory sweating.

PMID:40725520 | DOI:10.3390/jcm14144831

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Influence of sex on the outcomes of uniportal video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis

Wideochir Inne Tech Maloinwazyjne. 2025 Feb 10;20(1):55-60. doi: 10.20452/wiitm.2025.17934. eCollection 2025 Apr 9.

ABSTRACT

INTRODUCTION: Primary palmar hyperhidrosis (PPH) impairs the quality of life. Video‑assisted thoracoscopic sympathicotomy is an effective treatment method; however, the impact of sex on surgical outcomes accord‑ ing to the denervation level (T3 vs T3-T4 sympathicotomy) remains unclear.AIM This study investigated the efficacy, complications, and symptom relief rates of isolated T3 vs combined T3-T4 sympathicotomy for PPH, focusing on sex differences.

MATERIALS AND METHODS: A retrospective analysis of 327 patients undergoing bilateral uniportal video‑assisted thoracoscopic sympathicotomy for PPH between 2012 and 2022 was performed. The patients were divided into 2 groups depending on the procedure type (isolated T3 sympathicotomy [n = 167] vs T3-T4 combined sympathicotomy [n = 160]). Demographic data, procedure outcomes, and complications were compared.

RESULTS: Success rates were 95.8% in the T3 sympathicotomy group and 93.8% in the T3-T4 sympathicotomy group, with no significant difference. The most common complication was dryness of the hands. The overall complication rate was lower in the T3 than in the T3-T4 sympathicotomy group (9.6% vs 14.4%; P = 0.04). Compensatory sweating occurred in 2.4% and 3.1% of the participants in the T3 and T3-T4 sympathicotomy groups, respectively (P = 0.52). The frequency of compensatory sweating, chest pain, and dryness of the hands was significantly higher in men. Age, sex, and duration of surgery had no independent influence on the occurrence of complications.

CONCLUSIONS: Isolated T3 sympathicotomy is an effective and safe option for the treatment of PPH, and is associated with fewer complications than combined T3-T4 sympathicotomy. Higher complication rates in men emphasize the need for sex‑specific surgical planning and patient counseling.

PMID:40547836 | PMC:PMC12177343 | DOI:10.20452/wiitm.2025.17934